Is clopivas safe to replace plavix? in
our country we face financial problem after stent. the patient can
not continue on plavix because of high price. is it safe to shift him
to clopivas as it is cheaper.
Dr. K., Sanaa, Yemen, December 31, 2010
Cmdawson from North Carolina -- a study published
some years ago hypothesized that it is the polymer on the first generation
drug-eluting stents that may be causing hypersensitivity reactions in some
patients. See our related topic: "Allergic
Reactions After
Drug Eluting Stent (DES)". What kind/brand of stent did your
father
get?
Angioplasty.Org Staff, Angioplasty.Org, December 31, 2010
Hi, My father has been on Plavix since
Jan 2010 (11 months) and has suffered from very bad allergies with
itchy, red raised bumps for the past 9 months. Patch test indicated
no allergies to metal, so his GP has just taken him off Plavix 14 days
ago. Rashes are still bad, about how long should he wait before being
sure it wasn't the Plavix? Dermatologist contacted stent manufacturers
and data sheet reports the drugs on the stents should be off by now
but she is not 100% convinced of that. The rash is so bad he is losing
weight and completely miserable.
Cmdawson, Cape Carteret, North Carolina, USA, December 29, 2010
Age 82. Had first angina in a tennis match
that led to having two coated stents. Have played tennis six days per
week for 26 1/2 years. Seven weeks on Plavix caused unsteadiness, fatigue,
joint pain, sleep problems. Could not play tennis. Against doctor's
wishes, switched to Effient. Five weeks later, I'm much better but
still have each of the mentioned problems, but not as severe. No tennis
possible yet. What a disappointment. I would have chosen bare stents
if only told the facts. Plavix is pure poison for some of us. I refused
to start on statins until I knew my reaction to Plavix...and will not
start on them. In 38 weeks, I'm stopping medicines and will return
to tennis and take my chances.
Secretone, Sarasota, Florida, USA, December 28, 2010
Jodie in Michigan -- first of all, you should
look at our related and more appropriate topic, "Financial
Assistance for Plavix and Other
Prescription Drugs". You will find (unfortunately) more people
in the same boat. Some of this may be helped as of the first of the year, when
some provisions of the new healthcare reform law go into effect. Is your cholesterol
really over 700? That's a very high number -- we assume you are doing everything
you can diet-wise to keep it as low as possible. So Lipitor or some other statin
(Crestor, etc.) would be important for you to take. What kind of stent did you
get? Drug-eluting or bare metal? We don't quite understand why you can't get
your Lipitor mailed to you. Surely it can't cost more than a couple dollars to
mail it.
Angioplasty.Org Staff, Angioplasty.Org, December 28, 2010
My heart attack was on 4/15/2010. I spent
months going to drug companies getting free medicines. My cardiologists
have my lipitor (cholesterol is over 700) but want me to make the three
hour trip to get them because they don't have the money to mail them
to me. I only have enough Plavix until Feb 11, 2011. Medicare only
covers 20% of the drug so I will not be able to fill the Plavix after
that. The Lipitor I am supposed to get free until June 9, 2011.Then
Medicare will charge me a little over 200.00 for this drug which I
won't be able to afford anyway. I have faxed letters to the drug companies,
the cardiologists. I have a stent and I am nervous about not having
Plavix. Am I safe without it? I also take a full strength aspirin.
I am so lost. I know this was my last Christmas and I am preparing
myself for my second heart attack which I know will end my life. I
feel lost at 56 years old. I am already a widow and now I know my 9
children will lose their mother as well. The drug companies cant help
after Dec 31, 2010, as I have to spend over 600.00 on medication to
get help. I think I am doomed, I also have BiPolar medications to fill,
2 of 3 not covered. What am I going to do?
Jodie, Colon, Michigan, USA, December 26, 2010
Go Ducks in Oregon -- thanks for your info.
