apixaban
3 interactions related to apixaban
apixaban + fish oil
Apixaban is a direct factor Xa inhibitor that increases bleeding risk on its own. Omega-3 fatty acids in fish oil reduce platelet aggregation in a dose-dependent way; a 2024 JAHA systematic review of 120,643 patients found omega-3 doses of approximately 3 g/day or less of EPA+DHA did not significantly raise bleeding risk, while higher doses (notably high-purity EPA in cardiovascular trials) showed a small absolute increase in bleeding events.
apixaban + st. john's wort
St. John's wort strongly induces both CYP3A4 (apixaban's primary metabolizing enzyme) and P-glycoprotein (its efflux transporter). Co-use accelerates apixaban metabolism and clearance, lowering plasma concentrations and increasing the risk of stroke or thromboembolism.
chia seeds + blood thinners
Chia seeds are high in plant-form omega-3 (alpha-linolenic acid) and soluble fiber, both of which can mildly reduce platelet aggregation and theoretically add to the bleeding risk of warfarin, DOACs, aspirin, and antiplatelet drugs. The Drugs.com chia monograph explicitly flags caution with anticoagulants based on case reports for related species.