In a study published in the Journal of the American Geriatrics Society, researchers noted that many patients have limited knowledge concerning potential serious interactions between dietary supplements and the direct‐acting oral anticoagulant (DOAC) apixaban.

Researchers surveyed 791 patients taking apixaban between April and October in 2018; 771 respondents reported OTC product use and 266 reported taking at least 1 OTC product that has potentially serious interactions with apixaban daily or most days. A total of 53 respondents reported taking multiple OTC products that had potentially serious interactions with apixaban.

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Aspirin was taken daily by 116 respondents, 75 of whom reported taking additional potentially interacting OTC products as well. Frequent ibuprofen or naproxen use was reported by 14 respondents; occasional ibuprofen or naproxen use was reported by 225 patients. Regarding dietary supplements that had potentially serious interactions with apixaban, 160 respondents reported daily or almost daily use.

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Regular use of OTC products with interactions with apixaban was associated with less knowledge of potential interactions between OTC products and apixaban (P <.01). Overall, approximately 66% of respondents gave uncertain or incorrect responses about the potential for increased bleeding with combined usage of nonsteroidal anti‐inflammatory drugs (NSAIDS) and apixaban. However, 71% of patients demonstrated awareness that concurrent aspirin use could lead to bleeding.

Individuals who had less knowledge about the potentially serious interactions between OTC products and apixaban were more likely to use an OTC product (odds ratio, 0.54).

The researchers noted that this study had a response rate of 33%, which limit the generalizability of their findings. Additionally, the dosing of OTC products was not assessed and the researchers did not discuss whether aspirin use was clinically appropriate for the respondent’s situation, both of which may be linked to further limitations.

DOACs are now the anticoagulants of choice for prevention and treatment of a variety of diseases, and use of both DOACs and OTC products is increasing. As such, the researchers called for greater efforts to educate patients and health care providers about the potential dangers of taking OTC products in combination with apixaban.


1.     Tarn DM, Barrientos M, Wang AY, et al. Prevalence and knowledge of potential interactions between over‐the‐counter products and apixaban [published online October 29, 2019]. J Am Geriatr Soc. doi:10.1111/jgs.16193