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Plavix, Effient, Aspirin and Stents (2008 archive)

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What is the normal dosage and length of treatment with Plavix (clopidogrel) or Effient (prasugrel) and aspirin after having a stent? Have you experienced any allergic reactions or side-effects?

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Archived Postings from 2008 on This Page (196):

• I'm a 42 year old woman who has had a RCA stent placed in November. I am on Plavix 75mg, 81mg aspirin, but I also take 5mg coumadin daily. Now the doctors are talking about taking me off the Plavix. I haven't even made the 90 day mark. I go for blood tests weekly and they really aren't sure what to do. Any ideas about going off Plavix this early??
Bonnie M., Florida, USA, December 31, 2008

• I'm not sure when I started taking Plavix probably 3 yrs ago. They were afraid I experienced a TIA, although I had been on aspirin therapy. I had had an aneurysm repair about a year prior and they guessed that a very small clot from the surgery broke free, there were no lasting effects or evidence of a stroke. Since the aspirin did not prevent they chose to use Plavix. BUT you need to know that I now believe that the reason the aspirin did not work is due to my taking at least 800mg Ibuprofen nearly every day for back pain. ( I now want to stop taking Plavix and my Drs. won't let me. I plan to go to my Neurologist with a plan to reduce frequency and increase aspirin, garlic and exercise, with frequent blood tests for platelet activity.
Kim, Georgia, USA, December 30, 2008

• my husband had a heart attack two weeks ago and had a stent put in one of his arteries. The other two arteries appear to be functioning well. He is 51 years old with low cholesterol (below 200), is very fit, has no history of heart attacks in the family and is not diabetic. He has been put on 1.5 tablets of plavix a day along with aspirin, Lipitor and some other tablets. However, recently, he felt some pain and numbness in his right arm and had a severe dizzy spell. Could this have anything to do with Plavix?
Aurora, Ireland, December 29, 2008

• My husband is on Plavix, one a day. Has anyone experienced loss of calcium in their bones and teeth due to taking Plavix? A friend of ours indicated that her husband's teeth had rotted from the inside due to taking this medicine. The dentist where she goes to is also making his own study into this problem.
Denise Drudy, Tampa, Florida, USA, December 26, 2008

• Thank you Katie -- we are very sorry for your loss. Your story points up a very important issue for our readers: patients who have received stents, especially drug-eluting stents, MUST TAKE THEIR PRESCRIBED MEDICATIONS AS INDICATED. It's not that Plavix is a dangerous drug -- it can be a life-saving drug in a number of circumstances. One of those is that when you get a stent, you must take antiplatelet medications to keep the blood from clotting around the stent. Plavix is one. Ticlid is yet another -- it was used before Plavix was available -- it tends to have more side effects, but some patients do better on it. There is also a new antiplatelet drug on the horizon -- Prasugrel -- not yet FDA approved. Aspirin is also an antiplatelet medication that is given together with the others. But this Forum is filled with stories of patients who stopped their meds and subsequently had problems. This is not to say this is the cause for your mother -- there are many possibilities. But we very much appreciate your posting. And it is critical that cardiologists, nursing staff and general practitioners understand this and communicate this clearly to patients and/or their families.
Angioplasty.Org Staff, Angioplasty.Org, December 23, 2008

• I wanted to add comments regarding Plavix and the serious side effects of not taking it as prescribed. Although, my family and I were not aware of the dangers, my Mother may have been, we are not sure. All I know is that she stopped it for about 2 1/2 to 3 weeks and then had to go into the hospital for a Heart Catheterization. The first one failed and her two new stent's collapsed, so they went in again because she was having a heart attack. My concern is for patients to know exactly how dangerous this medication is, especially if you decide not to take it (for reasons of cost, fear of internal bleeding, etc.) My question to the Medical community is this, is there an alternative medicine to give these patients that is not such a risk to their health if they stop? My Mom passed away two days after the repeat heart cath and I can't stop thinking it could have been prevented. If this saves one life, it is worth posting. I don't want any other family to have to deal with the pain and guilt my family and I are dealing with.
Katie, Dearborn, Michigan, USA, December 20, 2008

• Hi! This is Fran from Massapequa Park, New York. My son passed away on November 27, 2008. You had questions. We do not know whether it was a blockage or blood clot in the stent. Death Certificate states as follows: Ventricular Fibrillation, interval between onset and death 15mns. Acute inferior M.I.60mns. Autopsy not performed. Thank you for your kindness.
Fran Sandler, Massapequa Park, New York, December 18, 2008

• My husband is on Plavix 75 mg and 81 mg aspirin. He has had 2 instances of spontaneous bleeding - one mediastinal last Nov. and this week bleeding from the colon. The cardiologist has somewhat reluctantly agreed to 1/2 Plavix daily. Is there any data on the effectiveness of 1/2 Plavix daily, or alternately on 1 Plavix every other day? Thank you.
Susan N., Missouri, USA, December 17, 2008

• Fran -- we are so sorry to hear of your loss. Your story reminds us all that we cannot stress enough that stent patients who are on dual antiplatelet therapy (aspirin and Plavix) MUST discuss ANY surgical procedures with both their surgeon and interventional cardiologist. And that they should NEVER stop these drugs without first consulting their interventional cardiologist. There are compromises that can be made (see our related topic on "Plavix and Surgery") but the medical professional who is most knowledgeable about this issue would be your interventional cardiologist. That being said, Fran, your story is disturbing because your son was 18 months out from a stent placement, and the fact that he suffered an MI that long after implantation raises all kinds of questions, the kind that we unfortunately get many of here, namely (1) is there a way of predicting how long a specific patient needs to be on antiplatelet therapy after stenting with drug-eluting stents? and (2) is there a "plavix rebound effect" which would mandate a period of gradual withdrawal for safety's sake. These questions have not yet been answered by the medical profession. One question to you -- do you know whether or not it was established that his cardiac arrest was caused by a blockage or blood clot in the stent? In any case, our sincerest sympathies to you.
Angioplasty.Org Staff, Angioplasty.Org, December 16, 2008

• My 51 yr old son died on Nov.27, 2008 of cardiac arrest. He had an MI 8 yrs ago. Second drug eluting stent 1 1/2 yrs ago. Regimen of 75mg plavix, 81 mg aspirin. He had elective colonoscopy on 11/25/08 with stoppage of plavix and aspirin 5 days prior to surgery. Surgery successful patient died. He passed away on the 7th day after stopping plavix and aspirin. Why is there not different protocol when stopping a serious drug? Be Aware of what you are doing. Question, Question, Question. My husband & I begged him not to do this. Maybe this info can help others. Plavix users be aware.
Fran Sandler, Massapequa Park, New York, USA, December 15, 2008

• I've been on a 75mg daily dose of Plavix for just over a month following multiple stent placement. The only side effect that I am aware of is a near total loss of taste. No food, no matter how it is seasoned tastes like anything. I'm aware that I am stuck taking Plavix for some period of time but would like to know if anyone else has lost there taster as well and what can be done about it. My cardio says to tough it out as it will probably help me drop a few pounds. I didn't think that was either funny or helpful.
Clay, Texas, USA, December 14, 2008

• Pauline -- it's not clear from your post whether or not you have a stent, but for stent patients Plavix AND aspirin are two very important medicines and need to both be taken for at least 6 months. Patients who are taking Plavix for reasons other than stents should discuss their medications with their cardiologist. By the way, ibuprofen (Advil, Mortrin, etc.) also interferes with aspirin's antiplatelet properties, so avoid taking both.
Angioplasty.Org Staff, Angioplasty.Org, December 12, 2008

• Plavix, aspirin, stents, garlic, grapefruit, antacids, Benadryl. I understand the most current studies say that taking aspirin is no longer necessary with Plavix. My GP has told me to stop taking it; no word from my cardiologist yet. Should I? No garlic tablets instead of statins. Antacids decrease the antiplatelet purpose of the Plavix. I've been given Protonix for stomach distress and am afraid to take it. Only acetaminophen for headaches, fevers, aches in general even though it is ineffective for me. My favorite fruit, grapefruit is forbidden. Now I'm told I should take Benadryl for my sleepless nights. Tell me why I am continuing to take Plavix with so many basic life helping no-nos?
Pauline M Moll, Pocatello, Idaho, USA, December 12, 2008

• Tom -- thanks for the update and encouragement to others on positive steps they can take to reduce their risk factors.
Angioplasty.Org Staff, Angioplasty.Org, December 12, 2008

• To: Neal, London, England -- Neal, your own predicament illustrates well the present state of confusion. You are far more patient than I was. When, after two+ years, the doc still did not want to change the strategy, my strategy was to change the doc. It was a very careful move, followed by very gradual withdrawal schedule, which lasted several months. It ended last August, and I am happy to report it now, in December. If you do decide to do something like that as well, make sure to tip the odds in your favor by doing it very gradually, and also doing all the other good stuff which they agree on, quit smoking, diet, low salt, doing the cardio stuff, etc. Good luck! And let us know.
Tom, Encinitas, California, USA, December 12, 2008

• I am a 56 year old male. I had stents in 1999, and 6 months later a balloon procedure was done because of scar tissue build up. I have been on 325 mg aspirin since that time. On 12.02/08 I was again admitted for the balloon procedure, because of chest pains. My cardiologist said he did not think my pain was related to my heart, but said I may have had trouble later, and did balloon. He prescribed 75 mg of plavix. After 7 days my hand, head, and feet began itching, and was out of control. My right hand swelled up almost 2 times the size of my left. Today my GP took me off of plavix, and administered a steroid regiment for 1 week. She told me to restart plavix in 7 days, and if itching came back, we would know for sure. I did research, and it appears I was indeed suffering from plavix side effects.
Mike, Tennessee, USA, December 11, 2008

• Thanks for the link about the rebound effect. Given the length of time I've been on Plavix my GP has overridden my cardiologist and said I should remain on it until there is better understanding and statistical analysis of this possible adverse effect to sudden withdrawal. Perhaps I should try a gradual withdrawal of one tablet a fortnight for fourteen weeks to get me off the 7 x 75mg a week dosage and over the critical ninety day risk period. Regards, Neal.
Neal, London, England, December 11, 2008

• Any help would be greatly appreciated. My husband had a heart attack Nov 25, 2008 and 2 stents which occluded and then 2 more deployed with angioplasty on them the next day. He was started on the usual meds; metoprolol, plavix, aspirin, niaspan and was already on lisinopril, simvastatin and glyburide. He was already battling eczema over a large part of his body which seemed to worsen in hospital. He was put on lasix day after coming home for swelling in legs and feet. A few days after he was home, his lips swelled tremendously and they took him off his lisinopril and lasix. Two days later his tongue swelled, went to ER and re-hospitalized for 2 days. Took off all meds except plavix and aspirin and glyburide. He was given steroids in hospital. Two days after coming home second time, he has hives and lips started swelling, so he used the epipen on himself. Cardiologist then changed plavix to ticlid and took off aspirin. We are now 2 days later and he is still having small outbreaks of hives and his tongue swelled a little last night and he didn't tell me. He is living on benadryl constantly and we are at wits end. Next is allergy testing for other culprits. Any ideas or advice? Anyone know of medicine reactions with glyburide to look for?
Karen, North Carolina, USA, December 11, 2008

• Neal -- there are no studies that we know of proving an increase in platelet activation after stopping Plavix, but that has been at least suspected in a study done here in the States. See our February article "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents", which reports on a new observational study in JAMA about a possible Plavix "rebound" effect, where stopping may result in a short period of increased platelet activation (blood clotting, resulting in heart attack). Dr. Rumsfeld, lead author, has emphasized that this doesn't prove a link, but they are continuing. There also is no protocol for stopping Plavix, although he has heard of physicians withdrawing the drug gradually instead of stopping suddenly. As always, our "only" advice is to discuss this study and your concerns with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, December 11, 2008

• Hello, Following an MI and stenting, I've been prescribed Plavix since 2001: dosage is 1 x 75mg Plavix [AM] together with 2 x 75mg Aspirin [AM/PM] daily. I now have a new cardiologist who has said he wants me to stop taking Plavix. I'm wondering if there could be any potentially serious adverse effects if Plavix is withdrawn abruptly after such a long period? Should the dose be reduced gradually? I'm worried my blood platelets will go haywire after extended Plavix use. Can anyone here offer advice?
Neal, London, England, December 10, 2008

• C.S. -- Plavix and aspirin are prescribed together post-stenting (a.k.a. dual antiplatelet therapy). Fish oil has been shown to be beneficial in artery health -- don't know of any interaction. As for statin substitute -- none we can recommend -- statins lower cholesterol, so certainly diet can play a significant role -- but you should discuss medical therapy with your cardiologist and see what he/she recommends.
Angioplasty.Org Staff, Angioplasty.Org, December 10, 2008

• Can you take Plavix, ASA, & Fish Oil all after a stent? And what alternative do you recommend if you do not want to take a statin?
C.S., Kentucky, USA, December 10, 2008

• Hi everyone,Francesca here,. Ask your doc first about what I am doing....... I am taking 3 - 75MG plavix a WEEK sorry, mistake. I don't know what else to do as both UK and US Doc's are of completely different opinions - I think we are human guinea pigs at this point! The best thing is to have a stress test, but they are so expensive here in the US, maybe on the National Health, it just checks for any other blockages - Get your blood test done EVERY SIX MONTHS, and check your cholesterol,and Liver Enzymes, make sure you are constant with the same results - get rid all fats especially, saturated fat, except small amounts of Olive Oil, out of your diet, lots of garlic every day.(apparently helps reduce cholesterol, thins blood, and helps with constipation that sometimes is a side effect from what we take.(NO grapefruit) If you are taking Statins(Crestor) watch out for shoulder pain, mine has worsened after taking Crestor, ask your doc if you can reduce the amount, I take 20mg's now. Buy a blood pressure machine and monitor your BP every three days.....take control and ask as many questions as possible.....let's keep on top of the Plavix issue, the TV ads here are bombarded with Plavix being the new miracle drug. Remember the "wonder" Anti Inflammatory drugs all taken off the market. Anyone who has high blood pressure, please feel free to go to my website and listen to the music, it helps reduce tension. I am NOT selling anything, just listen to music and see if it calms you/ Anyone want to e mail please do: Best of luck and will keep you posted. Am still alive at least!!! Francesca
Francesca Milano, Las Vegas, Nevada, USA, December 8, 2008

