Table of Contents
V. Drug and Supplement Interactions
XIII. FAQ: Can you take Xarelto and aspirin together?
What is Aspirin?
Aspirin is the brand name for acetylsalicylic acid and is an orally administered non-steroidal anti-inflammatory agent (NSAID). It is a drug in the family of salicylates, which can be found in plants such as willow trees. [1]
What’s interesting about Aspirin is that it was the first synthetic NSAID drug ever made—not an exact copy of something existing in nature. It was produced in 1897 by Felix Hoffman, a German research assistant at Bayer & Co. [2]
How Does Aspirin Work?
When there is inflammation due to fever or pain, a chemical called prostaglandin is released in the body. NSAIDs work by blocking an enzyme called cyclooxygenase, which makes prostaglandins. Lower levels of prostaglandins result in reduced inflammation and diminish the function of blood platelets. [3] Aspirin is known as an antiplatelet drug, helping to lower the blood’s ability to clot by preventing platelets from sticking together to form a clot. Aspirin is often used to reduce the risk of heart attack and stroke. [1]
Prescribed Use
Aspirin (an NSAID) is a medication with the following effects:
- Analgesic: for minor pains and aches, relieves pain without anesthesia [4]
- Antipyretic: reduces fever [4]
- Anti-inflammatory: lowers inflammation [4]
- Antiplatelet: Given in long-term low-dose to prevent heart attack, stroke, and cancer [4]
In high doses (300 mg), Aspirin can help with:
- Pain relief
- Reduce fever
- Reduce swelling [4]
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In low doses (75 mg), Aspirin has an antiplatelet effect. This can help if you have had:
- Heart attack
- Chest pain
- Stroke
- Transient ischemic attack (TIA)
- Peripheral arterial disease (PAD)
- Coronary bypass surgery [4]
Side Effects of Aspirin
Reye’s Syndrome
Reye syndrome is a rare but serious condition that mainly affects children and teens. It can cause severe swelling in the brain and liver damage. The risk appears to be higher when aspirin is used during or after a viral illness, such as the flu, chickenpox, or a cold. For this reason, aspirin should not be given to anyone under 18 unless a doctor specifically recommends it. [5]
Reye syndrome may appear as a child is starting to recover from a viral infection. Symptoms can include repeated vomiting, unusual tiredness, extreme sleepiness, confusion, memory problems, seizures, or coma. Seek urgent medical care if these symptoms occur after a recent viral illness. [5]
Common side effects of Aspirin:
Common side effects of low-dose aspirin affect more than 1 in 100 people. These side effects are usually manageable, and simple steps may help reduce discomfort.
- Mild indigestion — make sure to take aspirin with food
- Bleeding more easily than normal [6]
Serious side effects include:
- Coughing up blood
- Blood in your urine, stool, or vomit
- Yellowing of the skin or the whites of the eyes, which may be less noticeable on brown or black skin
- Darker urine, which may be a sign of liver problems
- Painful joints in the hands or feet, which may be a sign of high uric acid levels in the blood
- Swelling in the hands or feet, which may be a sign of water retention [6]
These are not all the side effects of aspirin. Be sure to talk with your doctor for a detailed list.
Drug and Supplement Interactions
Some medicines can affect how low-dose aspirin works, so patients should tell their doctor before starting aspirin if they take other medications.
- Blood thinners, such as warfarin and clopidogrel, can increase bleeding risk.
- NSAIDs, such as ibuprofen and naproxen, can increase stomach irritation and other side effects.
- Prednisolone can increase the risk of side effects.
- Blood pressure medications, such as furosemide and ramipril, should be discussed with a doctor.
- Digoxin, lithium, acetazolamide, methotrexate, and diabetes medications should be reviewed with a doctor or pharmacist.
- Transplant medications, such as ciclosporin and tacrolimus, should be reviewed before starting aspirin.
- Herbal products and supplements can affect how aspirin works or increase side effects.
- Turmeric may increase bleeding risk. [7]
What is Xarelto?
Xarelto is an oral anticoagulant, also known as a blood thinner. Rivaroxaban is the name of the active ingredient in Xarelto. One of the most common uses for Xarelto is in the prevention of blood clots, specifically deep vein thrombosis in the legs and pulmonary embolism in the lungs, post-knee or hip replacement surgery. [8]
How Does Xarelto Work?
Xarelto is used to treat or prevent blood clots from occurring. This drug helps to prevent blood clots from forming by inhibiting the activity of factor Xa, which is responsible for blood clotting. When factor Xa is blocked, thrombin decreases. Thrombin is an enzyme in the blood that promotes blood clotting. Therefore, when factor Xa is blocked, thrombin decreases, and this helps to prevent blood clots. [8]
For a more detailed description of Xarelto, read our article What is Xarelto, and How Does it Work?
Prescribed Use
There are a handful of times when Xarelto may be the doctor's medication of choice for a prescription.
