NutriStack
Clopidogrel and Warfarin, a caution.
Triple therapy (warfarin + clopidogrel + aspirin) or dual therapy (warfarin + clopidogrel) substantially increases major bleeding risk compared to either agent alone.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Clopidogrel and Warfarin
- Pair type
- Caution
- Evidence (highest tier)
- Strong
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Strong evidence
Caution
What is happening. Triple therapy (warfarin + clopidogrel + aspirin) or dual therapy (warfarin + clopidogrel) substantially increases major bleeding risk compared to either agent alone.
Mechanism. Warfarin and clopidogrel inhibit different hemostatic pathways. Combined inhibition of coagulation cascade (warfarin) and ADP-mediated platelet aggregation (clopidogrel) creates synergistic bleeding risk.
Recommendation. Only combine when clearly indicated (e.g., post-PCI with AF). Use the shortest duration possible. Monitor INR more frequently. Consider DOAC instead of warfarin when feasible.
Sources (3)
- Dewilde WJ et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing PCI: WOEST trial. Lancet. 2013. PMID 23415013
- Wang M, Zeraatkar D, Obeda M, Lee M et al.. Drug-drug interactions with warfarin: A systematic review and meta-analysis. British Journal of Clinical Pharmacology. 2021. PMID 33769581
- Lun R, Dhaliwal S, Zitikyte G, Roy DC et al.. Comparison of Ticagrelor vs Clopidogrel in Addition to Aspirin in Patients With Minor Ischemic Stroke and Transient Ischemic Attack: A Network Meta-analysis. JAMA Neurology. 2022. PMID 34870698
Stack Score
How this pair moves the number.
Effect on the composite score
If both Clopidogrel and Warfarin are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
Check your full routine
One pair was the worked example. NutriStack runs every pair in your stack at once.
Drop in your supplements and prescriptions and the public database surfaces every interaction, synergy, timing rule, and contraindication, every one linked to its primary source.