Moderate
Established
描述
Combining apixaban with aspirin increases major bleeding risk beyond that of either agent alone through additive antithrombotic and gastric mucosal effects.
机制
Aspirin inhibits COX-1–mediated platelet thromboxane A2 synthesis; apixaban inhibits factor Xa. Together, they impair both platelet activation and fibrin clot formation, with aspirin also injuring GI mucosa.
临床意义
Clinical trials (AUGUSTUS, ARISTOTLE) document a 2–3-fold increase in major or clinically relevant non-major bleeding when combined.
处理措施
Limit use to evidence-based indications (e.g., post-ACS, mechanical valve bridging). Use the lowest aspirin dose (75–100 mg/day) and add a PPI. Reassess combination necessity at every visit.