• It's me again - these docs in the US are on Oprah all the time, they have great diets for heart - thought you might like to have a look. Francesca
Francesca Milano, Las Vegas, Nevada, USA, December 8, 2008

• To Tel, UK - sorry, I said three Plavix a day, NO, three a WEEK......typing error......There is talk about going off too quickly having a side effect, so ask your doc if you can come off your prescriptions!!! I have refused to go back on one a day. Better yet, go and get a couple of opinions - it's worth it. It's the not knowing that drives us all nuts.-) Please ask your doctors about the different opinions, your case may be different from mine.........-)
Francesca Milano, Las Vegas, Nevada, USA, December 8, 2008

hi Jack I have been on Plavix for 3 years now (see my post to Francesca). I too have had weird stomach issues in that time. But stomach pains have been one of the symptoms. It will be interesting to see if they go away when I stop the plavix. I will let the forum know.
Tel, United Kingdom, December 8, 2008

hi Francesca. I too am under a UK cardio. I have been on plavix and aspirin since my first BM stent fitted in Jan 2006. I had need of a further stent, which was a DES and it was fitted in Dec 2006, so I just continued with the Plavix and Aspirin, but now my cardio is saying I should come off the Plavix. No tailing off, just stop it. My last DES was an Endeavour make. I am nervous about stopping, but I guess the prescription will be stopped, so I will not be able to get the Plavix anyway !!
Tel, United Kingdom, December 8, 2008

• looking for someone on plavix and aspirin who experiences ringing in their ears and a tingling in the arms.
GM, Connecticut, USA, December 7, 2008

• Francesca -- did you say 2 or 3 Plavix per day? What strength are you taking?
Angioplasty.Org Staff, Angioplasty.Org, December 7, 2008

Follow-up from Nov 11: Hi. This is Francesca again. Went to see my cardiologist yesterday and told him about the UK Doc saying I must come off Plavix after a year. He still says I have to take it for the rest of my life. I was already down to two per day, now he's put me at three and says UK is too far behind in the Stent/Plavix issue.My e mail address is,website - if anyone has any new thoughts on this in the USA!! I need help....
Francesca Milano, Las Vegas, Nevada, USA, December 7, 2008

• Jack -- there is a response to Catherine's post right above hers. Ticlid (ticlopidine) is an older drug that was used as an antiplatelet before Plavix. It tended to have more side-effects, but some cardiologists have found their patients tolerate it in case where Plavix causes a bad reaction. And Paul, missing a day shouldn't cause any problem -- Plavix stays in the system a while. Problems occurs when patients stop taking Plavix prematurely. It's not that it damages the stent, but Plavix keeps the blood "slippery" so it doesn't clot.
Angioplasty.Org Staff, Angioplasty.Org, December 7, 2008

• I am a 57 yr old male with 3 drug eluting stents for the past 6 months. I fogot to take my plavix for one day. Could damage have happened to the stent for missing one day...Should i tell my doc? thanks.
Paul, Florida, USA, December 7, 2008

Catherine, Ann Arbor, Michigan, USA, April 7, 2008 asked a question "Is there any other alternative to Plavix" I don't recall seeing an answer to this question. Is there an alternative? My wife is on Plavix, aspirin and lipitor following two DES implants. She has severe stomach ache/pain which the onset was sudden, she has gone to the ER several times and they continue to run tests but come back with no answers. She is scheduled for an endo but doesn't know about the plavix and aspirin issue.
Jack, Scottsdale, Arizona, USA, December 7, 2008

• We have not heard about an issue with lung growths. The biggest downside to long-term Plavix is bleeding complications, but many patients are on it long-term and do fine. Also the danger of late stent thrombosis (thus the need for longer-term Plavix) has been associated with drug-eluting stents, not bare metal ones. But don't take anything you read on the Web as a substitute for advice from a medical professional. And let the Forum know what your husband's cardiologist recommends.
Angioplasty.Org Staff, Angioplasty.Org, December 3, 2008

• An emergency response is needed! My husband has had 3 non-drug eluting stents and is on Plavix, Cozaar, Lipitor and low-dose aspirin. I heard that after a year a person should come off Plavix or growths on the lungs will start to grow. |Is this true? He is seeing his cardiologist tomorrow and we want to be informed.
Maggie, Ontario, CANADA, December 3, 2008

• Has anyone ever been prescribed more than 75mg Plavix a day? I recently survived two angioplasties to place a total of 6 stents. The second occurred after experiencing blood clots in 3 DES.
Berg, California, USA, December 1, 2008

• Hi I am riya, have you had problems yourself? It is true that Plavix can have side-effects, but that's not in all people. As you can read below, current guidelines for drug-eluting stents are at least 12 months for Plavix and lifetime for aspirin. Concerned about the "rebound" effect, some cardios are suggesting tapering off.
Riya, India, November 25, 2008

• Cathy -- Plavix (clopidogrel) reduces blood clotting systemically -- but you shoudl discuss any concerns you have with your cardiologist or vascular surgeon -- whoever placed the stent.
Angioplasty.Org Staff, Angioplasty.Org, November 20, 2008

• I am on Plavix after having a stent placed in my iliac vein. I was diagnosed with may thurners syndrome. I can not find any information concerning the use of plavix and aspirin with stents placed in a vein. Does Plavix reduce the risk of clotting in veins?
Cathy H, Boston, Massachusetts, USA, November 17, 2008

• Joe -- have you discussed these issues with your cardiologist? Standard Plavix-aspirin therapy after drug-eluting stents is one year or more, depending on the cardiologist, patient's tendency towards clotting, etc. Given your specific situation, the blood spots on your skin, low platelets, etc -- you should discuss your drug regimen with your cardiologist. We do not recommend self-medicating or cutting out, scaling back, etc. without involving a medical professional. Hope this helps -- and pleaselet the Forum know what your physician recommends.
Angioplasty.Org Staff, Angioplasty.Org, November 15, 2008

• This is second time I have posted these response comments. I have very low platelets and I would like to come off Plavix after two and a half years. I have a Boston Scientific Taxus coated stent...placed Feb, 2006. Originally told to stop Plavix after one year. However, Dr told me later to stay on it with one baby aspirin a day. My blood is thin anyway with chronically low blood platelets following radiation treatments 12 years ago following prostate surgery. I do have blood spots periodically on my skin...especially on the hands and arms. Is it possible to stop taking aspirin or plavix...or the amount? Every other day? Do doctors take into consideration blood platelet count? originally posted from Joe T., Georgia, USA, September 29, 2007
Joe, Atlanta, Georgia, November 14, 2008

• Thanks for the story, Tom.
Angioplasty.Org Staff, Angioplasty.Org, November 12, 2008

• I hope this helps someone. Last April, after two event-free years of Plavix following one DES, the doc was still reluctant to let me stop the Plavix. Easy for him to say, huh! Having read on this excellent website about the potential problems when stopping Plavix abruptly, I had worked out a strict withdrawal schedule over a 3 months period. First, one pill every other day for two weeks. Next, 1/2 pill, but skipping every third day, etc. Slow and steady. The schedule ended after two weeks of 1/4 pill every other day, that was last August. Happy to be reporting this in November. Free at last! I am sure it also helped to quit smoking, mind the diet and work out hard enough where the HDL and LDL numbers are equal.
Tom, Encinitas, California, USA, November 9, 2008

Follow-up to my October post -- After much testing and consultation, it has been advised to me to stick with Plavix until my one year period, post stent, has occurred. The blood in the urine issue is being monitored. My hemoglobin is normal. I have been told that a few drops of blood may color the urine more red or rust colored than the actual loss of blood. Still hematuria (sic?) is a serious condition, but balancing against the risks of restenosis, I will stick with dual antiplatelet therapy for now.
Brian Morgan, Gaylord, Michigan, USA, November 9, 2008

To Brian from Michigan (and many other posters) -- one of the concerns and one of the most often seen complications with Plavix, or any anticoagulant/antiplatelet medication, is bleeding. We are not medical professionals and we cannot and do not give medical advice. We would strongly suggest, however, that you discuss your bleeding problem with your interventional cardiologist. Cessation of clopidogrel (Plavix) is a tricky subject, in terms of trying to weigh the risks of bleeding against the risks of stent thrombosis (clotting). Normal antiplatelet therapy is 75mg of clopidogrel with a baby aspirin daily. Francesca -- there is no proof that chelation therapy provides any benefit.
Angioplasty.Org Staff, Angioplasty.Org, November 8, 2008

• I am in the same boat. I had a stent last May and have been on Plavix, prescribed in the USA for over a year. Now my doctor in the UK says I have to get off it. So I chose by myself to taper it, and am taking 2 per week. How do you find out if your stent is ok? I take aspirins every day,and Simvastatin,(which they now say kill you) but I have to take Simvastatin for cholesterol, they say. Also Metoprolol for blood pressure. I eat well, but what would happen to me if I did the chelation therapy? Would the stent fall out? I am so confused.
Francesca Milano, Las Vegas, Nevada, USA, November 7, 2008

• Is there an alternative drug for Plavix? And must one take 325mg of aspirin along with the Plavix? My Mother is doing HORRIBLE after her stent surgery! She also has ulcerative colitis and she is bleeding very badly. Her Dr. says the risk of lowering the aspirin is greater than the rectal bleeding. He offered no other options. She is also getting chronic infections, ears, nose, UTI's, can't eat, very dizzy, weak. I think something is very wrong but I cannot seem to get any answers from her Dr. PLEASE help!
Nancy G., Florida, USA, November 6, 2008

• Earl -- Thank you very much for your story. Actually it's most likely a classic case of very late stent thrombosis -- which occurs in a very small percentage of cases (not small, if it's YOU) -- and which is the reason there is so much concern over how long to continue antiplatelet therapy. The data from the "Plavix Rebound" effect, which is still only observational -- not proven -- is that the events seem to occur much more in the first month. The cause (and thus prevention) of late or very late stent thrombosis continues to be a problem without a good solution. We sincerely hope your recovery continues. Smart move going to the firehouse!!!
Angioplasty.Org Staff, Angioplasty.Org, November 5, 2008

• Concerning the "Rebound Effect", I feel that I need to add my experience to this website. I am a very active 74 year old male with "long genes" on both of my parents sides of the family (mom 105, dad 96 at deaths). I play ice hockey two days a week in an "old timers league". However, in the summer of 06 I was having what I thought was heartburn issues. It would happen randomly - watching TV, wake me up at night, etc,never associated with exercise(obviously, but not to me at the time, it was Unstable Angina). After two months of this, I called my doctor's office, explained what was happening and they had me come in immediately. I was sent from there to the emergency room and from there into the cardiac unit. Catheterization showed an 80% blockage in the 1st branch off of the LAD and a CYPHER DES was implanted on 8/31/06. From that date I was on Plavix until 6/04/08 when I started a four week phase-out with my cardiologist's approval. I wanted to get off of Plavix because of bruising and injuries from hockey. On 9/23/08, 3 months from the phase-out, leaving the hockey rink, I started having chest pains. There is a fire station a block from the rink. I drove there and they immediately got an EKG, got Aspirin into me, nitro, started an IV, and I was on the way to the nearest hospital, into the Cath Lab and catheterized. They found and removed a clot at the stent site. There was heart muscle damage. EF two days after the event was 35 to 40%. I am now in exercise rehab program. Sounds like a classic case of "Plavix Rebound Effect" doesn't it? Comments, please.
Earl R., Michigan, USA, October 29, 2008

• Valerie -- it's a complicated issue, as you have written. Look over the related topic on Plavix and Surgery as well. In these types of situations, it can be useful to have the cardiologist and surgeon consult with each other about the risk/benefits.
Angioplasty.Org Staff, Angioplasty.Org, October 29, 2008

• I have more than one medicated stent. In fact, I have a stent within a stent. Am on Plavix & 325mg. of aspirin. I have severe pain in my lower spine due to disc problems. Have had nerve blocks before (one about two weeks after a stent placement and one a few months later). Both times I was allowed to go off Plavix for a week to five days. I had only been on it since December of 2007. Now, I was all set to have another nerve block in a few weeks, when the cardiologist says NO WAY can I go off Plavix for even five days!!! The pain in my lower spine is so severe than it is unbearable!!! Pain management has said we can manage it with medication. Well, I am also bipolar and trust me, I take LOTS of medication already and do NOT want to take MORE long term!!! I have a question for my dr...what if I was in an accident away from home and no one knew I was on Plavix or had heart problems? With no immediate access to my medical records, would I be in more or less jeopardy in regards to NOT being on Plavix if I had surgery or other medical situations where I was unable (& no other family available) to let medical staff know my health history? In May of this year, I had another heart cath and the dr. said my arteries all looked open heart surgery needed. Since I am now being told my heart "situation" is very complicated regarding my arteries, should I have open heart surgery and just get it all fixed??? I need some kind of other direction here. Thanks for listening.
Valerie DeCurtis, Lakewood, Ohio, USA, October 27, 2008

• Al -- hi and welcome. Most physicians recommend aspriin for life for their patients suffering from heart disease. Medical opinions vary about Plavix and if you read through this and related topics, you'll see the range. We strongly suggest that you ask this question of your interventional cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, October 25, 2008

• Hi, My name is AL. I'm new to the forum and would like to ask one question to whoever wishes to respond. Today is Oct 21, 2008. I had 2 drug eluting stents put into my wonderful heart in May 2007, nearly 1 1/2 year ago. I take 75mg Plavix and 81mg baby aspirin daily. I am type 2 diabetic. My question is do I really need to take both of these drugs still? Can and/or should one of them be discontinued? I'm 53 years old and don't believe I should be taking the amount of drugs I am at my age. Anyone, please respond. Thank You.
Al, Joliet, Illinois, USA, October 21, 2008