Check over our Forum Topic titled "Not
Feeling Well After Stenting" -- a number of patients
seem to report these discomforts. I think the journal article you are referencing
is from JACC 2003, titled "Postprocedure
chest pain after coronary stenting: implications on clinical restenosis".
Dr. Sharma , whose interview with Angioplasty.Org will soon be online,
and colleagues looked at stent patients back in 2000 -- and found that
overexpansion of the stent may be a contributing factor for PPCP. Since
then, the use of Intravascular
Ultrasound (IVUS) has come into use much more (the authors
stated that they started using it more after this paper) and IVUS is important
in properly sizing stents. Dr. Sharma et al thought that there may be sensory
nerves in the adventitia (deep vessel wall) that get irritated by the vessel
wall expansion and that's where the pain is from. They also found that
a little over 1/3 of stent patients in the study had some form of PPCP,
most were explained by some event that occurred during the procedure, but
about 1 out of 10 could not be explained that way. This is an important
and perplexing issue and we will put this in our queue for further research
of more current studies about PPCP. Thanks again for bringing this issue
up.
Angioplasty.Org Staff, Angioplasty.Org, December 26, 2010
Just went thru all the postings since
1/2/2010. Didn't see anything on continuing chest pains after DES.
Rec'd first one 9/2009 for fix 99%er in LAD and chest "discomfort" started
almost immediately. It's there most of the time, but not usually distracting.
Had another DES installed a couple weeks ago, a big one, and "discomfort" immediately
changed to "distracting." It also didn't clear up my breathlessness.
Have been on the usual meds since the first one, with only the normal
side effects. Found an article on Journal of American College of Cardiology
about PPCP (Post procedural Chest Pain). It's in medical-ese, but talks
about vessel stretching as being a cause. I'm wondering how many other
people experience this issue? My cardiologist and VA pcp say it's muscular/skeletal
and not heart related. Also, if any of your members or guests are feet-on-the-ground
Vietnam war vets, the VA will help with the cost of your IHD meds.
Go Ducks, Oregon, USA, December 24, 2010
Easy bruising is a known side effect of Plavix.
Past guidelines recommended Plavix and aspirin for 4-6 weeks after a bare
metal stent, however cautious cardiologists are recommending 6 months,
especially for patients who may be more prone to thrombosis.
Angioplasty.Org Staff, Angioplasty.Org, December 24, 2010
In September 2010 I had an MI NSTEMI.
After being admitted to hospital and subsequently given a nuclear stress
test. It was determined that I had a blockage and would require an
angiogram, angioplasty and stent. Because I have a history of ulcerative
colitis they gave me a bare metal stent (titanium). It is now December
23rd, I have been taking 75 mg plavix, 325 eco aspirin, 2.5 mg of lisinopril,
and metoprolol. They have temporarily stopped the Simvastatin due to
my liver enzymes being very elevated. I am covered in large bruises.
they are not caused by any trauma. As one lot heal another lot arrive.
They are all over my arms, hands, thighs, buttocks and legs. I have
had this problem since starting the meds 3 months ago.. I also take
6 Asacol pd. for dormant UC> I keep reading that bruises are not normal
and yet my cardiologist doesn't seem concerned at all. She said she
will take me off Plavix at the 6 month mark and reduce the aspirin
to 81 mgs. Although she wants me to take the aspirin for life. in the
meantime I have to stay on this regimen even with the bruises. Any
advice would be appreciated. I want to trust my Doc but this is not
normal.Any advice will be appreciated.
Jan, Calabasas, California, USA, December 23, 2010
To Mr. Ed,
North Carolina: Three years ago I was taking the
same drugs and developed the same reaction which you described.
After about three weeks of it, the skin rash went away, the body
adapted, all became tolerable. Yes, there is a hope! However,
4 months later the high dose aspirin created stomach ulcers and
the Plavix promoted their bleeding, which turned into another
emergency. Check with your doc if you can use the baby dose aspirin.
I did, he approved, it worked ever since.
