Major
acetylsalicylic acid × clopidogrel
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Antiplatelet agents – P2Y12 receptor inhibitors
Mechanism
Additive antiplatelet action: aspirin inhibits COX-1 → thromboxane, clopidogrel blocks the P2Y12 receptor. Effective dual antiplatelet therapy after ACS or stenting, but GI bleeding risk doubles.
Management
DAPT (aspirin 75–100 mg + clopidogrel 75 mg) – 12 months after ACS, 6 months after elective stenting. Then switch to monotherapy (aspirin or clopidogrel). During DAPT, add a PPI (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