Ann Pharmacother

Aspirin plus DOAC increases bleeding risk in afib without reducing stroke

January 15, 2026

In a multicenter cohort of 611 patients with afib and no history of ASCVD (411 on DOAC monotherapy and 200 on aspiring plus DOAC therapy), major bleeding was markedly less frequent with DOAC monotherapy (1.37 vs. 5.74 per 100 patient-years; relative risk, 0.35; 95% confidence interval [CI], 0.16–0.77), and combination therapy remained an independent predictor of major bleeding (odds ratio, 3.15; 95% CI, 1.32–7.79). Patients on both agents also had higher rates of clinically relevant nonmajor bleeding, while ischemic event rates were similar between groups.

Clinical takeaway: Evaluate afib patients on DOACs regularly—discontinue aspirin when not indicated to reduce bleeding risk without compromising thromboprophylaxis.

Source:

Yzaguirre SA, et al. (2025, December 26). Ann Pharmacother. Evaluation of the Use of Primary Prevention Aspirin in Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant for Stroke Prevention. https://pubmed.ncbi.nlm.nih.gov/41450132/