Clopidogrel × Ibuprofen

Ibuprofen blocks platelet aggregation via COX-1 inhibition, additively with clopidogrel. NSAIDs also injure gastric mucosa, raising GI bleeding risk 2–3-fold.

Gum bleeding, epistaxis, bruising without trauma, black or tarry stools, haematuria. Higher risk in older patients, prior peptic ulcer disease, and chronic kidney disease.

For analgesia on clopidogrel, use paracetamol. If NSAIDs are needed (arthritis, pain flare), choose a short course of no more than 5 days with gastroprotection (pantoprazole 20 mg/day). For osteoarthritis, alternatives include topical NSAIDs and physiotherapy. Ibuprofen can also competitively displace aspirin from the COX-1 active site, which matters for dual antiplatelet therapy.