Apixaban and Sulfinpyrazone: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Aug 8, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Sulfinpyrazone
No brand names on recordApixaban
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
You've been prescribed two medicines that both affect how your blood clots. Apixaban (Eliquis) is a blood thinner, and sulfinpyrazone can reduce how well your platelets stick together. When you take them together, their effects add up, so bleeding can happen more easily and, in some cases, be serious.
This is worth taking seriously, but it's also very manageable. Watch for warning signs like unusual bruising, pink or red urine, black stools, nosebleeds that won't stop, or bleeding that doesn't slow down. If any of that happens, or you feel unusually weak or dizzy, get medical help right away. Keep taking both exactly as prescribed and check in with your pharmacist or doctor so they can keep an eye on you.
Effect: Additive pharmacodynamic effect on hemostasis increasing bleeding risk (potentially serious/fatal). Apixaban is a direct factor Xa inhibitor; sulfinpyrazone has antiplatelet activity. No prodrug is involved; the mechanism is PD, not PK.
- Direction/magnitude: Increased bleeding risk; magnitude not quantified.
- Onset: Unspecified.
- Evidence: Theoretical.
- Management: Promptly evaluate any signs/symptoms of blood loss. Discontinue apixaban with active pathological hemorrhage. Apixaban PD effect persists at least 24 h after last dose; a specific anti-FXa reversal agent is available, and PCC, aPCC, or rFVIIa may be considered. When PCC is used, PT/INR/aPTT or anti-FXa monitoring is not useful.
What happens
Increased risk of bleeding and can cause serious, potentially fatal bleeding
Interaction Deep Dive
Using apixaban together with antiplatelet drugs raises bleeding risk1. In any patient receiving both anticoagulant and antiplatelet therapy at the same time, promptly assess any indications or symptoms of blood loss2. In patients experiencing active pathological hemorrhage, stop apixaban. Counsel patients about the signs and symptoms of blood loss, instructing them to report these right away or present to an emergency room. Apixaban should be discontinued in patients with active pathological hemorrhage. There is an agent available that reverses the anti-factor Xa activity of apixaban. Apixaban's pharmacodynamic effect is anticipated to remain for a minimum of 24 hours following the final dose. Options that may be considered include prothrombin complex concentrate (PCC), activated prothrombin complex concentrate, or recombinant factor VIIa. If PCCs are administered, it is not useful and not recommended to monitor apixaban's anticoagulation effect through a clotting test (PT, INR, or aPTT) or anti-factor Xa (FXa) activity. Activated oral charcoal decreases apixaban absorption, which in turn reduces apixaban plasma concentration1.
Why it happens (mechanism)
Additive effects on hemostasis
How to manage this interaction
Both drugs raise bleeding risk, so your care team manages this mainly by watching you closely and knowing what to do if bleeding occurs.
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Learn the warning signs: unusual bruising, red or black stools, pink/red urine, coughing or vomiting blood, prolonged bleeding, severe headache, dizziness, or weakness.
- Report bleeding immediately or go to an emergency room if it is serious.
- Reassure yourself that reversal options exist: apixaban's effect lasts at least 24 hours after the last dose, and a specific reversal agent (and other clotting products) can be used if needed.
Ask your pharmacist or doctor whether this combination is right for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
3 reports — tap to read
a) A clinical study involving high-risk patients following acute coronary syndrome who were treated with aspirin or with aspirin combined with clopidogrel (APPRAISE-2) was stopped ahead of schedule because apixaban produced more bleeding than placebo. Among patients on single antiplatelet therapy, the rate of ISTH major bleeding was 2.8% per year with apixaban versus 0.6% per year with placebo, and among those on dual antiplatelet therapy it was 5.9% per year with apixaban versus 2.5% per year with placebo 1.
b) Among patients taking apixaban, adding aspirin raised the bleeding risk from 1.8% per year to 3.4% per year, while combining aspirin with warfarin raised the bleeding risk from 2.7% per year to 4.6% per year in a clinical trial (ARISTOTLE); the use of dual antiplatelet therapy alongside apixaban was limited (2.3%) in this trial 1.
c) In a retrospective study, combining a direct oral anticoagulant (DOAC) with antiplatelet therapy (APT; n=78) as opposed to DOAC therapy by itself (n=329) did not meaningfully change the rate of major bleeding (1.3% vs 1.2%) or clinically relevant non-major bleeding (10.2% vs 6.4%) across 6 months of treatment. The patients were mostly Caucasian men with a mean age of 63.7 years. Those on concurrent APT had significantly greater mean body mass index (30.7 vs 28.4), higher mean CHA2DS2-VASc score (4.28 vs 3.85), and a greater likelihood of diabetes (26.9% vs 17.3%) than those given DOAC monotherapy. DOACs were prescribed for VTE treatment or atrial fibrillation and comprised apixaban (58.5%), rivaroxaban (38.1%), and dabigatran (3.4%). Single antiplatelet therapy was used in 94.9% (74 patients), with aspirin 81 mg once daily being the most frequent regimen (69 patients). Additional APT regimens included aspirin 81 mg twice daily (3 patients), aspirin 325 mg daily (1 patient), clopidogrel 75 mg daily (1 patient), and dual APT with aspirin 81 mg and clopidogrel 75 mg daily (4 patients) 3.
Common questions
Can I take Apixaban and Sulfinpyrazone together?
Taking sulfinpyrazone with apixaban adds up to a higher bleeding risk, so keep both as prescribed but watch closely for bleeding and get help right away if it happens. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Sulfinpyrazone interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Apixaban and Sulfinpyrazone interaction managed?
Both drugs raise bleeding risk, so your care team manages this mainly by watching you closely and knowing what to do if bleeding occurs. Keep taking both as prescribed unless your prescriber tells you otherwise. Learn the warning signs: unusual bruising, red or black stools, pink/red urine, coughing or vomiting blood, prolonged bleeding, severe headache, dizziness, or weakness. Report bleeding imm… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Apixaban or Sulfinpyrazone need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: ELIQUIS(R) oral film coated tablets, apixaban oral film coated tablets. Bristol-Myers Squibb Company (per Dailymed), Princeton, NJ, 2024. DailyMed
- Product Information: SAVAYSA(R) oral tablets, edoxaban oral tablets. Daiichi Sankyo Inc (per FDA), Basking Ridge, NJ, 2023. DailyMed
- Tinkham TT, Vazquez SR, Jones AE, et al: Direct oral anticoagulant plus antiplatelet therapy: prescribing practices and bleeding outcomes. J Thromb Thrombolysis 2020; 49(3):492-496. PubMed
Keep reading about Sulfinpyrazone
Keep reading about Apixaban
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