Concentrations of apixaban may increase due to inhibition of P-gp and BCRP by velpatasvir. However, a large, retrospective, multi-centre cohort study of patients coadministered HCV DAAs and DOACs, including sofosbuvir/velpatasvir and apixaban, reported a low incidence of bleeding which was similar to historic controls of patients with liver disease on DOACs alone, providing reassurance that any increase in apixaban levels is unlikely to be clinically relevant. Patients should be reminded to promptly report any signs of bleeding or bruising as with anyone who is prescribed DOACs. [Note: product labels state that apixaban is contraindicated in patients with hepatic disease associated with coagulopathy and clinically relevant bleeding risk. It is not recommended in severe hepatic impairment and should be used with caution in patients with mild or moderate hepatic impairment.]