NutriStack
Apixaban and Ibuprofen, a caution.
NSAIDs increase the bleeding risk when combined with DOACs through antiplatelet effects and GI mucosal irritation. While DOACs have fewer food/drug interactions than warfarin, NSAID co-use remains a significant risk factor.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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What the row says.
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At a glance
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. NSAIDs increase the bleeding risk when combined with DOACs through antiplatelet effects and GI mucosal irritation. While DOACs have fewer food/drug interactions than warfarin, NSAID co-use remains a significant risk factor.
Mechanism. NSAIDs inhibit platelet aggregation and damage GI mucosa. Combined with apixaban's Factor Xa inhibition, overall hemostatic function is significantly impaired.
Recommendation. Minimize concurrent use. If pain relief is needed, prefer acetaminophen. If NSAID is necessary, use the lowest dose for the shortest time and monitor for bleeding signs.
Sources (3)
- Davidson BL et al. Bleeding risk of patients with acute venous thromboembolism taking NSAIDs or aspirin. JAMA Intern Med. 2014. PMID 24934614
- Tan E, Braithwaite I, McKinlay CJD et al.. Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis.. JAMA Network Open. 2020. PMID 33125495
- Miroshnychenko A, Ibrahim S, Azab M et al.. Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis.. Journal of Dental Research. 2023. PMID 36631957
Stack Score
How this pair moves the number.
Effect on the composite score
If both Apixaban and Ibuprofen are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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