Ticlopidine and Apixaban: 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
Apixaban
Ticlopidine
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.
These two medicines both make it harder for your blood to clot. Apixaban (Eliquis) is a blood thinner, and ticlopidine (Ticlid) keeps your platelets from sticking together. Taken together, they work on bleeding in two different ways, so the effect adds up and your risk of bleeding goes up.
Watch for warning signs like unusual bruising, pink or red urine, black or tarry stools, bleeding gums, nosebleeds that won't stop, or coughing up blood. If you notice any of these, or feel very dizzy or weak, get medical help right away. Please keep taking both exactly as prescribed, and your doctor and pharmacist can watch you closely and manage this safely.
Effect: Additive risk of bleeding, potentially serious or fatal.
Mechanism: Pharmacodynamic additivity on hemostasis. Apixaban is a direct factor Xa inhibitor; ticlopidine is an antiplatelet (P2Y12 inhibitor). No pharmacokinetic interaction is the primary driver here, this is a PD interaction. Onset unspecified; evidence is theoretical but severity is major.
- Monitor: Signs/symptoms of blood loss; CBC/hemoglobin as clinically indicated. Routine PT/INR/aPTT does not quantify apixaban effect.
- Manage: Assess bleeding risk vs benefit; promptly evaluate any bleeding. Discontinue apixaban for active pathological hemorrhage. Andexanet alfa reverses anti-FXa activity; PCC, aPCC, or rFVIIa may be considered. Apixaban PD effect persists at least 24 hours.
What happens
Increased risk of bleeding and can cause serious, potentially fatal bleeding
Interaction Deep Dive
The concurrent use of apixaban with antiplatelet agents raises the likelihood of bleeding1. In patients receiving both anticoagulants and antiplatelet drugs together, any indication of blood loss should be assessed without delay 2. In cases of active pathological hemorrhage, apixaban should be stopped. Patients should be informed about the signs and symptoms of blood loss and instructed to report such findings right away or present to an emergency room. Apixaban must be discontinued when active pathological hemorrhage is present. 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. In situations where PCCs are administered, tracking apixaban's anticoagulant effect through a clotting test (PT, INR, or aPTT) or anti-factor Xa (FXa) activity provides no benefit and is therefore not advised. The absorption of apixaban is diminished by activated oral charcoal, which consequently reduces apixaban plasma concentration 1.
Why it happens (mechanism)
Additive effects on hemostasis
How to manage this interaction
The goal is to keep you protected while lowering bleeding risk. If your care team prescribed both, keep taking them as directed unless told otherwise.
- Your team may monitor you more closely and individualize the plan for your situation.
- Learn the signs of bleeding: unusual bruising, red or dark urine, black stools, prolonged nosebleeds or gum bleeding, vomiting or coughing blood, severe headache, or feeling faint.
- Report any of these to your pharmacist or doctor immediately, or go to an emergency room.
- Ask your pharmacist before adding aspirin, NSAIDs like ibuprofen, or other over-the-counter products.
Reversal treatments exist if serious bleeding occurs, so your team can manage this.
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 plus clopidogrel (APPRAISE-2) was stopped ahead of schedule because apixaban produced a greater rate of 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, and adding both aspirin and warfarin raised the bleeding risk from 2.7% per year to 4.6% per year in a clinical study (ARISTOTLE); the use of dual antiplatelet therapy with apixaban in this trial was limited (2.3%) 1.
c) In a retrospective study, using direct oral anticoagulant (DOAC) together with antiplatelet therapy (APT; n=78) versus DOAC alone (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 mainly Caucasian men with a mean age of 63.7 years. Those receiving concurrent APT had a significantly higher mean body mass index (30.7 vs 28.4), a higher mean CHA2DS2-VASc score (4.28 vs 3.85), and were more likely to have diabetes (26.9% vs 17.3%) than those on DOAC monotherapy. DOACs were prescribed for VTE treatment or atrial fibrillation and consisted of 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 comprised 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 Ticlopidine and Apixaban together?
Apixaban and ticlopidine both increase bleeding risk, and taking them together adds up. Keep taking both as prescribed, watch closely for any bleeding, and get help immediately if it occurs. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ticlopidine and Apixaban 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 Ticlopidine and Apixaban interaction managed?
The goal is to keep you protected while lowering bleeding risk. If your care team prescribed both, keep taking them as directed unless told otherwise. Your team may monitor you more closely and individualize the plan for your situation. Learn the signs of bleeding: unusual bruising, red or dark urine, black stools, prolonged nosebleeds or gum bleeding, vomiting or coughing blood, severe headache,… 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 Ticlopidine or Apixaban 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 Apixaban
Keep reading about Ticlopidine
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