• I am a 67 year old female with no heart problems , noting that I've just had two different visual arterial tests and with them finding very clear arteries with no plaque in them. I have a double start heartbeat in the upper valve which has not given and problems at all ( always been there with no splash back).I have high blood pressure and cholesterol with a low salt diet and no physical reason for the high BP except I seem to be an A type personality. My family has a high incident on heart attack but for the men. The women seem to have heart trouble but seem to live till in their 80's at least. I don't understand why I'm on Plavix when aspirin may work as well with all my advanced ( Remicade +) rheumatoid medicine.
Ren, Battle Creek, Michigan, USA, October 16, 2008

• I am 60 years old Indian male and have gone through six (6) angioplasty & seven stents placed in all the three 98% blocked coronary arteries from June 2002 to August 2003. Three (3) drug coated and four (4) bare metal. I am taking baby aspirin and 10 mg of Lipitor & 12.5 mg of Toprol-XL now & took one plavix for one (1) year after the last angioplasty. There is no heart attack so far. I am able to run 5 miles per hour on tread mill five days a week for 40 minutes & do muscle strength exercises 3 times a week in a health club. With the use of 10 mg Lipitor, low fat diet and exercise, My LDL is 62, HDL 42, Triglyceride 58. Total Cholesterol 116. Ejection Fraction rate of heart is 62%. Before the angioplasty, Total cholesterol was 263, LDL 167, HDL 38 and Triglycerides 225. I have reduced my weight from 162 to 140 LBS which falls within normal range of my height 65 inches.
Dharam Goel, Gaithersburg, Maryland, USA, October 16, 2008

• I had an Endeavor DES implanted on August 28th 2008. My LAD was completely occluded in a certain area (70 to 80% occluded otherwise); I have been taking aspirin (325 mg) and Plavix 75 mg with no problems until two weeks ago when I noticed blood in my urine. This problem continued and I went to the ER room where a CAT scan of the bladder was done. Additional blood tests were also done. Everything was normal, but I was given a follow up appointment with a urologist. Both my cardiologist and family doctor thought for sure that Plavix alone wouldn't explain the blood in the urine issue. Unfortunately, so far at least, the urologist cant find any reason OTHER than the Plavix as a cause for this. I discontinued aspirin a while ago so I doubt that's the cause after this length of time. The amount of blood I am passing in my urine is quite significant. My hemoglobin count is normal (minimal level, it used to be on the high end of normal). I have three choices: First continue taking the Plavix but have periodic blood tests to measure for anemia, and possibly have frequent blood or plasma transfusions. Second, discontinue Plavix and take regular aspirin. Third, continue to take Plavix but on an every other day basis. I am in a quandary here and would appreciate some input. One final thing: The Plavix related bleeding is always worse after a vigorous workout in a gym or jogging or walking. Any type of vigorous exercise makes it worse, as does sitting for long periods of time. Again the urologist cant find any other reason for this other than the Plavix.
Brian Morgan, Gaylord, Michigan, USA, October 11, 2008

Hi John, I am writing about my 51 y/o husband who had a DES to the LAD 12/06 prior to getting on a kidney transplant list. He's been on Plavix and ASA 81mg since. He received a kidney tx on 7/18/08. Since then his Hct has been dropping He's been on Aranesp 100 mcg q week . He just got out of the hospital after receiving 2units PRBC's His HB had dropped to 8 however his plts are 309,000. His cardiologist doesn't necessarily feel this is coming from Plavix, his neph thinks it is from his antirejection meds suppressing his bone marrow. As an RN I am concerned about him staying on the Plavix, since it's been 2 yrs already, also He's IDDM. Have you ever come across any situations like this?
Cel S, Mount Prospect, Illinois, USA, October 9, 2008

• FR -- Plavix (clopidogrel) is very important to take for the prescribed period of time, and is particularly important to take in the weeks immediately post-stenting. Hopefully your cardiologist made this clear to you. Plavix keeps the blood platelets slippery, so that they don't clot around the stent. Ideally, the patient should take this drug until the artery wall "heals" over the metal stent struts. Recommended times are 6-12 months or more for drug-eluting stents. Also it is important to stay on the prescribed aspirin dosage for the same reason (aspirin and Plavix are both antiplatelet medications; they have similar effects, but work differently). All studies that have been done emphasize the importance of stent patients staying compliant with dual antiplatelet medications, to avoid clotting, or stent thrombosis which can result in a heart attack. Perhaps your physician can give you a few samples of clopidogrel to bridge the gap. If you have no choice, be sure to take your aspirin (assuming that's been recommended for you). But talk to your cardiologist -- nothing you read on this, or any web site, should be used as a substitute for advice from your doctor.
Angioplasty.Org Staff, Angioplasty.Org, September 29, 2008

• I had a stent put in on Aug. 28th 2008. I have been on the plavix and Toprol XL once a day for each but have run out of the meds and am waiting for them to come in the mail. Should 4 or 5 missed days affect the way I feel or cause me any problems?
FR, New York, USA, September 29, 2008

Fred B., Manitoba, Canada, September 27, 2008

• My mother 67y/o had x3 stent placements in Nov 06 and remained on Plavix for 16 months and then tapered off. She was hospitalized x4 with bleeding colon ulcers during that time. She has been off the med for 7m and now seeing another cardiologist and he wants to put her back on Plavix 1 tab every other day. She has Diabetes, ESRD, on peritoneal dialysis and no bleeding since off the Plavix. What is the benefit with all the risk?
Sara, Kansas, USA, September 17, 2008

• P.B. -- what you are describing is the issue of late stent thrombosis -- the medical profession has been studying this, but there is still no answer about prevention, other than staying on antiplatelet therapy (Plavix and/or aspirin) long term. It may be that certain individuals are more prone to clotting. But this late clotting, which is still very low in percentage, seems to be something that occurs with drug-eluting stents. Staying on Plavix or aspirin, of course, presents complications when a patient has to have surgery, as you unfortunately found out. We second your recommendation about questioning your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, September 16, 2008

• My husband was taken off of plavix 18 months after Drug eluting stent placed in RCA. In May Cardiologist dc Plavix for necessary tests. My husband was scheduled for a spinal fusion last Friday and had been off of aspirin for 7 days. He came through operation ok but coded in elevator on way to room. Through the skills of the code team my husband was saved and a new bare metal stent was inserted proximal to the old stent. We were told that the combo of time off aspirin and plavix, stress of surgery and the small diameter of first stent caused an extremely large blood clot to form just above the original stent (Cardiologist said it was visible to the naked eye-apparently that is large). I would encourage all of the members to really question your cardiologist about the safety of discontinuing plavix/aspirin therapy for any reason.
P. B., Florida, USA, September 5, 2008

• My dad had a small blockage and had a stent put in this summer ~ his doctor has him on Plavix ~ since then, he has frequent headaches and dizziness ~ he us usually fine in the mornings, but by afternoon, his headache and dizziness return. Has anyone else had these symptoms while on Plavix? Thanks.
Sheri, Texas, USA, September 3, 2008

• A general response to the many similar questions we see here. If you have any questions about side-effects, stopping Plavix for surgery, etc. please consult with your interventional cardiologist -- and certainly do this before taking any action such as stopping taking any drugs. Aspirin and Plavix are currently recommended for 6 months minimum after drug-eluting stent (DES) implantation, but many cardiologists feel that a year or more is necessary until more is learned about very late stent thrombosis (blood clots occurring more than a year after stenting with DES). Also check out the "Related Topics" at the top right of this page.
Angioplasty.Org Staff, Angioplasty.Org, September 1, 2008

• I had stent placement in 2003 and again in another artery this Feb. 2008. I had no problem the first time around with Plavix. I went off of Plavix in 2005. This time with the stents in 2008 I am back on Plavix. You wouldn't believe the constant hemorrhaging from my nose this time around. sometimes I bleed for over 4 hours, literally hemorrhaging. I become so well know in the ER. The worst part every time I bleed I get so nervous my pressure goes up too, too, high. I asked my cardiologist to please take me off the Plavix, of course he can't it isn't a year my stent is there. I was told what would I rather have a Heart attack or stroke or a nosebleed. Let's be reasonable of course I don't want a heart attack or stroke but I also don't want hemorrhaging from my nose every few days either. I can't go no where, or do anything I feel like my life has been taken from me this time with the Plavix. Believe it or not I went food shopping started hemorrhaging. I couldn't even drive home. I had to call my sister off her job to come with someone take my car home and get me to the ER. You think this is anyway for a person to live of course I'm told think of the alternative, stroke, death,etc. I think with such a adverse side effect they would come up with a better solution other than Plavix. Can't they try to find a substitute especially for people like me who has nosebleed for 4 hours at a time. I never had a nosebleed in my life, not even as a child until Plavix. I can't take it anymore.
Joanie, Bronx, New York, USA, August 30, 2008

• I had a stent put in my heart in June and the Dr. wants me to take plavix I did not feel well taking it and stopped and it was fortunate that I did as I had an ablation on July 2nd and they asked if I took plavix and I said I had stopped a few days before and they said it was fortunate that I had //the Cardiologist did did not tell me this ..I take cayenne tablets to avoid clotting and I take Magnesium, which also thins the blood. ..I am on Coumadin and Sotalol Dr is very upset and said I have to take plavix or he will not treat me. I have stomach problems and have not wanted to take aspirin or plavix.. I have never taken medicine as I always find alternatives that will not harm you know of an alternative to plavix and aspirin?
Evelyn, Utah, USA, August 22, 2008

• I have been on Plavix for five months, and I keep getting progressively weaker. Can the Plavix cause severe weakness and weariness?
Tommy W., Missouri, USA, August 5, 2008

• I am currently on Plavix for the last 16 months. Also combining it with Ecotrin and Crestor. I am new to the forum and have a few questions seeing that I am a pilot regarding these medications after receiving 2 stents 16 months ago (I'm 44 years of age).
Paul, Pretoria, South Africa, July 31, 2008

• I was on plavix for 6 months after having a heart attack and 2 coated stents put in. Three years after my attack, I had another, a blood clot between the two stents. I have a friend who is a drug rep. for Plavix and said they now recommend staying on Plavix for life in my instance after the first attack as the coated stents are a "bare wire" waiting to grab something passing on by. I will be staying on this med. for life. Only issue I have is I pulled a hamstring and got a huge red bruise from the bottom of my butt to the back of my knee! It is disgusting! Anyways, good luck and happy hearts to all!
Bill, Palm Harbor, Florida, USA, July 31, 2008

• My husband had four Cypher stents implanted in October 07. Six years ago he had one bare metal stent implanted. For the bare metal stent he only stayed on Plavix three months. This time he must stay on it for at least one year. I have noticed since he has been on Plavix for the past nine months, his short memory is being affected. Could this be a side affect of Plavix? He has a very low platelet count.
Dorothy, Rumson, New Jersey, USA, July 25, 2008

• I have quit a dilemma. I have been on plavix for 4 years now for CAD. Recently June of this year had the TAXUS Express2 implanted in my right coronary artery. Unfortunately I have been diagnosed with breast cancer. As the result of the medicated stent, I am unable to receive breast surgery due to the Plavix. So here I am in Stage II grade three cancer and I have to wait 4 to 6 months before I can have it surgically removed. I was told if I go ahead with surgery it would only be a 2 to 3% chance of heart attack or possibly emergency angioplasty. I am willing to risk it but no doctor will do the surgery if I remain on plavix or get my cardiologist clearance. Has anyone had a similar dilemma and what did you do?
JM, Warren, Michigan, USA, July 23, 2008

• Bill -- check out our related topic on "Plavix and Surgery" for more info.
Angioplasty.Org Staff, Angioplasty.Org, July 22, 2008

• One issue with medicated stents that has not been addressed very often is the complications they present for other medical treatments. I have been been flattened by back pain that can only be resolved by surgery or an epidural steroid shot, but because of my coated stent no one will perform either procedure until I stop anti-platelet treatment (plavix) for a minimum of 5 days. However my cardiologist won't give that release. I cannot walk 50 feet or stand for more than 30 seconds without sitting down. My sleep is limited to 2 to 3 hours a night. He is in essence confining me to wheelchair. If I had known the limitations on treatments coated stents present I would have opted for un-coated. I'm sure this presents problems for people who need dental work, colonoscopies etc. The fact that the medical community is not sure how long to continue Plavix seems to indicate a certain fear of the risks of coated stents at the outset. Combine that with treatment complications and I have to ask: Why use a coated stent?
Bill Steadman, Durango, Colorado, USA, July 21, 2008

• I had two stents put in 2 years ago and two more just a few days ago. I had bleeding on the plavix so the doctor took me off after about a year. I have seen generic plavix on line for way cheaper than the the brand. Anyone knows of a good reliable site to buy generic. I also have looked into ozone RHP treatments and have found this to be very interesting. I tried 20 chelation treatments and didn't notice any difference on how I was feeling. Plus look I went back in for two more stents. Any inputs on ozone, generic, chelation would love to talk.
Glencito, Northern California, USA, July 15, 2008

• I have been on Plavix for almost 7 years and had absolutely no problem. I had a mild heart attack in December 2001, and had a stent put in an inferior vessel on the back left side of my heart. I run between 500,000 - 600,000 platelets. That's a little high, so, I plan to stay on Plavix. My only side effect, would be a bruise if I was hit fairly hard.
Philip, Louisiana, USA, July 13, 2008

• John -- stents are quite an important tool for the cardiologist. Patient selection and the decision to stent is a complex issue, but for the correct patient, a stent is very helpful.
Angioplasty.Org Staff, Angioplasty.Org, July 9, 2008

