Moderate
Acetylsalicylic acid × diltiazem
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Calcium channel blocker, non-DHP (benzothiazepine derivative)
Mechanism
Diltiazem impairs platelet function via calcium channel blockade; aspirin is an antiplatelet. Mild additive bleeding risk, rarely clinically significant.
Symptoms
Usually asymptomatic. In patients with bleeding risk factors (peptic ulcer, older age): rare gum bleeding and epistaxis.
Management
Standard combination in ischaemic heart disease. Cardioprotective aspirin doses (75–100 mg) are acceptable without special measures. In patients with bleeding risk factors: PPI cover with pantoprazole.