In patients who are on an anticoagulant, there is no evidence to support adding an antiplatelet agent, and SIGN and NICE guidelines now say that this is not recommended. We don’t have data on whether this applies to patients who are at increased risk of vascular events (such as in recent stenting) and lower than average bleeding risk, so such cases should probably be discussed with the specialist, which frankly is probably a CYA as we all know they’re going to say to take the clopidogrel. They always do.
Top 10 drugs associated with hospital admissions due to adverse reactions are, in descending order:
- ACE inhibs
Be particularly wary of anticholinergic burden, and of the NSAID + diuretic + ACE/ARB triad, which is deadly for kidneys.
(Pulse on-line learning module)