Tom in Encinitas, Encinitas, California, USA, December 18, 2010
I am 39yrs male and I had two drug eluting
stents put in in Sept. In October I started have problems with fatigue
and light headedness and even some vision problems. I am on Effient
and aspirin. I have been reading on here about similar people experiencing
the same problems. I tried switching to Plavix and it was even worse.
Any suggestions on trying to alleviating these problems? It is very
hard having these problems and trying to work and make a living.
Eric, Mesa, Arizona, USA, December 15, 2010
Big H in Ontario -- You're referring to what's
been called the Plavix "rebound" effect.
This was an "observational study", meaning that the researchers
looked at data and formed a hypothesis about what was occurring, namely
that in the 90 days after stopping Plavix, the heart attack rate was doubled
in both stent and non-stent patients. To date there's been no validation
that this rebound effect in fact exists, and a small study actually refutes
the concept enitrely. Yet the authors of the original study have told us
that the data show something is happening and more recent investigation
has shown the effect is even more pronounced in the first 30 days. We cannot
give medical advice and can only recommend that you discuss these issues
with your cardiologist. If you are not having problems with Plavix, it
has been shown to have benefit for cardiac patients. What type of stents
did you get?
Angioplasty.Org Staff, Angioplasty.Org, December 15, 2010
May 16, 2008 had 2 stents put in LAD (90%)
two blockages one below the other. Currently only on Plavix 75mg, Lipitor
20mg and baby aspirin. I asked about being taken off Plavix and Cardiologist
says to stick with it no side effects. However my goal is to come off
all meds if I can I exercise 4-5 times/wk running 5km and weight lifting
to maintain muscle mass. I am 55yrs old. What is rebound effect of
Plavix, never heard of this before today. I forgot the cardiologist
just told me last month I have a slight heart valve leak that I was
born with but not to worry because its better now than when I had my
heart attack, guess because of all the exercise and diet change. I
have recently only started with weight training and found out on one
of the apparatus I do my reps and then almost pass out can this be
due to the leaking valve?
Big H, Ontario, Canada, December 14, 2010
CWW from Georgia -- see our
response from November 19 regarding the national
guidelines for how long stent patients need to stay on Plavix
and aspirin. If your cardiologist recommends staying on it, check
out our Forum on "Financial
Assistance" -- there are some links there that
readers have found useful.
Angioplasty.Org Staff, Angioplasty.Org, December 12, 2010
I have two heart stents implanted in
2005, I was put on Plavix 75mg and aspirin 325mg I have since lost
my job and can't afford my Plavix. I am not taking my Plavix. now ,
but I take aspirin 325mg twice a day is this dangerous for me
cww, Sylvania, Georgia, USA, December 10, 2010
Mr. Ed from North Carolina -- Some readers
have reported skin rashes that seem to be from Plavix. An immunologist
may be helpful in pin-pointing the cause. There are also alternatives
to Plavix: one is an older drug, not used much anymore in the U.S.,
called ticlopidine or Ticlid. It was pretty much replaced by Plavix
because it had some unwanted side-effects in patients. Ticlid is used
much more in Japan and some cardiologists here have used it with patients
who are Plavix-sensitive. There is also a newer more powerful antiplatelet
drug called prasugrel or Effient. The concern here is that it may cause
more bleeding in certain patients. Discuss these options with your
cardiologist. By the way, do you have any allergies that you know of,
for example, to metal?
Angioplasty.Org Staff, Angioplasty.Org, December 8, 2010
53 very active,
athletic guy. Had 3 Xience V DES implanted on August 6, 2010 after
a stress test showed an 'issue'. First attempt ended up in surgery
to remove the catheter which 'somehow' coiled and kinked so it could
not be removed from my right femoral artery. vascular surgeons did
their magic and removed it(nice scar). Next morning they went up my
left femoral artery and fixed the one (and only) 100% blockage in the
Right descending. I had very few symptoms as my body had already 'bypassed'
this with extensive 'collateral' arteries. Anyway left the hospital
on 75 mg Plavix, 80 mg Simvastatin (Zocor), 25 mg Toprol XL and 325mg
aspirin. Developed an itchy skin rash within days of being released
from the hospital. It has progressively gotten worse. New cardiologist
took me off Simvastatin and wants me on Lipitor when my skin condition
subsides, but my skin is just getting worse. I've tried every topical
imaginable and take benadryl at night when the itching is unbearable.