Xarelto is used to:
- Prevent or treat a type of blood clot called deep vein thrombosis (DVT)
- Prevent pulmonary embolism (PE), which is a blood clot in the lungs — previous DVT can lead to a PE
- After knee or hip replacement surgery, to prevent a DVT or PE
- To lower the risk of a DVT or PE coming back after the patient has received treatment for blood clots for at least 6 months
- In patients with atrial fibrillation (heart rhythm disorder), to lower the risk of stroke caused by a blood clot
- In patients hospitalized for an acute illness with an increased risk of getting blood clots, who do not have a high risk of bleeding
- Sometimes Xarelto is paired with Aspirin in people with coronary artery disease or peripheral artery disease
- In the instances listed above, Xarelto is used to prevent blood clots, stroke, heart attack, and serious heart problems. [8]
Side Effects
Common side effects of Xarelto include:
- In adults: bleeding
- In children: bleeding, cough, vomiting, and gastroenteritis [8]
More severe side effects of Xarelto may include:
- Higher risk of blood clots or stroke if Xarelto is stopped suddenly
- Serious bleeding, which can sometimes be life-threatening
- Bruising more easily than usual
- Bleeding that lasts longer than expected
- Frequent nosebleeds
- Unusual bleeding from the gums
- Heavier menstrual bleeding or unexpected vaginal bleeding
- Red, pink, or brown urine
- Bright red or black, tar-like stools
- Coughing up blood or blood clots
- Vomiting blood or vomit that looks like coffee grounds
- Headache, dizziness, or weakness
- Pain, swelling, or new drainage from a wound
- Pain in the upper left abdomen, under the left ribs, or near the left shoulder
- Spinal or epidural blood clots, especially after spinal anesthesia or a spinal puncture
- Back pain, tingling, numbness, or muscle weakness, especially in the legs or feet
- Loss of bladder or bowel control [8]
This is not a complete list of side effects related to Xarelto. For a more comprehensive description of side effects, read our article Side Effects of Taking Xarelto.
Drug Interactions
There is a long list of medications that can interact with Xarelto. Different interactions can cause different effects; some interfere with Xarelto’s action, while others increase certain side effects. Some foods may interact with the drug as well.
Use caution when using these classes of drugs while taking Xarelto:
- Long-term use of NSAIDs
- Aspirin
- Warfarin
- Heparin
- Clopidogrel (Plavix)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) [8]
To learn more about drug and food interactions associated with Xarelto, read our article Xarelto Food and Drug Interactions.
Similarities
Both Xarelto and Aspirin work to prevent blood clots from forming to protect against a heart attack or stroke. It may be recommended by your doctor to take Xarelto, Aspirin, or another anticoagulant or antiplatelet drug, depending on the condition being treated.
In patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD), Xarelto and Aspirin may be prescribed together by a doctor. It is not recommended to take Xarelto and Aspirin together always due to the blood-thinning effect of both medications. In the instances of CAD or PAD, Xarelto and Aspirin may be combined to reduce the risk of major cardiovascular events such as heart attack (myocardial infarction), stroke, or cardiovascular death. [8]
Differences
As mentioned above, Xarelto and Aspirin work to prevent blood clots. But these medications prevent blood clots in slightly different ways.
Antiplatelet vs. Anticoagulant
Aspirin is an antiplatelet drug. Antiplatelets lower the blood’s ability to clot by preventing platelets from sticking together and forming clots. This class of medicines interferes specifically with the binding of platelets.
Xarelto is an anticoagulant. Anticoagulants lower the blood’s ability to clot by stopping specific proteins and enzymes, also known as clotting factors, from helping blood clots to form. Xarelto specifically interferes with factor Xa, whereas different anticoagulants interfere with various binding factors to prevent clotting. [8]
Usage
Aspirin is often taken for pain, headache, and fever, as well as to prevent more serious conditions related to cardiovascular risk for stroke and heart attack. [4] Xarelto is not prescribed for everyday pains such as headache and fever, but more specific conditions such as heart rhythm problems and post-knee and hip replacement surgery to prevent a DVT or PE. [8]
Side Effects
Another difference between aspirin and Xarelto is their side effect profile. Aspirin commonly causes mild indigestion and can make you bleed more easily than usual. [6] Xarelto’s most common side effect in adults is bleeding. In children, common side effects include bleeding, cough, vomiting, and gastroenteritis. [8]
FAQ: Can you take Xarelto and aspirin together?
You should only take Xarelto and aspirin together if your doctor specifically prescribes both. Xarelto and aspirin can each reduce the blood’s ability to clot, but they work in different ways. Taking them together may increase the risk of bleeding, including serious bleeding.
In some cases, a doctor may prescribe low-dose aspirin with Xarelto for people with coronary artery disease or peripheral artery disease to help lower the risk of major cardiovascular events, such as heart attack, stroke, or cardiovascular death. However, this combination is not meant for everyone.
Before taking aspirin with Xarelto, ask your doctor or pharmacist:
- What dose of aspirin is safe to take
- How long you should take them together
- Which bleeding symptoms to watch for
- Whether any other medications or supplements should be avoided
The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis or treatment.