• My wife was given three drug eluding stents in 2006 . She had many complications from taking plavix. She is doing fine now. My question is why are people still given stents when common sense says they're of little value?
John, Rochester, New York, USA, July 7, 2008

• Cheryl -- check out our related topic on "Allergic Reactions After Drug Eluting Stent (DES)" for more info.
Angioplasty.Org Staff, Angioplasty.Org, July 3, 2008

• I need to know where to find peer reviewed studies on hypersensitivity to drug eluting stents. I know about the radar project, but is there more that acknowledges the symptoms of fever, joint pain/swelling, chest pressure, rash, (all my symptoms) I am highly allergic to nickel and now have three stents in my RCA. I really need this information
Cheryl Hein, Phoenix, Arizona, USA, July 1, 2008

• I had a drug eluding stent place in 2005, followed by 6 months of plavix. I had a heart attack ( clot at the stent sit )1 1/2 years after stopping plavix. A bare metal stent was used this time, but it scarred over 95% in 4 months. 2 more Drug eluting stents were added ( first one tore ) & I'm on plavix again. I was NOT on statins or blood pressure meds preceding the m.i. ( had side effects, but now I'm on both w/good numbers ). I'll be on plavix for a year . I'd like to stop the plavix ( taper off ) after 1 year & take nattokinase - 2000fu twice daily - forever. Any thoughts on this?
Milton Y., Sarasota, Florida, USA, July 1, 2008

• Three years ago I had my first stents and then took Plavix for a year. Shortly after stopping I had a heart attack with a clot right next to one of the stents. I am on Plavix but my cardiologist would like me to go off this summer (two years). Bleeding and side effects not a problem. I would prefer to stay on it. Any problems from long term use?
Joe H., California, USA, June 24, 2008

• After triple bypass 10 years ago I had a coated stent inserted 3 years ago. I've been on Plavix since. With in the last year I have developed a non-visible rash type symptom that was mainly on the bottom of my arms. Very sore like a sunburn. Changed from Altace to Benicar first, but it came back. Switched off generic Zocor to brand and it came back a few months later. Just switched to Lipitor and it's worse than ever now covering a good part of my body especially arm pits and skin folds. The only drugs left in my list are Atenolol and Plavix. Two GP's and a Cardiologist don't seem to be able to figure out what's going on. I work for a leading provider of drug information to the medical world and have just asked staff pharmacists for their thoughts but they too are baffled. This is approaching unbearable as it gets worse in the evenings. Any ideas?
Walter G., Indiana, USA, June 20, 2008

• I have two medicated stents overlapping, have been on plavix, 325mg aspirin,& zocor for 18 mo. My cardiologist wants me to go on low dose 81mg aspirin, My question is their any danger with two overlapping stents? Also my blood pressure runs around 115 over 54 he wants to give me Toprol xl 25mg. He said my heart tried to skip a beat when i took stress test one week ago. I was on this medicine once blood pressure dropped to 90 over 40. all i could do was sleep. Would you give me an opinion on taking the toprol. Thanks.
John G., West Virginia, USA, June 13, 2008

• P.B. in Florida -- we assume you are referring to our February article "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents", which reports on a new observational study in JAMA about a possible Plavix "rebound" effect, where stopping may result in a short period of increased platelet activation (blood clotting, resulting in heart attack). We'll be posting an update to this study very shortly, but the team that wrote the paper has done further analysis of their data and believes that the "spike" of adverse events seen immediately after stopping is even more pronounced than originally measured. Again, this "rebound" effect has not been proven directly and it is a hypothesis for further study, but it's based on observational data -- a review of over 3,000 patient records.

As you suggest, tapering off Plavix, instead of stopping cold, has been put forth as a possible measure to counter-act this observed phenomenon, but again -- tapering off is itself only a hyposthesis. It has not been proven. On the other hand, as a cardiologist recently told us, there's seems to be no downside to tapering off, so why not try it when going off Plavix? What some clinicians have been doing is recommending tapering off over 2-4 weeks: going to one 75mg Plavix every other day for a week or two, then cutting the pills in half (they're not scored, but you can still cut or break them) and taking half-a-Plavix every other day for another week or two, and then stopping. NOTE: This is NOT medical advice! We're only reporting what some clinicians around the country have been trying. We strongly suggest to all readers that, for your own safety, you do not do this on your own, but that you discuss this issue with your cardiologist and make an informed decision together.
Angioplasty.Org Staff, Angioplasty.Org, May 23, 2008

• As I stated in an earlier post my husband has been on Plavix for over a year now. His cardiologist may be taking him off Plavix for 5 days next week due to GI issues that require testing and then permanently because he has passed the 12 month mark. I mentioned tapering off of Plavix to the cardiologist but he danced around the subject. If he recommends discontinuing Plavix permanently is there a safe way to taper off? Every day, Every other day, Every 2 days? Thank you for your thoughts and opinions.
P.B., Florida, USA, May 22, 2008

Hi John from UK! You and I are evidently in the same boat, although on the opposite coasts. 2 years of doing well and wishing for the doctors to deliver on their earlier promises regarding Plavix. For what it's worth, six months ago on a flight to Europe, I met a man (a cardiologist) and eventually got to ask him why is there just one dose of Plavix, as if one size fits all, regardless of the patient's size. (We both are around 6'2" and 200lbs). He laughed and then described how he skips Plavix pill every other day. I asked him how does he "measure" it, and he said "it depends on how much I bleed from simple scratches". Well, I kept taking the Plavix during the trip, but since I returned home last October, I have been skipping every other day without any problems at all. No more nose bleeds! Now it is 2 years since the stent, but yesterday my own doctor was reluctant to say that it's ok to stop, he really left it up to me. (Behind every good doctor is a good lawyer?) The only thing he was quite sure of is that I should either stay with Plavix, or revert to aspirin. Now I have two Plavix pills left (that's 4 days, remember?), but I do not intend to get any more refills. The only thing about aspirin is stomach bleeding, I was there a year ago, but stomach bleeding gave me 12 hours worth of warning signals, A BIG BLACK WARNING FLAG, which is far, far better signal than a heart attack. I am not advising anything, this is a forum, so I am just sharing my own experiences and intentions, and wondering about yours. Ok, here is some advice after all - I also did all those other "right things", quit smoking, lost weight, exercise the heart, reduced mental stress, eat rabbit food, BP 110/70, etc. I continue eating steaks as a reward, one 2 lbs steak for every blood test that shows LDL cholesterol under 100. I will report further progress ... if the Lord is willing. Please let us know how do you do.
Tom Skarvada, Encinitas, California, May 21, USA, 2008

• Mr. Percell -- have you had problems yourself? It is true that Plavix can have side-effects, but that's not in all people. As you can read below, current guidelines for drug-eluting stents are at least 12 months for Plavix and lifetime for aspirin. And how you go off of Plavix may be equally important. Concerned about the "rebound" effect, some cardios are suggesting tapering off.
Angioplasty.Org Staff, Angioplasty.Org, May 21, 2008

• Plavix Side Effects -- Yesterday while visiting the cardiologist he asked me to stop taking Plavix. Stating the I have been on it too long since my stenting in 2006. He stated that there have been additional side effects such as brain hemorrhaging, kidney hemorrhaging, etc. Also that the American Medical Association, and National Board of Cardiologists have recommended no longer than one (1) year. What have you heard on this subject?
H. Percell, Salem, Oregon, USA, May 20, 2008

• Thanks for providing a valuable resource tool and giving me some insight into an issue that is clearly up in the air.
Patrick M., Florida, USA, May 20, 2008

• hi John I too am in Uk, and fitted with both BMS and DES. I too have asked myself the question. I guess you may be thinking....if the drug has gone in say 12 months, the stent then BM, and maybe it should heal over as normal BM, so after 18months should be covered. Is that where you are coming from??
Tel, United Kingdom, May 20, 2008

• John -- not such a basic question. It's not when the stent no longer elutes the drug, but when the stent becomes covered by endothelial cells and is no longer "exposed". This occurs more quickly with bare metal stents. But sometimes too quickly and too much -- thus: restenosis! Read the just-posted interview with Dr. Marc Feldman about optical coherence tomography (OCT) a new imaging technology which may answer your question. But for now, there is no direct way of seeing whether the stent has been adequately covered.
Angioplasty.Org Staff, Angioplasty.Org, May 20, 2008

• Hi, John from UK again with a very basic question. I have been on Plavix for 2 years now and my cardiologist and GP have no intention of taking me off it. My question is: when does the stent become 'bare' (i.e. it no longer has any eluting properties?) Then, logically a patient can come off Plavix and any attendant side effects should disappear.
John, United Kingdom, May 19, 2008

• Patrick -- Current guidelines are ASA for life -- Plavix for at least one year, although many cardios say longer, if the patient has no bleeding or other complications. But going off Plavix may have a previously unknown problem. We'll be posting an exclusive article in the next few days, updating our February article on the Colorado VA study about the potential Plavix "rebound" effect. Stay tuned.
Angioplasty.Org Staff, Angioplasty.Org, May 19, 2008

• So what’s the latest thought about remaining on Plavix & ASA? I’ve been on both for 18 months post stenting (one a DES, one bare metal: both in the RCA). Two cardiologists disagree…
Patrick M., Florida, USA, May 19, 2008

• Catherine -- there has never been a randomized clinical trial that showed any benefit to chelation therapy. There was one ongoing, sponsored by the NIH, but we believe any results are a couple years off. Instense statin therapy HAS been shown to at least stop plaque, and in some cases, slightly reduce it.
Angioplasty.Org Staff, Angioplasty.Org, May 19, 2008

• Had I even known I had a 70% blockage of the LAD artery, and truly comprehended how many new drugs the cardiologist would have attempted to keep me on, post-surgical placement of a bare metal stent, I would have first tried a round of chelation therapy first to see if it would clear the blockage before consenting to having a stent placed. I am one of those hypersensitive/hyper-allergic individuals to drugs. Now that I am stuck with a stent which can't be removed meaning when I react to these new drugs it is usually very serious I am between a rock and a hard place. Now that I know about chelation therapy, I am starting to push the docs to consider it as I am continuing to get weaker instead of recovering as I should.
Catherine, Ann Arbor, Michigan, USA, May 19, 2008

• My husband has been on Plavix for well over a year now and was hoping to discontinue the medication soon. How fortunate for the pharmaceutical companies to create a drug that doubles your chance of dying if you stop taking it. UNBEEEEELIEVABLE! I bet their stock is doing great.
P. B., Florida, USA, May 18, 2008

• Dee -- people have shown a number of hypersensitive reactions to clopidogrel, one is a urticarial rash (very itchy). But if you have a stent, do not stop taking the drug. See your interventional cardiologist to see if there is a substitute, or to discuss possible desensitization.
Angioplasty.Org Staff, Angioplasty.Org, May 18, 2008

• Is another allergic reaction to Plavix, possibly severe itching and skin peeling?
Dee, Chapel Hill, North Carolina, USA, May 18, 2008

UPDATE to April 7 posting. Well, the second opinion by another interventional cardiologist was a complete bust. The guy never even listened to my heart nor did he look at the mass of rashes and horrid looking bruises, To say the least my other docs were not pleased as this guy was SUPPOSED to be a good listener, clinician AND cardiologist! Since seeing him the first interventional cardiologist's nurse practitioner due to a 'personal emergency' cancelled the 'bridge appt.'! Great! She was supposed to have me seen by a different nurse practitioner but the appt. was never made despite our calling the office more than once. My housemate, who is in the medical field, really lost it and left a really angry message on the nurse practitioner's voice mail. We haven't heard a single word back from anyone at that office. This was supposed to be a really important 'Bridge Appt!' I'm scheduled to see the first interventional cardiologist who did the angiogram and stent placement in June. My medical social worker/therapist is going with me because she is really ticked at the level of care I am receiving and due to the 2 heart attacks and stroke I can be easily intimidated.... My social worker who has known me since 1997 has NEVER seen me this ill and overwhelmed doesn't even begin to describe how I feel most days. I cannot believe this all started because a nurse gave me Darvon instead of Darvocet when I was expected to go home the next day. The reaction sent me to CCU and it has been downhill ever since. Later I found out they tell all patients requesting Darvocet that is what they are receiving because the hospital only carries Darvon in their formulary and considers the drugs interchangeable! I can't rip the damn stent out but neither do I know what to do. I feel like I have a ticking bomb in my chest and I see the concern in every other doc's eyes EXCEPT the cardiologist. I've asked about alternative medicines and the cardiologist scoffs at it and as I said in my last post,I am the one left in 'the land of scared'. [Note: this posting has been edited due to length -- Ed.]
Catherine, Michigan, USA, May 17, 2008

• Anne -- your husband's cardiologist is following the guidelines that recommend a year of Plavix post-DES. Some cardiologists keep their patients on Plavix longer (some for life) assuming there are no complications, or surgery needs, or financial issues. There has been a recent study hinting at rebound effect when stopping Plavix. Stay tuned because we'll be publishing an update to this shortly. It has been suggested that tapering off Plavix might be a safe way to stop, but there's no proof of this yet.
Angioplasty.Org Staff, Angioplasty.Org, May 16, 2008

• My husband had three stents put in one on the 27th dec 2006 and two on the 20th july 2007 due to a blocked artery. His cardiologist has told him that he can stop taking plavix this coming July, but i am a bit concerned. How should he stop gradually or not. Is any harm done if he continues to take them apart from financial. He takes 75mg plavix, 75mg aspirin and 40mg Lipitor daily apart from tablets to control his diabetes.
Anne Cassar, Malta, Europe, May 13, 2008

• Gary -- Plavix allergies can sometimes take a while to show up. We are not certified to recommend any drug for you to take, but certainly consult your cardiologist about this. Do not stop taking Plavix, however, without discussing this with your interventional cardiologist. Read this topic and you'll see you're not alone. It is also possible to "de-sensitize" any Plavix hypersensitivity. An allergy specialist should be able to help you through this.
Angioplasty.Org Staff, Angioplasty.Org, May 8, 2008

