From the FDA Drug Label
7.3 Anticoagulants and Antiplatelet Agents Coadministration of antiplatelet agents, fibrinolytics, heparin, aspirin, and chronic NSAID use increases the risk of bleeding
The use of ibuprofen with apixaban may increase the risk of bleeding, as ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and concomitant use of NSAIDs with apixaban increases the risk of bleeding 1. It is recommended to exercise caution when using ibuprofen with apixaban.
From the Research
It is generally not recommended to use ibuprofen with apixaban, as this combination increases the risk of bleeding due to the effects of both medications on blood clotting. Apixaban (Eliquis) is an anticoagulant that prevents harmful blood clots by inhibiting specific clotting factors, while ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation but also affects platelet function and can irritate the stomach lining. According to a study published in Circulation in 2020 2, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) with oral anticoagulants has been associated with an increased risk of bleeding.
Some key points to consider:
- The ARISTOTLE trial found that incident NSAID use was associated with an increased risk of major bleeding (hazard ratio [HR], 1.61 [95% CI, 1.11-2.33]) and clinically relevant nonmajor bleeding (HR, 1.70 [95% CI, 1.16-2.48]) 2.
- A study published in the Journal of the American Geriatrics Society in 2020 found that approximately 66% of respondents were either uncertain or incorrect about the potential for increased bleeding from combining nonsteroidal anti-inflammatory drugs and apixaban 3.
- If you need pain relief while taking apixaban, acetaminophen (Tylenol) is usually a safer alternative that doesn't increase bleeding risk.
- However, if you absolutely need an anti-inflammatory medication, speak with your healthcare provider first, as they may recommend using the lowest effective dose of ibuprofen for the shortest possible time, while monitoring for signs of bleeding such as unusual bruising, nosebleeds, blood in urine or stool, or vomiting blood 2, 3.
Never adjust your medication regimen without consulting your healthcare provider, as they can evaluate your specific situation and bleeding risk factors.