Moderate
Acetylsalicylic acid × Clopidogrel
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Antiplatelet agents – P2Y12 receptor inhibitors
Mechanism
Additive antiplatelet effect via different targets: aspirin irreversibly blocks platelet cyclooxygenase; clopidogrel inhibits the P2Y12 receptor. The combination raises bleeding risk 1.5- to 2-fold versus monotherapy.
Symptoms
Gum bleeding, epistaxis, bruising without trauma. Severe cases: GI bleeding.
Management
The combination (dual antiplatelet therapy) is standard after acute coronary syndrome or coronary stenting. Limit duration to 1–6 months based on thrombosis and bleeding risk. Aspirin 75–100 mg/day. Mandatory PPI cover with pantoprazole.
Sources
- ESC: 2023 ESC Guidelines for the management of acute coronary syndromes (2023)– Eur Heart J 2023;44(38):3720–3826
- COGENT Investigators: Clopidogrel with or without Omeprazole in Coronary Artery Disease (2010)– N Engl J Med 2010;363(20):1909–1917