• Had a heart attack on April 19th.. stent in the main.. on plavix woke up today may 8 with whelps on lower back that got worse throughout the morning.. like everywhere.. assumed food allergy.. called heart doc.. no response as yet.. nurse on phone indicated allergies to plavix are common.. wasn't certain if it was safe to take Benadryl. still itching incredibly.. any ideas?
Gary, Oklahoma City, Oklahoma, USA, May 8, 2008

• Jennifer -- resistance to clopidogrel (Plavix) is certainly known, but studies of a variety of tests do not yet agree on what the mechanism is -- so it can be difficult to test for. An August 2007 study, published in the Journal of the American College of Cardiology, "Poor Responsiveness to Clopidogrel: Drug-Specific or Class-Effect Mechanism?", discusses this resistance and postulates that switching to ticlopidine (Ticlid) may work in these patients. Ticlid was used in the U.S. prior to Plavix; Ticlid is the only antiplatelet drug used in Japan, where Plavix is not reimbursed. A question for you: if your mother has never experienced symptoms such as angina or high BP, what was the initial event/reason for her being diagnosed with and treated for a coronary blockage?
Angioplasty.Org Staff, Angioplasty.Org, May 8, 2008

• My mother has had five stents put in one artery. Her cardiologist says that she is resistant to Plavix and that is why the clotting occurred after the first stent was applied. She also had clotting within six months of the application of stents 3 and 4. These stents were medicated. She is now on a double dose of Plavix to keep the latest stents from clotting. I am concerned about this dosage and the thinning of her blood. Is this dosage a good idea? My mother is 83 and has never had a single symptom - no shortness of breath, no angina, no high blood pressure. The first stent was applied so she would have better circulation to the heart muscle.
Jennifer, Peoria, Illinois, USA, May 7, 2008

• Debbie -- have your husband's surgeon read our article from over a year ago: "New Advisory: Will Stent Patients and Their Doctors Get the Message?" In January 2007, all the U.S. professional heart organizations, as well as the American College of Surgeons, etc. issued an unprecedented Joint Advisory about Plavix, stents and surgery. Key points that pertain to your question were:

  • Patients also should be instructed to contact their interventional cardiologist before stopping antiplatelet therapy, even if stopping is instructed by another healthcare professional;
  • Healthcare providers (surgeons, dentists, etc.) need to be made aware of the dangers of asking stent patients to stop antiplatelet therapy and should communicate directly with the patient's prescribing cardiologist;
  • Elective surgeries where there is a significant risk of bleeding should be postponed for 12 months after the stent implantation;
  • If an unexpected surgery must be done that requires cessation of therapy, aspirin should be continued if possible and full antiplatelet therapy should be resumed as soon as possible after the surgery;

Check out our related topic on "Plavix and Surgery" for other patients' stories about this issue. Compounding all of this Catch-22 situation is a more recent issue concerning a possible Plavix "rebound" effect -- where stopping Plavix may put the patient at double the risk of a heart attack for about 90 days. We're going to be interviewing the lead author of this study later this week for a follow-up.
Angioplasty.Org Staff, Angioplasty.Org, May 6, 2008

• My husband received four stents in January 2008 (one medicated). Upon discharge he was told very clearly that under no circumstances was he to stop Plavix for one year and was provided a wallet card to this effect to show any doctor suggesting this. A surgeon has advised him to stop one week prior to a routine colonoscopy, still insisting even after reviewing the wallet card. Is a one week interruption something to be concerned about?
Debbie MacDonald, Nova Scotia, Canada, May 6, 2008

• Hamid -- we cannot give medical advice and we always recommend to patients that they discuss these issues with their cardiologist. The guidelines state that Plavix should be given for a year after drug-eluting stenting; many cardiologists feel safer prescribing it for life. There are, however, complications that can occur (bleeding) and then there's the cost. As we noted in our April 30 post, we are increasingly concerned over the possibility of a "rebound effect" when stopping Plavix. We're going to be posting an update to our article next week -- stay tuned and good health to you.
Angioplasty.Org Staff, Angioplasty.Org, May 5, 2008

• Can I stop taking Plavix after having a drug-coated stent since 2 & 1/2 years ago? My cardiologist says that as far as I can afford I should take it!
Hamid Rahimzadeh, Tehran, Iran, May 5, 2008

• Frances -- the possibility of a Plavix "rebound" effect (see "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents") is not proven, but is an observational study -- and, if this rebound does exist, a "withdrawal" or tapering off method has not been tested. That being said, the authors of the study suggested that the tapering off methods you describe "might" be prudent. Also, many cardiologists in the U.S. are prescribing Plavix for more than a year. You've been keeping informed (good) and your concern is appropriate. We recommend discussing these issues and making treatment decisions together with your father's interventional cardiologist -- and let the Forum know what you decide.
Angioplasty.Org Staff, Angioplasty.Org, April 30, 2008

• My father is nearing the end of a year-long course of Plavix after implantation of a drug-eluding [eluting] stent. The 3-month danger period after stopping Plavix is a major concern. Does stopping Plavix slowly (e.g. taking every other day, every few days, or halving the dose for a while) help reduce the risk of heart attack? Does increasing aspirin dosage during this period help? Is there anything else one can do during those 3 months to reduce risk?
Frances, Tel Aviv, Israel, April 29, 2008

• Michael -- have you discussed these issues with the interventional cardiologist who did your stenting? Certainly no stent patient should stop taking their antiplatelet medications without consulting their interventional cardiologist. Fatigue has been noted as be a side-effect of Plavix in a small percentage of patients -- are you taking other meds as well? Ticlid used to be prescribed before Plavix was introduced. It tended to produce more side effects, although we have spoken with a number of cardiologists whose patients have done better on Ticlid. (In Japan, Plavix is not prescribed at all, only Ticlid.)
Angioplasty.Org Staff, Angioplasty.Org, April 29, 2008

• I am a healthy 45 year old male who received a DES in December 2007 (No high cholesterol, blood pressure, normal EKG, no history of heart disease, etc). I had previously been on no medication. I was put on Plavix and 325mg aspirin. I have continued to have some chest discomfort, numbness on left extremities and EXTREME debilitating fatigue since starting the Plavix. So much so, that I thought I had another blockage, and did the stress test and heart cath. Clean as a whistle, no blockages. After more tests, I can find nothing wrong, and am starting to suspect my symptoms are side effects of the Plavix. After reading all this information, I am afraid to stop the Plavix. My question is, can I be switched to Ticlid? Am I likely to experience the same side-effect symptoms with Ticlid as Plavix? The fatigue is so severe, I can't imagine suffering from it for the rest of my life.
Michael M., Georgia, USA, April 29, 2008

• Jody -- what type of stents were placed? Drug-eluting or bare metal?
Angioplasty.Org Staff, Angioplasty.Org, April 23, 2008

• I had 2 stents in Nov 06 due to a spontaneous dissection of the LAD. Have been on Plavix and 81 mg aspirin since. I have no coronary artery disease. My cardiologist is reluctant to take me off the Plavix since there are no studies on Plavix and dissections. I, of course, would like to get off it since this seemed to be a very rare event. Do you know of any information on the use of Plavix in the case of a dissection?
Jody A., Colorado, USA, April 22, 2008

• Lots of good info. Looks like I am in the same boat as many others. I had Heart attack and single CYPHER DES placed in left coronary artery in Sept. 2004. Was prescribed Plavix, Lisinopril, Toprol, Zocor, Spironolactone and 325mg Aspirin. Taken off Plavix after 3 months. Sept. 2006 had 95% blockage of CYPHER stent. Cardiologist then placed a TAXUS DES inside the CYPHER stent and put me back on Plavix. My side effects have been bruising and nearly constant fatigue but otherwise OK.
Joe R., Seattle, Washington, USA, April 22, 2008

• Jeff -- the major risk of Plavix is bleeding. The rebound effect at present is a hypothesis, gleaned from observational studies. The other downside is that Plavix is expensive. The study on Plavix suggests that tapering off might be one way to stop taking Plavix, but nothing has been proven at this point. You should discuss the specific issues with your cardiologist. By the way, the TAXUS is a drug-eluting stent, a.k.a. medicated stent
Angioplasty.Org Staff, Angioplasty.Org, April 22, 2008

• I am a 52 yrs.old male & had a Taxus Express2 Paclitaxel-Eluting coronary stent (3.0 x 20mm) implanted 3 1/2 years ago (10/2004) located in the MIO-LAD. Is that the non-medicated stent? I have been prescribed Atenolol 100, Lipitor 20, Plavix 75, Zestril 10, Folic acid 1 & Aspirin 81 for the past 3 1/2 years. On my last appt last week, my Cardiologist has instructed me to discontinue my Plavix since I was now approaching 4 years on the drug & that Aspirin should be sufficient go forward. I am not experiencing any ill effects from any of my medications. I am hesitant on stopping Plavix after reading the rebound effects article above. Should I discontinue Plavix? Am I facing a greater risk of blockage if I stop? What are the risks of continuing plavix long term? Thanks.
Jeff Lim, Walnut, California, USA, April 21, 2008

• According to the manufacturer, Boehringer Ingelheim, "Pradaxa® is approved for the prevention of venous thromboembolic events in adults who have undergone elective total hip or total knee replacement surgery."
Angioplasty.Org Staff, Angioplasty.Org, April 21, 2008

• Just being released today in UK is a `new` drug for anticoagulation........Pradaxa. It suggests it is better than Warfarin as it does not need constant monitoring. I also heard it said that its better than Plavix, or was this out of context?? Anyone have more info?
Tel, United Kingdom, April 20, 2008

• Regarding Plavix and hearing loss and tinnitus. I have a sister who has experienced severe hearing loss and severe tinnitus. I know she is on at least five other drugs. I am in the process of doing some research as I am concerned the medications play a significant role in the problems she is presently having. I was curious when I read the posting and now will keep my eyes out. I also know that every persons body metabolizes drugs differently and as variable as that is, so is the way our body reacts.
Jane R., Ontario, Canada, April 14, 2008

• I recently had two stents placed and have had extreme difficulty adjusting to the medications, etc. Does anyone know of a doctor who has had this procedure done him/herself? It'd be great to receive treatment from a doctor who has first-hand experience!!! Thanks.
Ron J., Louisiana, USA, April 13, 2008

• Gordon -- we'll guess that the 12 year old stent didn't clot, per se, but it closed up. That's called restenosis and it's not a blood clot, but a progression of the disease -- it's called in-stent restenosis and is often treated, as was yours, by placing another stent inside.
Angioplasty.Org Staff, Angioplasty.Org, April 13, 2008

• I received a bare metal stent last November following a heart attack after a stent I received 12 years ago clotted. My cardiologist prescribed 75 mg/day Plavix and 325 mg/day aspirin. I did what Mike suggested in his posting (January 7, 2008) and asked my doctor to test me for Plavix and aspirin resistance. I had a TEG test for Plavix and the AspirinWorks test for aspirin and both drugs are working like they are supposed too. I have heard that it is possible to develop resistance to aspirin or Plavix over time. Does anyone have a recommendation how frequently you should be tested to see if the dose is still effective? Thanks.
Gordon E., Wichita, Kansas, USA, April 13, 2008

• am a stent patients Oct 2005 and i just went thru hell while on plavix i had almost every side effect from plavix. How i know? It started 3 weeks after i had the stent put in and was on plavix then in nov 2007 they took me off plavix am a lot better now and for the 90 days you folks are talking about all so true i kepts a bottle of nitro and aspirin with me all times due to the ill effects am having since i've been off plavix.
Frederick, Brockton, Massachusetts, USA, April 7, 2008

• Catherine -- read over these posts. Patient DO have allergic reactions to Plavix and there are desensitization techniques available. Some cardiologists also try Ticlid instead. Allergic reactions, however, can be difficult to pin down. By the way, are you consulting an interventional cardiologist for your second opinion? The current recommendations from AHA/ACC/SCAI are for 4-6 weeks of Plavix after a bare-metal stent.
Angioplasty.Org Staff, Angioplasty.Org, April 7, 2008

• The interventional cardiologist who did the angiogram, angioplasty, and placed the bare metal stent seems to be the least concerned of all my docs. Everyone else is VERRRRRRRRRRRRy worried about me. Under NOOOOOOOOOO circumstances can I take aspirin and am now on my second round of prednisone for the rash and other symptoms including the worst stomach ache I've ever had in my life. I've reacted to simvastatin and potentially, platel, as well as Lipitor. I'm still on the Plavix 75mg. B.I.D. and dipyridamole I've tried the aspirin desensitization and just couldn't tolerate even the baby aspirin dosage. Am still trying to get in for a 2nd opinion with another cardiologist. Meanwhile I am getting sicker. Current interventional cardiologist said I would be on plavix for life at reduced dose eventually. GREAT! What if that is the the drug making me so miserable!!!!!!!!!! I cannot tell you how much pain I am in. This reaction to whatever has now hit my bones. It hurts just to be touched to the point where I am in tears every time I have to take a bath and apply the creams on my skin for the rash and I am not a person who cries even when a central line is inserted with NO pre-anesthesia such as versed. I can stay perfectly still during an art stick so I am not a wimp when it comes to pain. My Family doc ran a bunch of blood tests Friday and the only thing that came back weird was the potassium level (way low). I am still having angina AND on Friday had bloody stools. Bruises still 'appear' for no reason and hurt like hell but cardiologist isn't concerned. Every other specialist you can name IS worried. I don't want to eat and drinking is becoming a real challenge. Still trying to get into see a 2nd cardiologist but this all leaves me in the 'land of scared.' The headaches are monstrous but the family doc can't give me most of the drugs which relieve the pain because of the dipyridamole My mother was VERRRRRRRRY allergic to aspirin and I had an anaphylactic reaction to it several years back. No one in our family has been able to drink orange juice since we were kids. I feel like I have been on downward slide ever since the Darvon reaction in July and no one has an answer as to what is happening to me. I can't stay on prednisone the rest of my life. The stuff makes me jittery but right now it is the only thing relieving the allergic reaction. Is there any chance I could be reacting to the bare metal stent???????? This whole mess is making me neurotic and I have never been neurotic in my life! Is there any alternative to plavix which is the drug my allergist suspects I am reacting to now.
Catherine, Ann Arbor, Michigan, USA, April 7, 2008

