Moderate
Established
説明
Adding aspirin to rivaroxaban increases bleeding risk through additive antithrombotic effects; some indications (COMPASS trial) use this combination with careful patient selection.
機序
Aspirin inhibits COX-1–mediated thromboxane A2 in platelets; rivaroxaban blocks factor Xa, preventing fibrin clot generation. Together they target complementary steps in hemostasis.
臨床的意義
COMPASS demonstrated a 70% increase in major bleeding with rivaroxaban 2.5 mg BID + aspirin 100 mg, though offset by cardiovascular benefit in selected patients.
対処法
Use only in patients with established atherosclerotic cardiovascular disease per COMPASS criteria; prescribe rivaroxaban 2.5 mg BID (not the full anticoagulant dose); add PPI.