Can you take Xarelto (rivaroxaban) and aspirin (acetylsalicylic acid, ASA)?

From the Guidelines

Yes, you can take Xarelto (rivaroxaban) and aspirin (acetylsalicylic acid, ASA) together, but this should be considered for individuals with stable coronary and/or peripheral artery disease (PAD) and low bleeding risk to prevent major adverse limb and cardiovascular events 1.

Key Considerations

• The combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg daily is recommended for patients with PAD, high ischemic risk, and non-high bleeding risk 1.
• This combination therapy may be considered for people with stable coronary and/or PAD to prevent major adverse limb and cardiovascular complications 1.
• The COMPASS trial showed that the risk of major adverse cardiovascular events (MACEs) was significantly lower with the combination of rivaroxaban plus aspirin compared with either aspirin alone or rivaroxaban alone, but with an associated increased risk of bleeding 1.
• The recommended medication for stable CAD with high ischemic risk and low bleeding risk is rivaroxaban 2.5 mg twice daily + aspirin 75-100 mg 1.

Important Factors

• Bleeding risk: The combination of rivaroxaban and aspirin should only be considered for individuals with low bleeding risk.
• Ischemic risk: The combination therapy is recommended for patients with high ischemic risk.
• Disease type: The combination is recommended for patients with stable coronary and/or peripheral artery disease (PAD).

From the FDA Drug Label

XARELTO is used with low dose aspirin to: reduce the risk of serious heart problems, heart attack and stroke in adults with coronary artery disease (a condition where the blood supply to the heart is reduced or blocked) You may have a higher risk of bleeding if you take XARELTO and take other medicines that increase your risk of bleeding, including: aspirin or aspirin containing products

Yes, Xarelto (rivaroxaban) can be taken with aspirin (acetylsalicylic acid, ASA), but it may increase the risk of bleeding.

• The FDA label warns that taking XARELTO with aspirin or other medicines that increase the risk of bleeding may increase the risk of bleeding.
• The label also states that XARELTO is used with low-dose aspirin to reduce the risk of serious heart problems, heart attack, and stroke in adults with coronary artery disease.
• Patients should be closely monitored for signs and symptoms of bleeding if they are taking XARELTO and aspirin concomitantly 2, 2, 2.

From the Research

Combination of Xarelto and Aspirin

The combination of Xarelto (rivaroxaban) and aspirin (acetylsalicylic acid, ASA) has been studied in several clinical trials. The key findings are:

• The COMPASS trial showed that the combination of rivaroxaban and ASA reduced ischemic major adverse cardiovascular events (MACEs) by 24% in patients with chronic coronary artery disease (CAD) and peripheral artery disease (PAD) 3, 4.
• The XATOA registry found that the annual rate of net clinical outcome (NCO) events was low and numerically similar to those seen in the treatment group in the randomized COMPASS trial 3.
• The VOYAGER PAD trial confirmed the effectiveness of the vascular dose of rivaroxaban in patients with PAD after lower-extremity revascularization, as compared with ASA alone 5.

Patient Populations

The combination of rivaroxaban and ASA may be beneficial for the following patient populations:

• Patients with CAD and/or PAD at high risk of ischemia 6, 7.
• Patients with multiple risk factors, such as polypharmacy and multimorbidity 4.
• Patients who have undergone endovascular revascularization for symptomatic PAD 5.

Safety and Efficacy

The safety and efficacy of the combination of rivaroxaban and ASA have been evaluated in several studies:

• The COMPASS trial found that the combination of rivaroxaban and ASA reduced MACEs by 24% with a significant increase in major bleeding 4.
• The VOYAGER PAD trial found that rivaroxaban added to ASA or dual antiplatelet therapy after lower-extremity revascularization for PAD reduced ischemic risk and increased major bleeding without an increased risk of intracranial or fatal bleeding 5.
• The XATOA registry found that the annual rate of NCO events was low and numerically similar to those seen in the treatment group in the randomized COMPASS trial 3.

Key Findings

The key findings of the studies are:

• The combination of rivaroxaban and ASA reduces ischemic MACEs in patients with CAD and/or PAD 3, 4, 6, 5.
• The combination of rivaroxaban and ASA increases major bleeding, but the absolute risk increase is relatively small 4, 5.
• The benefits of the combination of rivaroxaban and ASA are consistent across different patient populations, including those with polypharmacy and multimorbidity 4.