• Thanks for your summary of the current position. I'll have to see what the GP says in July, and perhaps then ask for a specialist's opinion too. I haven't had a blood count (except for cholesterol, due this week), but I'm seeing the GP about the nose-bleeds tomorrow - expecting a repeat of the cauterisation treatment I had about 30 years ago. Out of interest, most of the nose-bleeds happen in the shower after I get up - perhaps brought on by the heat. [It's also when I suffered three out of four of my ACS incidents.]
John Edwards, United Kingdom, April 7, 2008

• John -- getting a consensus around this topic is not an easy task. The US guidelines call for a one year minimum for Plavix (lifetime for aspirin) and longer, if there is no bleeding risk. But the guidelines also state that drug-eluting stent patients should discuss stopping Plavix specifically with their interventional cardiologist. Very recently, a study from the VA in Colorado described what might be a rebound effect from Plavix cessation for the first 90 days (see our article, "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents".) While it sounds like you might be experiencing some bleeding, we would suggest that, since you are a stent patient, you consult an interventional cardiologist as well as to your best therapy. He/she may well concur with your GP. Curious, have you had your blood count done recently?
Angioplasty.Org Staff, Angioplasty.Org, April 2, 2008

• I had a single DES implanted in July 2006 (following ACS), with Plavix prescribed 'for at least 2 years' and small aspirin (for life), together with Lipitor 40mg. I've had no cardiac problems whatever in the past 20 months and I'm conscious that I'm approaching the 2-year anniversary. My GP has noted to stop prescribing Plavix at that point (he was reluctant to go beyond 1 year - and would also like to switch me to simvastatin!) and I'm wondering whether I should push to continue with Plavix, in the light of all the latest developments reported here. My only concern over Plavix (as we're lucky not to have to pay for it here) is the greater susceptibility to bleeding - especially nose bleeds (which I've always suffered from); they seem to be more difficult to stop now, and twice recently I've woken up with a bloody pillow. [I have also suffered from greater daytime tiredness since the angioplasty - but I can't be sure that's the Plavix.] As I no longer see my cardiologist, what's the consensus view?
John Edwards, United Kingdom, March 30, 2008

• Catherine -- let us know what the second opinion shows. The COURAGE trial, presented a year ago, was much touted in that medical therapy showed equivalence with stenting in the set of stable patients in the study -- but a little reported result was that 25% (that's 1-in-4) patients still reported some angina after 5 years, whether they had medical therapy OR stenting. It is known that women react differently than men as well. There are other therapies: anti-anginal drugs like ranolazine, EECP therapy, etc.
Angioplasty.Org Staff, Angioplasty.Org, March 30, 2008

• I am a complicated patient. After a colonoscopy/endoscopy done in July, had many complications. One of which was being given Darvon, known allergy for me. I was to have been discharged the following morning but instead was rushed to CCU because suddenly in addition to the usual allergic response my heart wasn't filling and emptying right. I have had every test you can name and only 3 weeks ago during an angiogram did the cardiologist find a 70% blockage of the LAD. Angioplasty performed and bare metal stent placed. Sent home on 4 new drugs (highly allergic to aspirin) Plavix, simvastatin, dipyridamole, and pletal plus long acting nitro AND nitroKwik. Great! thought 'frightmare of 2007' was just about over. WRONG! rushed back to hospital because I was experiencing an allergic reaction. Taken OFF simvastatin and pletal and the rash was treated topically with prednisone cream and pletal. Discharged after 2 and 1/2 days sicker than when admitted. Went to private allergist who started a course of oral prednisone with taper. Was feeling better only to have rash come back . Allergist, neurologist, and family docs very worried and cardiologist is blowing it all off IMHO. Plavix dose is 75mg bid and Dipyridamole is 50 mgs. t.i.d. I had both leukemia and polio as a young child. PLUS developed seizures & migraines from closed head injury; lifetime asthma; diagnosed P.A.T. since age 23; chronic renal problems; diagnosed hypothyroidism; rheumatoid arthritis; fibromyalgia; and Raynaud's Syndrome. The docs now think I also along with a heart attack had a stroke after the allergic reaction to Darvon. I am allergic to half the PDR and feel like I am taking the other half. I am scared, exhausted, and angry and feel like the cardio team thinks everything is hunky dory since they put in the stent but still can't explain the ongoing chest pain and angina and are simply treating it with Imdur and nitro quik. Am getting a second opinion fro a doc who specializes in women's cardiology. Any insights would be helpful.
Catherine, Michigan, USA, March 30, 2008

• Regarding Plavix, I barely tolerated it for 30 days after having a drug eluding [eluting] stent placed in an 50 percent blocked artery in July 2004. I was taking Protonix, but I still had a severe stomach ache and possible stomach bleeding. A month ago, my internist and I decided to put me on Protonix, 40mg, twice a day for 30 days. On the 31st day I continued with the Protonix twice a day, and I started taking an approximate 1/4 of a typical Plavix pill once a day for one week. No problems. Now I am taking 1/2 of a typical Plavix pill once a day and still on Protonix twice a day. I had a minor headache for 3 days, and I took extra-strength Tylenol. That got rid of the headache. I am still taking 1/2 of a Plavix pill, but without the headache and no extra strength Tylenol. On Sunday, March 30, I will increase the dosage to 3/4 of Plavix pill once a day and continue with Protonix twice a day. The goal is to be able to take a typical full Plavix pill once a day in preparation for an angiogram, IVUS, and possibly more stents in arteries. If I have stent placed in an artery, I want to be prepared to take Plavix for one year without any problems.
James J., A Non-Textbook 47 Year-Old Patient, California, USA, March 28, 2008

• Sue and Michael -- Yes. Patients have reported rashes after starting Plavix. And sometimes the hypersensitivity reaction to a drug (Plavix included) may not show up for a while. However, do not stop taking the drug without discussing this with your interventional cardiologist, because it is important to prevent stent thrombosis. Also read our posting below from November 30 about densitization protocols that have been developed at Scripps Clinic in La Jolla.
Angioplasty.Org Staff, Angioplasty.Org, March 25, 2008

• Are there reported cases of hives associated with Plavix? I had two stents placed on a Monday and starting with itching of the genitals two days later. I now have hives on the front of my thighs and radiating outward, slowly each day. I have ruled out environmental changes at home (laundry detergent, body soap) and other than the Plavix, my medication regime stayed the same with the exception of an increase in medication levels for Zocor and gliptizide.
Michael, Pennsylvania, USA, March 25, 2008

• My husband had a medicated stent abut 45 days ago. He had no reaction with the first 30 day supply. When he started on the second prescription, he has had many reactions-- severe debilitating joint pain, muscle pain, bruising, and itching. Could he have gotten a bad batch, or does it take several weeks to build up a sensitivity?
Sue, New York, USA, March 25, 2008

• Don G. -- We posted a feature in February, titled "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents", discussing the possibility of a rebound effect with Plavix. We had spoken directly with Dr. Rumsfeld, lead author on the study, but we haven't seen much coverage since. Interesting that your well-informed cardiologist was aware of this and is "weaning" you off. Such a strategy hasn't been proven to be of benefit in a randomized study, but such a study could take several years to complete, so if there's no downside, why not? And Sharon -- have you informed your doctor of the adverse reactions?
Angioplasty.Org Staff, Angioplasty.Org, March 24, 2008

• I was put on Plavix and 81 mg aspirin because of possible TIA's. MRI showed that no TIA's, but my dr. still said I should stay on Plavix. It's really affecting my stomach and esophagus. I want to taper off, but he says not for 6 months. Anyone out there taking Plavix who did not have a stent? Has anyone tapered off the drug? Please help!
Sharon, Pennsylvania, USA, March 24, 2008

• My BMS was placed in late February 08. The interventional cardiologist prescribed Plavix & Aspirin for a month, followed by 81 mg aspirin indefinitely. Last week, my local cardiologist cited the rebound affect and prescribed Plavix every other day for a month to wean me off the drug. The drug may be expensive but thanks to Canadian medicare, the government supplies it to me without charge. Regards.
Don G., British Columbia, Canada, March 23, 2008

• Plavix is a drug that is supposed to prevent, not cause, blood clots. We have heard of aspirin overdose being associated with Tinnitus, but not Plavix. Anyone else out there experience this?
Angioplasty.Org Staff, Angioplasty.Org, March 22, 2008

• I had a Plavix stent put in in Feb. of 2007. I had some hearing loss before but in May after Plavix I lost the rest of my hearing and have terrible Tinnitus along with it. They think that the Plavix caused a clot in my "good" ear and caused this problem. I was wondering if anyone also had had a similar experience.??
Jo-ann G., California, USA, March 22, 2008

• Dear D. Lynch -- you should follow your interventional cardiologist's recommendations. Plavix and aspirin both help prevent thrombosis, or clot formation. They each work in different ways, which is why dual antiplatelet therapy (Plavix AND aspirin) is recommended for at least 12 months after a drug-eluting stent (which the Cypher is). Your regular doctor should be made aware of two of the Guidelines released by all the major heart organizations in January 2007:

  • Patients also should be instructed to contact their interventional cardiologist before stopping antiplatelet therapy, even if stopping is instructed by another healthcare professional;
  • Healthcare providers (surgeons, dentists, etc.) need to be made aware of the dangers of asking stent patients to stop antiplatelet therapy and should communicate directly with the patient's prescribing cardiologist

Angioplasty.Org Staff, Angioplasty.Org, March 21, 2008

• I had a medicated stent placed last Sept 25, 2007. It is a cypher RX cxs13350 3.50mm x 13 mm lot 13263677. The doctor never talked to me about what kind he was putting in and whether I had a choice or not. I took plavix and 325 mg aspirin until Jan 21, 2008 when I was bleeding in the right groin two small dots oozing blood. I wiped it and no more noticed until the same time next night and I was bleeding half as much as the night before or 1 ounce of blood, about. I then went to the emergency room and the doctor there couldn't find anything. I went to my regular doctor and he said take just the 81mg aspirin. and I didn't have any problem with it after that until I went to see the cardiologist and he said I needed to keep the plavix and aspirin going and if I bleed again call him and meet him at the emergency room. I would like to know if I need to really keep taking the plavix and aspirin or continue the 81mg aspirin only. I am currently back on the plavix and 81mg aspirin at present.
D. Lynch, Florida, USA, March 20, 2008

• Jeff -- you're welcome. We invite readers to comment on your ITP and platelet/Plavix situation, as well. As for the stent sizes, a 3.0mm diameter artery is a pretty average size. Just as an example, Abbott recently received European approval for their 2.25mm XIENCE DES -- that's considered small. The XIENCE is also available in 2.5, 2.75, 3.0, 3.5 and 4.0mm diameters, so you can see the typical range of stent sizes, and 3.0 is smack in the middle. 32mm in length IS somewhat long, so that may be why the DES was used. The lesions (blockages) may also have been anatomically complex or eccentric, making them more prone to restenosis. For more information on some of the issues with Plavix and stents that were addressed over a year ago, read our feature, "New Advisory: Will Stent Patients and Their Doctors Get the Message?"
Angioplasty.Org Staff, Angioplasty.Org, March 16, 2008

• Re: ITP and DES placement. Thank you for your comments on my post. Believe me, I told everyone who came in contact with my case that I had ITP X 2 years including the range of platelet levels. Stent sizes are 3 X 24mm and 3 X 32mm which I assume are quite small and would necessitate inability to use bare metal. I would love to hear from someone - anyone with similar experience. I can tolerate down to 50(000) without issues, perhaps 30, but below that it becomes problematic. Also ITP tends to produce very large platelets. Is there any data on how much Plavix drops the platelet level on average? Found my first bruise this a.m.
Jeff, New York, USA, March 16, 2008

• Andy -- Don't be too ticked -- the article you found (there's no citation) but it was probably from sometime in 2003, when a German study came out that called the statin-clopidogrel interaction into question. Several studies were subsequently done and found no inhibition of clopidogrel's antiplatelet effects with any of the statins. Which is a good thing since virtually every heart patient is most likely on both. The most recent, and most robust, study was a secondary analysis done by the very prestigious investigators for the CHARISMA trial, initially presented in 2006. Titled "Lack of Evidence of a Clopidogrel-Statin Interaction in the CHARISMA Trial", published in the Journal of the American College of Cardiology in July 2007, it found no effects.
Angioplasty.Org Staff, Angioplasty.Org, March 15, 2008

• I'm getting a little ticked at my doctor. Have two stents... BMS in 10/99 in LAD; Taxus Exp2 9/06 in Circumflex. Also take Toprol XL, 81mg aspirin. Was on Lipitor since 99 but became intolerant in 06. Stopped taking it and tried Crestor & others... same reaction. For giggles I typed in Lipitor Plavix interaction and came up with the following. If I read this right, the Lipitor 20mg was basically rendering the Plavix ineffective or at best 25% effective. I tried to discuss with my doctor.. but he's stuck on a one size fits all medication regimen. I'm beginning to wonder if he just doesn't know or what is going on. I'm also wondering if BMS is funding the studies. Wouldn't it be nice to have a product that adds thousands of customers a year with no end in sight. atorvastatin and clopidogrel (Moderate Drug-Drug) MONITOR: The concomitant administration of atorvastatin may reduce the metabolic activation of the prodrug clopidogrel and its antiplatelet effects. The proposed mechanism is competitive inhibition of CYP450 3A4 enzymatic activity, which is responsible for the conversion of clopidogrel to its active metabolite. However, data have been conflicting. In a trial with coronary stent implant patients receiving clopidogrel 75 mg/day (n=44), the percent platelet aggregation was 34% with no atorvastatin, 58% with atorvastatin 10 mg, 74% with 20 mg, and 89% with 40 mg. Results from an in vitro study suggest that equimolar concentrations of atorvastatin inhibit clopidogrel metabolism by more than 90%.
Andy, Cleveland, Ohio, USA, March 15, 2008

