Rivaroxaban and Aspirin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Rivaroxaban
Aspirin
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.
What happens
Increased risk of bleeding
Interaction Deep Dive
Coadministration of rivaroxaban (factor Xa inhibitor, anticoagulant) with an antiplatelet agent, such as aspirin, may increase the risk of bleeding. Promptly evaluate any signs or symptoms of blood loss that occur in a patient treated concomitantly3. In patients with DVT and/or pulmonary embolism (PE) and stable cardiovascular disease receiving aspirin for cardiovascular risk modification, suspending aspirin for the duration of anticoagulation therapy for DVT and/or PE is suggested (conditional recommendation based on very low certainty in the evidence of effects); however, this suggestion does not apply to patients with a recent acute coronary event or coronary intervention 1. Discontinue rivaroxaban in patients with active pathological bleeding 3.
Why it happens (mechanism)
Additive effects on hemostasis
Literature reports
2 reports — tap to read
a) Concomitant use of direct oral anticoagulant (DOAC) and antiplatelet therapy (APT; n=78) compared to DOAC therapy alone (n=329) did not significantly alter the incidence of major bleeding (1.3% vs 1.2%) or clinically relevant non-major bleeding (10.2% vs 6.4%) over 6 months of treatment in a retrospective study. Patients were primarily Caucasian men with a mean age of 63.7 years. Patients receiving concurrent APT had significantly higher mean body mass index (30.7 vs 28.4), mean CHA2DS2-VASc score (4.28 vs 3.85), and were more likely to have diabetes (26.9% vs 17.3%) compared with those prescribed DOAC monotherapy. DOACs were prescribed for VTE treatment or atrial fibrillation, and included apixaban (58.5%), rivaroxaban (38.1%), and dabigatran (3.4%). Single antiplatelet therapy was utilized in 94.9% (74 patients), with aspirin 81 mg once daily as the most common regimen in 88.5% (69 patients). Other 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) 2.
b) In a drug interaction study, concomitant use of aspirin (NSAIDs) almost exclusively at a dose of 100 mg or less and rivaroxaban during the double-blind phase was identified as an independent risk factor for major bleeding. NSAIDs are known to increase bleeding and bleeding risk may be increased when NSAIDs are used concomitantly with rivaroxaban. Pharmacokinetics of rivaroxaban was not effected by aspirin 3.
Common questions
Can I take Rivaroxaban and Aspirin together?
Increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Rivaroxaban and Aspirin 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 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
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Questions for your pharmacist
- Does my dose of Rivaroxaban or Aspirin 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)
- Ortel TL, Neumann I, Ageno W, et al: American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4(19):4693-4738. DOI
- 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
- Product Information: XARELTO(R) oral tablets, oral suspension, rivaroxaban oral tablets, oral suspension. Janssen Pharmaceuticals Inc (per FDA), Titusville, NJ, 2023. DailyMed
Keep reading about Rivaroxaban
Keep reading about Aspirin
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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