Clopidogrel × Sertraline

Clopidogrel blocks platelet aggregation via the P2Y12 receptor; sertraline impairs primary haemostasis by inhibiting platelet serotonin reuptake. Additive bleeding risk, mainly gastrointestinal.

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

The combination is acceptable. In patients over 65 or with prior peptic ulcer disease, add gastroprotection — pantoprazole or esomeprazole 20 mg/day (avoid omeprazole — it suppresses clopidogrel activation). Antidepressant alternative without platelet effect: mirtazapine or agomelatine.