Major
Established
Deskripsi
Triple antithrombotic therapy (apixaban + clopidogrel ± aspirin) carries the highest bleeding risk of any oral antithrombotic combination.
Mekanisme
Clopidogrel irreversibly blocks P2Y12 receptors, abolishing ADP-mediated platelet aggregation; combined with apixaban's factor Xa inhibition, both platelet plug formation and fibrin clot generation are profoundly impaired.
Signifikansi Klinis
Large RCTs (AUGUSTUS, PIONEER) show a 2–3-fold increase in TIMI major/minor bleeding when anticoagulants are added to dual antiplatelet therapy.
Penatalaksanaan
Limit triple therapy duration to the minimum necessary (usually 1–4 weeks post-PCI); transition to dual therapy (apixaban + single antiplatelet) as soon as clinically feasible.