concurrent use of apixaban/Eloguis and ibuprofen/Motrin etc.

I take apixaban 5 mg twice daily for paroxysmal atrial fib. I have had only 1 short incident (self converting) of atrial fib in the last 18 months. Loop recorders or ablations or Watchman may be part of my future, but for now, managing conservatively and starting to ask myself how long do I want to continue taking apixaban. I can see myself deciding to just stop, hanging onto a week's worth for the "pill in pocket" strategy at some point down the road.

I now have a muscoloskeletal problem for which my ortho has recommended regular ibuprofen use in higher doses than I've ever taken (800 mg once or twice daily) as one element of the plan of care. We know ibuprofen can increase the right of bleeding, so the question came up during the office visit about taking both apixaban and regular large doses of ibuprofen at the same time. Naturally, he said I should run this question by my electrophysiologist. And I still might, but I wanted to get some input here first.

I'm a pretty healthy 75 year old and I score very low on a basic fall risk tool, so I see the likelihood of suffering a brain bleed as extremely small. But...car accidents. And so forth. And a brain bleed can be catastophic. So I don't consider this situation lightly.

At present, my thinking is that I will cut back the apixiban to 2.5 mg, not 5 mg, twice daily (given its 12 hour half-life), and take ibuprofen 400 mg, not 800mg, twice daily. Follow this plan for a few weeks to see if I can get inflammation under control. Reassess.

Is this reasonable thinking at all? Have you faced this situation in your life or your practice, and how did you navigate it, what lessons did you learn? I understand that every patient case is individual and don't expect anyone to say, "yes, that's exactly what you should do." lol