الوصف
Dual antiplatelet therapy with aspirin and clopidogrel provides superior thrombotic protection post-ACS and post-PCI but approximately doubles the risk of major bleeding compared with aspirin alone.
الآلية
Aspirin inhibits COX-1–mediated thromboxane A2 (reducing platelet activation); clopidogrel blocks P2Y12 receptors (reducing ADP-mediated amplification). The two pathways are complementary, providing broader but not synergistic antiplatelet coverage.
الأهمية السريرية
CURE and TRITON-TIMI 38 demonstrate a 2- to 3-fold increase in major bleeding; benefit–risk depends on indication, with clear net benefit post-ACS/PCI.
التدبير
Use evidence-based duration guidelines (typically 12 months post-ACS); add a PPI for GI protection; reassess at every follow-up whether dual therapy remains indicated.