I've read here about similar reactions - is it the Plavix? The new
cardiologist has switched me off Toprol to an ACE inhibitor - Ramipril.
Toprol was dropping my already low pulse (54) to 42.
Mr. Ed, Chapel Hill, North Carolina, USA, December 7, 2010
Well......... I'm the newbie. Having just
undergone a stent procedure on the right CA and at the age of 48, this
is quite overwhelming to say the least! Thought I'd join the others
who are in this category to learn a little bit more. Thanks to all
for feedback!!
Captain, Stratford, Ontario, Canada, December 2, 2010
Peppy in Indiana -- The Cleveland Clinic
doctor is correct that guidelines suggest one year of Plavix after
drug-eluting stents. You are also correct that the issue of a Plavix "rebound
effect" was suggested in a February
2008 article in JAMA. This was an observational study,
not a randomized controlled trial. The investigators have commented
further on this issue to Angioplasty.Org -- read our
post from July 2010. The bottom line is that they have
seen an effect, but whether or not it is actual has not been proven.
Also this "effect" occurred with or without stents, so perhaps
it's something that happens with certain subgroups only. The science
on this is not in, and there are many patients who have stopped Plavix
with no ill effects. As to whether or not tapering off the dose gradually
might help, Dr. John Rumsfeld told us that, while it might not, there's
also no downside to it. By the way, Dr. Rumsfeld, co-author of the
study, is an
acknowledged leader in cardiology -- he also told us that
he and his team looked through our Forum carefully and were amazed
to find anecdotal evidence, very much like the ones they had found
in their research.
Angioplasty.Org Staff, Angioplasty.Org, December 1, 2010
I participated in the heart chat on-line today
at Cleveland Clinic. Dr. Rimmerman, cardiologist, was the visiting doctor.
I asked about stopping Plavix after three years as my personal cardiologist
suggested with single artery disease. He agreed with her for my DES type
(Taxus2 Express) in the diagonal. I have been on Plavix for three years!
He said one year is the indication. I also asked him about a Plavix rebound
effect and he commented that he was not aware of one and to just stop
it. He said they do that at Cleveland with no modification to the aspirin
or other heart meds. I was amazed to hear this! I thought there was a
JAMA/2008 article about the rebound effect? Was I dreaming?
Peppy, Spencer, Indiana, USA, December 1, 2010
JMC in Plymouth -- you should discuss your
situation with your cardiologist -- and possibly have him/her conference
with your bowel surgeon about stopping Plavix. There are some risks to
stopping clopidogrel, although you are almost 5 months out -- and the risks
of stopping Plavix need to be weighed against the risks of not doing cancer
surgery.
Angioplasty.Org Staff, Angioplasty.Org, December 1, 2010
in july 2010 i had 3 stents placed i was then
put on clopidogrel within a week i was diagnosed with bowel cancer and
also after a ct scan of the brain was told i had a stroke and i did not
know as i had no symptoms. i have since been getting ready to have a
bowel op to remove the cancer and last week after a meeting with my surgeon
they have decided not to go ahead with the op and basically sent home
and told if i went ahead with the op i would die on the table. do you
know if i should get a further opinion as I'm in limbo and don't know
what to do next i don't know anything about clopidogrel and whether it
can be stopped before 12 months
j mc, Plymouth, England, United Kingdom, November 28, 2010
I had an Amplatzer septal occlusion device implanted
to correct an Atrial Septal Defect. My cardiologist has stated that my
regimen of Plavix in addition to my regular 81mg aspirin is a 6-9 month
temporary course until there is good cardiac tissue growth over the device...at
which point I will go back to aspirin only. I've had only minor side
effects from the Plavix...it gives me a little heartburn and there's
some very slight increase in my bruising.
