Drug General Information (ID: DDIAEMYND0)
  Drug Name Dicoumarol Drug Info Clopidogrel Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Anticoagulants Antiplatelet Agents
  Structure

 Mechanism of Dicoumarol-Clopidogrel Interaction (Severity Level: Major)
     Increased risk of bleeding Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Dicoumarol Clopidogrel
      Mechanism Risk of bleeding
Anticoagulant 
Risk of bleeding
Antiplatelet 
      Key Mechanism Factor 1
Factor Name Bleeding
Factor Description Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
      Mechanism Description
  • Increased risk of bleeding by the combination of Dicoumarol and Clopidogrel 

Recommended Action
      Management Caution and close monitoring of the INR and other bleeding parameters are recommended if clopidogrel is used in combination with an oral anticoagulant. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1 Hermosillo AJ, Spinler SA "Aspirin, clopidogrel, and warfarin: is the combination appropriate and effective or inappropriate and too danterous?" Ann Pharmacother 42 (2008): 790-805. [PMID: 18477734]
2 Johnson SG, Rogers K, Delate T, Witt DM "Outcomes associated with combined antiplatelet and anticoagulant therapy." Chest 133 (2008): 948-54. [PMID: 18198244]
3 Tay KH, Lane DA, Lip GY "Bleeding risks with combination of oral anticoagulation plus antiplatelet therapy: is clopidogrel any safer than aspirin when combined with warfarin?" Thromb Haemost 100 (2008): 955-7. [PMID: 19132214]