Alcohol Consumption with Clopidogrel and Eliquis (Apixaban)
Moderate red wine consumption is acceptable when taking clopidogrel and apixaban together, but you must limit intake to no more than one drink per session with alcohol-free days in between to minimize cumulative bleeding risk. 1
Specific Alcohol Limits
Men should consume less than 14 units per week, and women should consume less than 8 units per week, with the safest approach being one drink per session with interspersed abstinent days. 1 One standard glass of red wine (approximately 5 oz/150 mL) typically contains 8-14g of alcohol, translating to roughly 1-2 drinks maximum per day for men and less than 1 drink per day for women. 1
The key is avoiding regular daily consumption, which can elevate blood pressure and compound cardiovascular risks. 1 Spacing out alcohol intake with abstinent days between drinking sessions helps minimize the cumulative bleeding risk that comes from combining two potent antithrombotic medications. 1
Critical Situations Requiring Complete Abstinence
You must completely avoid all alcohol if any of the following apply: 1, 2
- Active bleeding or recent major bleeding event
- Planned surgical or invasive procedures
- Concurrent use of NSAIDs (ibuprofen, naproxen, etc.)
- Any liver disease or impaired liver function
- Recent gastrointestinal bleeding or ulcer history 2
Understanding the Bleeding Risk
The combination of clopidogrel (an antiplatelet agent) and apixaban (an anticoagulant) already carries substantial bleeding risk. 3, 4 Research demonstrates that apixaban combined with dual antiplatelet therapy (aspirin plus clopidogrel) resulted in significantly increased major bleeding rates—specifically, a 2.44-fold increase in major bleeding compared to placebo. 4 While you're on clopidogrel plus apixaban (not triple therapy with aspirin), the bleeding risk remains elevated above either medication alone. 5
Alcohol adds to this risk through multiple mechanisms: it can interfere with platelet function, may affect medication metabolism, and increases the likelihood of gastrointestinal bleeding, particularly in the upper GI tract. 2 Patients with multiple risk factors for GI bleeding—including advanced age, concurrent anticoagulant use, and alcohol consumption—face compounding risks. 2
Practical Recommendations
Adopt this approach to alcohol consumption: 1
- Limit to one standard drink (5 oz wine) per occasion
- Ensure at least 1-2 alcohol-free days between drinking sessions
- Never exceed weekly limits (14 units for men, 8 units for women)
- Monitor for any signs of bleeding (unusual bruising, blood in stool/urine, prolonged bleeding from cuts)
The safest approach remains complete abstinence from alcohol, which provides the best health outcomes and lowest bleeding risk. 1 If you choose to drink red wine, strict adherence to these limits is essential given your dual antithrombotic therapy.