Major
Apixaban × Clopidogrel
Direct oral anticoagulants (factor Xa inhibitors)×Antiplatelet agents – P2Y12 receptor inhibitors
Mechanism
Apixaban directly inhibits factor Xa; clopidogrel blocks the platelet P2Y12 receptor. The two antithrombotic mechanisms add up.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
Dual therapy is used after acute coronary syndrome or stenting in atrial fibrillation, generally for no more than 1–6 months. Apixaban dose is selected according to age, weight, and renal function. PPI cover with pantoprazole is mandatory.
Sources
- ESC: 2023 ESC Guidelines for the management of acute coronary syndromes (2023)– Eur Heart J 2023;44(38):3720–3826
- ESC: 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the EACTS (2024)– Eur Heart J 2024;45(36):3314–3414
- AUGUSTUS Investigators: Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation (2019)– N Engl J Med 2019;380(16):1509–1524