Glenys, Hi, I too was in the same boat as you. My health insurance ran out and was not able to afford Plavix. However, the good news is you can get it free of charge from Bristol Myers Squibb!! Call their toll free number, in turn they will send you paper work to complete and a portion to be completed by your Dr. Just be sure to follow up that your Dr. has in fact mailed in the forms. Within a couple weeks I had a 3 month supply of Plavix at NO charge to me!! The toll free number is 1-800-332-2056. The lady I spoke with was very helpful and I had the forms within days. I did the same for Vytorin which I also take. You can get their form online at their website. Every little bit helps a lot. In addition there is another site I would suggest everyone visit. They will mail you a complete packet of information on stents and your care as well as reminders, cards to carry in your wallet etc. I urge everyone with a stent to visit this web site and sign up for the free packet of information. God Bless... Shelly
Shelly, Florida, USA, March 14, 2008

• Jeff -- you've got a complex and relatively rare situation, but our question is: was the interventional cardiologist who placed your stents aware of your ITP condition? Low platelet count is an adverse effect of clopidogrel (Plavix) to begin with. We're not going to second-guess any medical doctor, not only because we're not M.D.'s, but because every patient is unique, and the best way to treat a patient is to have all the clinical info at hand. Current guidelines state that drug-eluting stents should be followed by a minimum of 12 months of aspirin and clopidogrel, and many cardiologists prescribe it for life. Bare metals stents are 4-6 weeks of clopidogrel. You should ask your interventional cardiologist why DES were used, especially given your blood disease. He/she may have had a good reason. In any case, you should regularly have your blood monitored while you're on these drugs, which you should NOT stop taking without discussing it with your interventional cardiologist. Let the Forum know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, March 14, 2008

• Entered a major "heart hospital" in the NY area for angio, was told 70% occlusion of the circumflex artery - no stent. Week later; cardiac event, two DE stents, ramus and lad arteries. Because of history of ITP [Idiopathic thrombocytopenic purpura] wanted bypass or bare metal. Got DES probably because of narrow artery locations - no one explained. ITP is a immune disorder that reduces platelet levels. Taking Plavix, 81 mg asa, zocor for life. Beyond petrified. Last platelet level 89 (000). Any experiences with ITP and Plavix/coronary artery disease ?
Jeff, New York, USA, March 13, 2008

• Glenys -- check out our related topic on "Financial Assistance for Plavix". You might find some suggestions there. Good luck and please keep us updated.
Angioplasty.Org Staff, Angioplasty.Org, March 12, 2008

• Plavix is a very expensive drug. I will not be able to continue with my medication when my Medicare drug plan runs out. Tough I guess. When is this drug going to be a reasonable price? I have four stents and have been advised to take plavix forever.
Glenys L., Florida, USA, March 12, 2008

• J.H. -- did you inform your cardiologist prior to stent placement that you had a history of not tolerating Plavix (clopidogrel)? Most guidelines caution against using DES in patients who will not be able to remain compliant with dual antiplatelet therapy.
Angioplasty.Org Staff, Angioplasty.Org, March 5, 2008

• I had a des 3 weeks ago, i have 8 plain stents. When twice on plavix before had to come off after a few weeks due to side effects. I am now suffering stomach and bowel problems i.e. pain and cramps finding it hard to eat. My cardiologist says i must take plavix for at least a year this does not seem practical to feel so unwell. Is there anything i can do or take to help? I also have had problems with ticlopidine in the past.
J.H., England, March 5, 2008

• S.S. in Georgia -- we cannot give medical advice and we always urge patients to ask their cardiologists these questions -- did you explain to him/her that you did not do well on Plavix? This issue, as you can tell from this topic (over 500 postings) is a big one -- and cardiologists and patients are caught in the middle between the up and down sides of Plavix. Current guidelines from AHA/ACC/SCAI recommend a minimum of one year of Plavix after DES. Many cardiologists prescribe it for life.

A recent study (see our feature: "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents") highlighted possible dangers of stopping Plavix, but that's just in the immediate three months following. Your cardiologist may have other reasons for wanting you on the drug -- it's definitely not just a drug taken after stenting. Ask your cardiologist and let us know the answer. Also we'd be interested in which studies were being referenced.
Angioplasty.Org Staff, Angioplasty.Org, March 1, 2008

• I am a 50 year old female who had a Cypher DES implanted in Dec 2003. In July of 2004 I had another blockage and additional implant of Cypher DES. In July of 2005, I was back in the hospital and my Doctor implanted an overlapping TAXUS Express2 (thought I may have an allergic reaction to Cypher). It's been over 2 1/2 years and I have not had any other episodes. My problem now is with Plavix which I took for 2 1/2 years and stopped in July of 2006 at my Cardiologist's advice. I just had an annual checkup and was advised by my Cardiologist that he was recommending that I go back on Plavix indefinitely. When I inquired as to the reason for this, I was told that there are some new studies coming out in 2 years and he was recommending that all his patients remain on Plavix. I did not do very well on Plavix, with terrible bruising and swelling. I am very concerned about going this route again. I do take 81mg Aspirin daily, Metoprolol and Zocor. I am very active physically and feel fine. Any suggestion would be greatly appreciated.
S.S., Georgia, USA, February 28, 2008

• My boyfriend had a DES placed in Dec. 2005 and put on plavix. Tried to stop the plavix twice as his quality of life goes to about a 2 on a scale of 1-10. First time he quit was March 2007 and had a stroke in May 2007. Second time he quit was Nov. 2007 (on a physician's advice) and has had at least 2 TIAs. So back on plavix since Feb. 4, 2008. Stress test shows DES is clogged but can't risk surgery until they find out what is causing TIAs. What hope is there??
Joyce, McAlester, Oklahoma, USA, February 24, 2008

• Noni -- the Vision stent is a bare metal stent. The reaction you are having MAY be related to Plavix, but it may be something else. You should consult with your cardiologist about this. Perhaps you can be put on Ticlid, but we cannot recommend that you change your medical regimen without consulting your cardiologist. Let us know what you find out..
Angioplasty.Org Staff, Angioplasty.Org, February 23, 2008

• i had a Multi-Link Mini Vision stent placed on January 3, 2008. Since then I have been taking 75 mg Plavix and 325 mg ASA. Recently (after taking Plavix 75mg for 50 days) I developed swelling of leg and feet and itching. My questions are (1) Is this BMS or DES? (2) Can I stop taking Plavix and continue on 325mg ASA alone? Many thanks for your suggestion.
Noni B., New Jersey, USA, February 22, 2008

• Mamie -- thanks for the compliment. The study showed that the rebound effect, if it in fact exists, is there whether or not you have a stent. So having a DES wouldn't put you more at risk for this "rebound" effect. Are you experiencing side effects from the Plavix? Because it has several beneficial effects for heart patients, regardless of stent or no-stent. However, at three years you are quite far out, and we recommend that you discuss stopping Plavix (if that's what you want) with your cardiologist -- he/she will give you the risk/benefits of doing this and together you can make an informed decision. Let us know how your fare.
Angioplasty.Org Staff, Angioplasty.Org, February 21, 2008

• Very interesting article on Stopping Plavix and rebound effect. Most people on long term Plavix use are harboring stents...mainly drug eluting stents. I am going on 3 years of this miserable med and want desperately to wean off in another year. I have 5 DES. Now, my sister and cousin both have bare metal stents. They received these in 2001. Sister has 2 stents, cousin has one. They were on Plavix for 2 years and each got off cold turkey due to low blood counts and internal bleeding. Neither one of them have had any re-bound effects from getting off Plavix. No heart attacks...bare metal stents are doing their job. I do not think we should discount the use of bare metal stents. I wish I knew back in 2004 what I know now. I would never agree to drug eluting stents as with these DES..Plavix forever or else. I had too eager of an interventionalist. I wish they could be removed. )-:
Mamie, Houston, Texas, USA, February 20, 2008

• Ron -- the word here is "revascularization". It means opening up the coronary artery and eliminating the blocked area. It can be done with angioplasty: a balloon, and maybe a stent. It can also be done by bypassing the blocked area. There's really no difference. However, and I'm sure you've heard this before, continuing to smoke is without question the worst thing you can do. Smoking has been proven to cause ulcerations in the lining of the arteries, which leads to blockages. Ask your doctor to help you with smoking cessation. It's not easy, but stopping smoking (we did) is the best medical procedure you can do. Better than bypass! And don't go off your meds. Neither bypass or angioplasty "cures" coronary artery disease. These are merely mechanical solutions to a biolocial problem. The disease will progress -- and it will progress much more quickly as long as you're smoking.
Angioplasty.Org Staff, Angioplasty.Org, February 20, 2008

• I had 3 drug coated stents put in, in November and have had pain and discomfort all along. I'm 47 years old and a smoker still. Was told at the time I would need by-pass, but new cardiologist says stents are fine. Now bad news -- I quit taking all meds including plavix 1 month after heart attack hoping he would have to do by-pass to get it over with. Deadly yes but I want by-pass done.
Ron Garrard, Canada, February 19, 2008

• Sherry -- Guidelines for post-DES patients are a minimum of one year of Plavix (or Ticlid) and aspirin for life, but many cardiologists prescribe Plavix for longer. These are antiplatelet drugs which keep blood clots from forming in the arteries, which can cause a heart attack. Toprol is a blood pressure med and Lipitor a statin to keep your cholesterol down. Both are long-term meds. None of these should be stopped without consulting your cardiologist because they are beneficial to preventing the progress of coronary artery disease. Are you having problems with the meds? Bad reactions?
Angioplasty.Org Staff, Angioplasty.Org, February 18, 2008

• I had a stent put in May 15 2007. I take a plavix, toprol, lipitor, 325mg aspirin and an Ambien CR each day. When can I STOP and is this mix hurting me?
Sherry, Ohio, USA, February 17, 2008

To John K. from the U.K. -- Thanks for the post. There's a bit of controversy over whether or not the internet helps patients or hinders them. Your story shows that informed patients are often an excellent source of Continuing Medical Education for healthcare professionals who may not be up on the latest research! It's a big problem, one that we've discussed before -- and while specialists like cardiologists are acutely aware of the need for continued antiplatelet therapy (like yours AND your regular GP) sometimes the non-specialized healthcare workers are not. Thanks again for sharing your story and cheers!
Angioplasty.Org Staff, Angioplasty.Org, February 16, 2008

• I was placed on Coumadin as I "threw" a clot to my lungs. I suffered with Coumadin bleeding. I was off of Coumadin and told to go on Plavix. Almost immediately I got two-three nosebleeds daily. One day awoke with a bloody pillow. My PCP agreed for me to go off the Plavix and stay on my 81 mg ASA. Bleeding stopped. He wanted 1 Plavix every three days. I had been on the Plavix for less than two weeks. Am loath to restart. I take 9 meds daily.
Robert F., Crystal Lake, Illinois, USA, February 15, 2008

• Hi, About 18 months ago I posted here after having 2 DES inserted. I felt well, I was pleased with the effect and was looking forward to life. My cardiologist put me on Plavix and small aspirin with, at that time, no indication of how long I would remain on Plavix, but at least a year. In the last few weeks I have developed a rash and I continually feel tired and unwell. I went to my GP but saw a stand-in GP who immediately said. 'I'm stopping your Plavix, not because of your symptoms but because of cost to the Health service, maybe your symptoms will clear up as well'. You can imagine that we had a heated discussion and the upshot was I demanded to see my own doctor. His reaction: 'I will never take you off them unless your cardiologist recommends it, keep taking them.' I also spoke to my cardiologist and he of course said that for him there was no question..Plavix for life and I see him about the symptoms in 2 weeks. Bottom line...Don't give in, it is your life they are playing with. I suppose they work on the basis that dead we are no cost and no problem.
John K., United Kingdom, February 14, 2008

• Karen -- we assume you're referring to the study we reported on last week. Going off Plavix has presented the problems noted, and there are no tested solutions right now, althugh suggestions have been made to taper off the dose as a possibility. Your mother is being prudent in postponing surgery until she can talk with her cardiologist. That's what all the recommendations suggest. Let us know how things go.
Angioplasty.Org Staff, Angioplasty.Org, February 14, 2008

• Hello My Mom had drug eluting stents put in in June of 2006 and has been on a regime of Plavix and aspirin ever since and doing OK. She had "an episode" this past Oct. She had another Cath. done and it showed that the stents were open and all her other tests were good. No change or damage to her heart etc. She had a successful hip replacement in Nov. 2005 even with the undiagnosed heart disease, thankfully. She needs the other hip done and we went for her pre-op testing yesterday. The ortho's cardio. said he would clear her for surgery and that she should take the Plavix up to a week before the surgery and the aspirin the day before ....But we should be aware of the risks and mentioned the new study. Mom has decided to postpone the surgery pending a visit to her own cardio. But he has really scared us...What are the odds of her having a problem?
Karen B., Pennsylvania, USA, February 13, 2008

• Jack -- we'll preface this with our standard statement that nothing written here should take the place of medical advice given by your doctor. That being said, ALL guidelines state that stent patients should be placed on dual antiplatelet therapy -- which would be either Plavix (clopidogrel) or Ticlid (ticlopidine) -- AND aspirin. The idea is to keep the blood from clotting. Aspirin and Plavix work differently, which is why both are prescribed. However, your cardiologist may not have prescribed aspirin for a good reason (perhaps concerned with bleeding complications, etc.). But you should definitely call him/her with this question. If aspirin is in fact recommended, ask what dosage of aspirin you should be taking. (And let your cardiologist know that aspirin was NOT mentioned.) Let us know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, February 12, 2008

• I just had 2 stents put in 1 month ago and was only told to take Plavix - for life. No one mentioned aspirin and the more I read, the more it seems I should be on that too. Is not being on aspirin dangerous?
Jack L., New Jersey, USA, February 8, 2008

To All Patients On Plavix: take note of a very important new study published in today's Journal of the American Medical Association. The finding are basically that there may be a "rebound effect" when you stop taking Plavix -- so for a period of around 3 months immediately after you stop, the risk of your blood clotting and having heart attack, is DOUBLE what it is later on. And this effect was seen no matter how long the patients were on Plavix: 3 months, 6 months, a year and more. And the authors studied over 3,000 patients.

