MajorAntiplatelet agents – P2Y12 receptor inhibitors×Direct oral anticoagulants (factor Xa inhibitors)
Updated · Methodology
Mechanism
Clopidogrel blocks the platelet P2Y12 receptor; rivaroxaban directly inhibits factor Xa. The two antithrombotic mechanisms add up, roughly doubling major bleeding risk.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
Dual therapy is used after acute coronary syndrome or stenting in atrial fibrillation, generally for no more than 1–6 months. Rivaroxaban dose is adjusted to age and renal function. PPI cover with pantoprazole is mandatory.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- ESC: 2020 ESC Guidelines for the management of atrial fibrillation (2020)
- EMA: Xarelto (rivaroxabán) – ficha técnica en CIMA (2026)– AEMPS CIMA, Xarelto 20 mg comprimidos recubiertos con película, nº registro 08472018 (EU/1/08/472), secciones 4.3, 4.4 y 4.5