Damaris, Monroe, Wisconsin, USA, November 23, 2010
Baddog -- what does your cardiologist recommend?
Are you tolerating the Plavix (clopidogrel) well? What brand stents did
you get? It may be that you can go off of aspirin or get a substitute,
but we cannot give medical advice about this issue. Instead, we can strongly
recommend that you get your cardiologist's advice, preferably the interventional
cardiologist who placed your stents. And let the Forum know what he/she
recommended. It could help others.
Angioplasty.Org Staff, Angioplasty.Org, November 23, 2010
I have had two chemically treated stents and
an angioplasty in the past year. I am directed to take Plavix and aspirin.
However, I am extremely allergic to aspirin and developed aspirin induced
asthma. I can't see how my coughing and breathless struggle can out-weigh
the benefits of the aspirin. Is there any replacement for the aspirin
other than coumadin??
baddog, Wellford, South Carolina, USA, November 22, 2010
Forum Moderator: In response to your fine answer,
the cardiologist did not specifically answer my question about the long
term side effects she is concerned with about Plavix. She did say that
Plavix was a very safe drug that she prescribes all the time as a cardiologist,
of course. Cost was not an issue or discussed as my husband has great
insurance, thank goodness. I did get the results of the carotid sonogram
and was stunned to hear I have moderate disease with a 50% blockage in
both carotids. I am discouraged but will try to keep with diet, exercise,
and meds. Family history is full of vascular problems, however they all
lived into their high 80's and 90's with little intervention as it wasn't
overly known or available. I hope that works in my favor. I left a question
with her nurse: "with the results of the carotid sonogram will she revise
her advice to discontinue Plavix and remain on aspirin". Haven't heard
back yet.
Peppy, Spencer, Indiana, USA, November 20, 2010
Gayle -- this is a question for your cardiologist.
Cramping and other adverse effects are often an adverse reaction to statins
(Lipitor being one). There are studies that show statins can be beneficial
to certain patient populations. But if you don't need them and they are
causing side-effects.... In any case you should discuss this with your
cardiologist and not stop taking any prescription medication without
consulting him or her.
Angioplasty.Org Staff, Angioplasty.Org, November 19, 2010
I had a medicated stent 5 years ago. I have
been on Plavix, low dose aspirin and Lipitor for 5 years. My cholesterol
levels were never high (total 110-120). I sometimes have severe cramping
in my legs and feet and a tingling sensation in legs at night when I
go to bed. Do I need to stay on the Lipitor. I understand this is a side
effect.
Gayle, West Hempstead, New York, USA, November 19, 2010
Peppy -- the duration
of dual antiplatlet therapy (DAPT) consisting of Plavix or its equivalent
plus aspirin) after drug-eluting stenting is the topic of great debate
and, as you are feeling, uncertainty in the medical profession. Guidelines
currently states that DAPT should be a minimum of a year, assuming the
patient has no bleeding complications. However, many cardiologists prescribe
DAPT for more than a year. Plavix does have side effects -- but also
some benefits, depending on the patient's clinical profile. There is
currently a major study, called DAPT which will test these drugs at 12
months and at 30 months to see if there's a difference in outcomes. There
is evidence of a rare occurrence, called very late stent thrombosis (VLST)
but it is not clear what the cause is, nor if DAPT even plays a role.
We recommend, as always, to discuss the risks and benefits with your
cardiologist. What side effects is she concerned about (outside of the
expense, of course!)?
Angioplasty.Org Staff, Angioplasty.Org, November 19, 2010
My cardiologist retired. New cardiologist saw
me and told me to stop Plavix. I've been on for three years. She said
I had good blood flow, stent in diagonal and not a main artery, and there
were side effects to long term use of Plavix. I have a Taxus2 DES. This
is scary stuff. I've done well. She said my other arteries were clean.