This does NOT mean you should not take Plavix. The benefits of the drug, especially for stent patients, are well-documented. It means that there needs to be more research as to what this effect is and possible strategies for going off Plavix -- for example, slowly reducing the dose, or increasing aspirin during this period, etc. The advice to patients that the co-author of the study gave to us at Angioplasty.Org is that if a patient has finished their prescribed dose of Plavix, they should discuss with their cardiologists whether they should continue or not, especially in light of this study.

By the way, the authors of this study started it precisely because of an incident that occured to one of their relatives. They've also read this Forum and commented that what they saw on Angioplasty.Org was exactly what they'd observed in many patients. Dr. Rumsfeld in particular made some interesting comments to us about the importance of what patients say about their own experience, and that the medical profession needs to listen to patients more carefully. Read the article.
Angioplasty.Org Staff, Angioplasty.Org, February 6, 2008

• Pamela, I'm glad your boyfriend is doing better, and got the Plavix he so needed. I too received my 3 month supply a while back :) It's such a relief to have the meds you need. I also get my Vytorin from the manufacturer. I wish more people were aware of these programs as so many do without. I hope your boyfriend continues to do well ;) Keep posting. Hugs, Shelly
Shelly, Florida, USA, February 5, 2008

• Hello Shelly and all others in need of free plavix, my boyfriend is 49 and just had two heart attacks within a week of each other and is on plavix with no income and can't go back to work right now, in the hospital he was given an application from Bristol-Myers Squibb who make plavix, we filled it out wrote a short letter of explanation, and sent it off through the cardiologist, and we just heard back that he was approved, and that a 90 day supply will be waiting for him at his cardiologist office this will also cover 3 refills so basically he is covered for a year and after that he can reapply, all within 3 weeks and his cardiologist office gave him samples to get him through till this came through, I don't know what would of happened without their help, obviously it would have been not too good!!! please check this out, hope this helps someone. This is called The Bristol-Myers Squibb Patient assistance Foundation, Inc. P.O.Box 1058 Somerville, NJ 08876 Phone (800) 736-0003 If anyone has any comments or questions, [please post to this topic].
Pamela Eiseman, Gainesville, Florida, USA, February 4, 2008

• A bit off topic, but I wonder if NICE in the UK will be making more financial constraints regarding Prescriptions for Plavix use, as they appear to be about to do regarding types of stents to be used in UK.... `The draft guidance also states that drug eluting stents should only be used if the price difference between it and a bare metal stent is no more than £300` I suspect that the difference in price is considerably more than £300 ( 600USD), unless manufacturers `knock up a special Value Stent` for the UK!!!!!!!
Tel, United Kingdom, February 4, 2008

• I have been advised to take Plavix and not to stop taking it for any reason. Further it has been suggested that I continue it for life. This is advice from my Primary care physician and my cardiologist. I have had two trips to the ER since. I was administered 4@ 75 mg Plavix in the ER each time. My DES were placed Sept. 2007 and restenosis occurred Dec.2007. Two additional DES were added at that time. I will be waiting to read if administering Plavix for life will become the standard.
R. G., Wisconsin, USA, February 2, 2008

• Hilda -- you are not alone -- read our posting below from November 30 about densitization protocols that have been developed at Scripps Clinic in La Jolla.
Angioplasty.Org Staff, Angioplasty.Org, February 2, 2008

• I have been on plavix for 3.5 months, and I am itching like a dog with fleas. Are there any remedies besides benedryl?
Hilda H., Alabama, USA, February 2, 2008

• Tel -- you've brought up an extremely interesting point. While there's been much written about the optimal length of Plavix therapy (medical guidelines now recommend one year of clopidogrel or ticlopidine post-DES) little has been written about what happens after that year of Plavix is stopped. A number of DES patients or family members have posted to this Forum Topic about having stopped taking Plavix after a year, and then having a heart attack within weeks. One such story was posted just three days ago. It's a disturbing thought and, although these are just anecdotal events, we believe this area urgently requires further study. Your idea of "weaning" off of Plavix is also an interesting one. We'll run it by some cardiologists and report on their thoughts. Thanks so much for contributing this post!!
Angioplasty.Org Staff, Angioplasty.Org, January 31, 2008

• With all of the issues regarding the stopping of Plavix after 12 months following DES, with no none really knowing when to stop, is it not possible to have a halfway house and reduce the Plavix to every other day for say 6 months after the first 12 months. Is that an option???, at least for some sort of peace of mind if nothing else. I have 2 stents one BMS and one DES, the former fitted to a bifurcation in 2006 and the latter in Jan 2007. It was noted at the time of the implanting of the DES that there was restenosis of the BMS, but it was felt that the RCA was in greater need of a stent. As a consequence I am aware that the BMS must still be partially blocked, but because the DES is now 12 months old it has been decided to stop the Plavix. Any comments please.
Tel, United Kingdom, January 31, 2008

• P. in Jersey -- your cardiologist prescribed Plavix and aspirin no doubt to keep clots from re-forming in the narrowed artery. How long you stay on this drug should be a question you discuss with your cardiologist who knows your clinical situation best. Bleeding complications are the most common serious side effects of this therapy, but if you're not at risk, this medical therapy can be very beneficial in terms of prevention.
Angioplasty.Org Staff, Angioplasty.Org, January 31, 2008

• I had a MI, small one they tell me, two weeks ago, and was put on Plavix 75 mg and Aspirin, 325 mg afterwards. I did not get a stent inserted. Apparently, the artery with the clot was too small. I wonder how long I will be on plavix? I weigh 110lbs and am also concerned with the aspirin dose.
P., New Jersey, USA, January 31, 2008

• Ralph -- have you discussed these results with your cardiologist or even primary care physician? 10,000 is a very low count -- you should be talking to him/her ASAP. Bleeding complications are a known adverse effect of Plavix.
Angioplasty.Org Staff, Angioplasty.Org, January 31, 2008

• Does Plavix lower your platelet count? My platelet count is 10,000. It should be about 250,000.
Ralph D., New Jersey, USA, January 30, 2008

• Joe -- read our posting below from November 30 about densitization protocols that have been developed at Scripps Clinic in La Jolla. Your cardiologist has probably seen these reactions (rash, etc.) before. Switching to Ticlid might work (that's all they use in Japan) but you might have an allergy to that as well. La Jolla is not far from you. Check it out.
Angioplasty.Org Staff, Angioplasty.Org, January 29, 2008

• I am a 61 year old male, in previous good health without any meds until 3 weeks ago when I developed exertional angina. @ 2 -3 weeks ago, I had 2 DES(Cypher)stents placed( one stent was difficult to place). I did fine with Plavix, Aspirin, Lipitor and Metoprolol and Prilosec until yesterday when I developed a very itchy rash and swelling on hands, and hive like rashes on my elbows, scalp and inter-gluteal area. I just started low dose prednisone (steroids) and Benadryl and this seems to help. The cardiologist felt that most likely this was due to Plavix. Have others had similiar problems and were they able to continue Plavix or was a change to Ticlid necessary? Thanks!
Joseph S., California, USA, January 29, 2008

• James -- the issues you raise are THE issues with drug-eluting stents and Plavix. As you can read in the many, many posts to this Forum Topic, there is still much debate about the optimum length of antiplatelet therapy required after DES. The medical reason for taking a patient off Plavix is to reduce the risk of bleeding. The financial reason is something else again. All the major medical societies have recommended one year as the minimum for dual antiplatelet therapy, assuming there are no bleeding problems. But many cardiologists prescribe it for longer and, while it's not possible for us to say that your grandfather-in-law's heart attack was caused by stopping Plavix, your story is striking and unfortunately not unique. Plavix is stopped -- stents acutely close off -- heart attack. The cardiologists who treated your grandfather-in-law might be able to determine from the cath films whether the stents were blocked off by clots (or thrombi) or whether they had restenosed (something which is not an acute event, but takes place over time, and represents a progression of coronary artery disease). The two look different on the cath film. If it's determined that it was an acute clot formation, by all means discuss this with the cardiologist. It may help change his (and the VA's) practice of stopping Plavix after a year.
Angioplasty.Org Staff, Angioplasty.Org, January 29, 2008

• I spent yesterday in the hospital with my wife and her 82 year old grandfather who had a massive heart attack. While reviewing the grandfather's medications, the grandmother revealed that her grandfather's Dr. had taken her grandfather off of his plavix over the phone about 2 weeks ago because he said he only needed it for a year and the VA would no longer pay for it. And 2 weeks later his 2 stents had total blockage and he had a massive heart attack. I am a pharmacy student on this website researching the effects that taking him off the plavix had on his heart attack. Everyone should know that being taken off a medication such as plavix should be the decision of yourself and your Dr. If you have a fear of being taken off of this medication after a year make your concerns known to your Dr. I am getting the feeling after the more research I do that the decision to take patients off of plavix after a year is more of a monetary rather than a medical decision. There is currently a debate on whether plavix and aspirin should be lifelong or temporary therapy.
James F., Virginia, USA, January 28, 2008

• P. Benge -- current guidelines are for one year of antiplatelet therapy following drug-eluting stenting. Beyond that it is up to the cardiologist and patient. There are bleeding risks involved with any drug like Plavix -- but many cardiologists prescribe Plavix for their DES patients for longer periods. On the other hand, some studies have shown no benefit for Plavix after 6 months. It's a complicated area, and to emphasize that, we always like to quote an exchange that took place during the FDA Stent Safety Panel last December. Panel member Dr. Chris White of New Orleans (Dr. White is one of the top interventional cardiologists in the country) said he didn't see any reason for changing the FDA labeling for drug-eluting stents to require Plavix for longer periods than 3-6 months. He said there has been no evidence presented that would mandate such a change. But when Dr. White was asked by the Panel chairman, if he himself had a DES and was at low risk for bleeding, how long would he take Plavix, Dr. White answered, without hesistation, "indefinitely". There was laughter in the hearing room, mainly because the exchange precisely hit upon the conundrum of "how long for Plavix". We would not begin to get in-between your and your cardiologist on this or any matter of medical advice. He/she knows your husband's clinical situation best. Read over other entries and also our "Patient Advisory" and then talk to your husband's cardiologist about your concerns.
Angioplasty.Org Staff, Angioplasty.Org, January 27, 2008

• My husband had a DES put in RCA last February. His cardiologist is considering taking him off of Plavix next month. Is there a greater danger period immediately after discontinuing the Plavix? What should we watch for? We aren't fond of this medication but we are a little nervous to do without it. Thank you
P. Benge, Florida, USA, January 20, 2008

• Ask your doc to test for Plavix and Aspirin Resistance . 20-30 people tested are, Why take more of something if it doesnt work. even worse why Die not Knowing about other options or drugs that might. Your doc can't know if your not tested. I wouldn't let mine continue to roll the dice and just suffered from another clot while on plavix . If you dont ask then they won't tell.
Mike, Stent Clotter x3 on plavix/aspirin, Florida, January 7, 2008

• I had a DES in Sept.07, went home next day doing o.k., 3 da. later had the artery to start leakage in left leg, it was black and quite swollen. More surgery to stop bleed, came home with Plavix & ASA. One week later started having severe pains in both arms, called the NP in Dr. office she said probably unrelated, got worse called again and she made me an appt. the next day. He did an echo and said it was not my heart but an inflammation. Since I have a lot of arthritis, namely RA and Dermatomyositis which had been in remission for several years. Referred to Rheumatologist, on mega doses of Prednisone, have cut back now but still have some pain. I am sure it was a reaction to Plavix or the DES, talked to the research group in Texas, they say they are seeing a lot of inflammatory reactions. I have ins. that covers 1/2 of Plavix but its still bad when you are on a fixed income. However, it does look like a drug company that made 60 billion on Plavix alone last year 06, could afford to help people that have no ins. It's no wonder the drug companies push it. Research I did quoted that figure, of course they would fight a generic. By the way it costs $25,000 for a DES in the hospital I went to in Missouri, they say it is more for a DES. I wish I had had a choice, if I knew what I knew now it would have been a bare metal stent.
Martha, Missouri, USA, January 5, 2008

• Michelle -- our sympathies to your family. Plavix allergies usually involves rashes, etc. As for blood clots, that is exactly what Plavix is used to help prevent -- it is an anti-clotting drug. 600mg of Plavix done as a "loading dose" is currently recommended by many and is thought to reduce complications from the stenting. All the major medical societies recommend Plavix for at least a month or two after bare metal stenting. There is a known condition called "Plavix resistance", and more currently is being learned about this -- basically it's when a patient does not respond to Plavix -- rendering the Plavix (and possibly other antiplatelet medications) ineffective at preventing clots. We don't know of any studies correlating patients with a Plavix allergy to resistance. We'll try to research this.
Angioplasty.Org Staff, Angioplasty.Org, January 3, 2008

• Hello- My father passed away on 11/15/07 at the age of 62. He was placed on Plavix following a bare metal stent placement. My father had a history of a Plavix allergy but the doctor who did the multiple stent placements put him on it anyway. Before each stent placement he gave him 600mg of Plavix. My dad had some symptoms listed as adverse reactions to a Plavix allergy. I really need somebody's help or opinion as to whether Plavix can cause a blood clot to a person who has a Plavix allergy?? We need help....
Michelle, Lancaster, Pennsylvania, USA, January 1, 2008

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