Rivaroxaban and Iloprost: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Rivaroxaban
Iloprost
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) and antiplatelet agents may increase the risk of bleeding. Promptly evaluate any signs or symptoms of blood loss that occur in a patient treated concomitantly. Discontinue rivaroxaban in patients with active pathological bleeding3. Coadministration of direct oral anticoagulant (DOAC; including rivaroxaban) and prescription antiplatelet therapy (predominantly clopidogrel) resulted in increased risk of major hemorrhage in a study of elderly patients who received a coronary artery stent compared to antiplatelet therapy alone 2, but coadministration of a DOAC (including rivaroxaban) and antiplatelet therapy (predominantly low-dose aspirin) did not significantly alter the incidence of major bleeding or clinically relevant non-major bleeding compared to DOAC therapy alone in another study of patients with VTE or atrial fibrillation 1.
Why it happens (mechanism)
Additive effects on hemostasis
Literature reports
3 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 (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) 1.
b) In a retrospective study of patients 65 years or older who received a coronary artery stent (N=70,900), coadministration of direct oral anticoagulant (DOAC; dabigatran or rivaroxaban) and prescription antiplatelet therapy (predominantly clopidogrel) significantly increased the risk of major hemorrhagic events compared with antiplatelet therapy alone (HR, 2.36; 95% CI, 1.91 to 2.93) over 12 months following stent placement; this risk was similar to coadministration of warfarin and antiplatelets (HR, 2; 95% CI, 1.83 to 2.18). When patients were stratified by index atrial fibrillation (AF) status, the risk of major hemorrhagic events was also significantly increased with coadministration of DOAC and antiplatelet therapy for both AF (HR, 1.94; 95% CI, 1.48 to 2.54; n=10,238) and non-AF groups (HR, 3.09; 95% CI, 2.15 to 4.46; n=60,662). Hemorrhages in the first 30 days after stenting were considered periprocedural morbidity and excluded. The average observation period was 11.5 months, with 24.470,270 person-days of exposure; antiplatelet only therapy accounted for 73.8% of person-days of exposure, antiplatelets plus DOACs for 0.6%, and antiplatelets plus warfarin for 4.7% 2.
c) In two drug interaction studies where clopidogrel (antiplatelet agent) 300 mg loading dose followed by 75 mg daily maintenance dose and rivaroxaban (factor Xa inhibitor, anticoagulant) 15 mg single dose were coadministered in healthy subjects, an increase in bleeding time to 45 minutes was observed in approximately 45% and 30% of subjects in these studies, respectively. The change in bleeding time was approximately twice the maximum increase seen with either drug alone. There was no change in the pharmacokinetics of either drug 3.
Common questions
Can I take Rivaroxaban and Iloprost together?
Increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Rivaroxaban and Iloprost 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
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Rivaroxaban or Iloprost 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)
- 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
- Bekelis K, Chang CH, Malenka D, et al: Direct oral anticoagulant and antiplatelet combination therapy: hemorrhagic events in coronary artery stent recipients. J Clin Neurosci 2018; 50:24-29. DOI
- 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 Iloprost
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