Major
apixaban × clopidogrel
Direct oral anticoagulants (factor Xa inhibitors)×Antiplatelet agents – P2Y12 receptor inhibitors
Mechanism
Additive antithrombotic effect on two levels: apixaban blocks factor Xa while clopidogrel inhibits platelet aggregation. Major bleeding risk (mostly GI) rises 1.5–2-fold.
Management
Dual antithrombotic therapy (DOAC + clopidogrel) for AF plus recent stenting – for 6–12 months following the AUGUSTUS/ENTRUST-AF PCI regimen, then transition to apixaban monotherapy. Add a PPI (pantoprazole).
Sources
- AUGUSTUS Investigators: Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation (2019)— N Engl J Med 2019;380(16):1509–1524
- 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
- ESC: 2023 ESC Guidelines for the management of acute coronary syndromes (2023)— Eur Heart J 2023;44(38):3720–3826