She is doing a sonogram of the carotids this week. I'm continuing to
take Plavix until I get those results. Very conflicted about following
her advice.
Peppy, Bloomington, Indiana, USA, November 16, 2010
I have been reading all these posts and I am
wondering how many of you have looked into what Linus Pauling has to
say about what causes heart attacks and the build up of plaque in the
arteries. I had a stent placed in one of the arteries to my heart. After
that I started walking two miles a day at a brisk pace. I noticed that
I was starting to get light headed after about 20 minutes. I said there
is no way I can live like this so I went on line and found the Vitamin
C. institute. After that it changed my life. I would suggest that anyone
who wants to feel better type in the words "Practicing medicine without
a license" that's all no www. and no .com and you will get owen fonorows
web page. He is carrying on Dr. Pauling's work. I think a lot of you
will be amazed.
Louis, Troutville, Virginia, USA, November 8, 2010
I myself had Drug Coated Stent on August 31,
2010. I'm taking Lisinopril 10 mg. and Fish Oil around 11:00 A.M. I'm
also taking Plavix 75 mg., Metoprolol 50mg, Simvastatin 40mg and E.G.
Aspirin 325 mg all together. So far no pain or other symptom. Just wait
and see. One complaint is Plavix is too expensive but what choice do
we have????? I hope there will be Generic for Plavix offer soon.
IronFist, Mountlake Terrace, Washington, USA, October 30, 2010
Hiker David -- For more info on 100% blockages,
check out the Forum Topic on "Chronic
Total Occlusions" -- there is some controversy in the
cardiology field about whether or not a patient who has developed collaterals
around a chronic total occlusion (CTO) will benefit from opening it. Dr.
Jeffrey Moses, just named head of interventional cardiology
at NY-Presbyterian Hospital, has expressed his opinion strongly to Angioplasty.Org
that in most cases, it's the right thing to do -- that it provides definite
benefit for the patient. As for Plavix, many cardiologists prescribe
it for more than a year to patients who are at risk for thrombotic events
and any ACS patients, assuming there are no bleeding complications.
Angioplasty.Org Staff, Angioplasty.Org, October 30, 2010
I hike on the Appalachian trail 250 miles a
year, 50 to 100 miles at a time, had a heart cath 7 years ago RCA 60%
blocked. Went on Crestor and baby aspirin No stint Have had regular follow
ups cholesterol avg 150 Bp good. Had a stress echo and Doc said slight
change thought a heart cath would be wise but advised I could go on a
50 mile hike first. I did no problems Had Cath RCA totally blocked but
I had grown significant collateral arteries no heart damage ejection
fraction 70 bp good Never any pain Dr thought had been blocked about
3 years He reopened and put a chemical stint [drug-eluting stent,
ed.] Oct.2010 Put me on plavix and a 325mg aspirin and continue
crestor Advised me I could start hiking again in 4 weeks if all went
well. No problems NO pain A little light headed and itching from the
plavix. I am 61 years old. Is it normal to grow your own bypass and what
will happen to the collateral arteries now the RCA is open will they
continue to function as a backup in case this stint fails. Also He says
I can stop Plavix after a year if I choose to. Why would I not choose
to?
Hiker David, North Carolina, USA, October 29, 2010
husband in pain from Wisconsin -- where is this
pain? Is it chest pain, like angina. Or is it where the catheter was
inserted in the groin/thigh area??
Angioplasty.Org Staff, Angioplasty.Org, October 29, 2010
My husband had two stents put in in August 2010,
he is 33 years old. He had an 80% and 100% blockage. He currently takes
Plavix, aspirin, metoprolol, and lisinopril, he complains about pain.
He says it seems like nerve pain. They tried him on gabapentin, naproxen
500mg and vicodin and he said neither helped. Can that pain be from any
of his medications. Sometimes he is in so much pain that you can not
touch him.
husband in alot pain, Milwaukee, Wisconsin, USA, October 28, 2010
PDF -- We've cross posted your query to a related
topic, "Plavix
and Surgery". You should check out that topic as well
-- e.g. John's posting from May 4, 2007
Angioplasty.Org Staff, Angioplasty.Org, October 23, 2010
I had two Taxus Express2 DE stents placed in
the mid LAD in Feb 2007 and have been on plavix and aspirin since then.
