I have a 70 year old female on apixaban for atrial fibrillation (5mg bid) and no arterial or venous thrombosis history who has just been diagnosed with PV. What is your practice on thrombosis prophylaxis in patients that are anticoagulated already? Do you add aspirin?
If they are on full anticoagulation with apixiban (or other form of full A/C) then they do not need additional aspirin. If they come off full anticoagulation for some reason, then they can start aspirin 81 mg daily. In an observational study the combination of aspirin with full anticoagulation was associated with a 6-fold increase in hemorrhage so we try to avoid the combination in nearly all cases.