I have a colonoscopy scheduled and they request that I stop plavix 7
days prior to the procedure. Is there any risk involved in stopping plavix?
All I can find says the jury is still out on this one. A cardiologist
I spoke to last year said to stop taking plavix all together but I don't
feel comfortable doing that. Any suggestions?
PDF, Chania, Crete, Greece, October 22, 2010
yvandy.....Did the Drs. label what caused his
first bleed? Was it an AVM? If so, he might have others that are bleeding
on occasion. Plavix plus aspirin sent my hgl plunging (was on plavix
30 days) but now on 81 aspirin and hgl up (not normal) but livable.....going
to get a second opinion.
talkalotgal, Ohio, USA, October 18, 2010
Thanks for the quick response. He is already
taking Lipitor, Zetia and Niaspan. However, we will talk to his cardiologist
about this study to see if any adjustments are warranted.
Concerned wife, Boston, Massachusetts, USA, October 17, 2010
Concerned Wife -- Plavix (clopidogrel) and aspirin
are antiplatelet drugs: they keep the blood from forming clots. In an
MI, blood clots (i.e. forms thrombus) inside the coronary artery, usually
in a narrowing, and blocks the blood flow, causing the infract. So Plavix
and aspirin can help prevent another infarct. Imdur helps relieve anginal
pain; however, it does nothing regarding the cause of that angina. The
only drug we know of that has been shown, in some cases, to reduce the
plaque itself, is intense statin therapy. This action was demonstrated
in the ASTEROID study, published as "Effect
of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis" in
the Journal of the American Medical Association in 2006. Researchers
at the Cleveland Clinic found that high doses of rosuvastatin (Crestor)
reduced the plaque, as measured by Intravascular
Ultrasound. If your husband is not taking statins, you might
want to discuss this study with his cardiologist. As for the problem
with doing a stent placement, we see you are in Boston where there are
many excellent interventional cardiologists. If you have any questions,
you can always get a second opinion as to whether this is feasible or
not -- although we understand the issue: no one wants to risk a problem
caused by passing a wire or any device through a healthy LAD bypass graft.
Good luck and let the Forum know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, October 16, 2010
My husband had an MI 9 1/2 years ago, and triple
bypass. Went in for cath 3 days ago and found out that he has a 95% blockage
in another artery. Unfortunately, due to location, there is nothing they
can do - can't do a stent because they would have to go through the prior
bypass (LAD) to get to it and it's too risky. Told only option is meds
- 90mg Imdur every morning plus Plavix with aspirin (in addition to current
BP and cholesterol meds). Question - have there been any studies or instances
where Plavix with aspirin have been shown to REDUCE a blockage? I'm wondering
if we are just working to keep it from going above 95% or if there is
a chance it could improve?
Concerned wife, Boston, Massachusetts, USA, October 16, 2010
Hi, I recently went for angioplasty in July
2010. I was having jaw pains and the angiogram confirmed I had two blocks.
The cardiologists managed to clear one artery and put in a stent. But
the other artery is 100% blocked. When I walk a lot, the area around
my ankles swell a bit, and my legs ache. Is this normal? By the way,
I am 34 years old.And nice to meet you all :)
PC, Kuala Lumpur, Malaysia, October 15, 2010
One day missed is not of concern. Also, the
current guidelines for drug-eluting stents are 12 months minimum; for
bare-metal 4-6 weeks. Many physicians prefer longer periods.
Angioplasty.Org Staff, Angioplasty.Org, October 14, 2010
I received a DES about 15 months ago, on plavix+aspirin
since.It appears I may have forgotten to take my plavix yesterday. Is
this cause for concern? How long does plavix stay in your system?
Mr. B, Denver, Colorado, USA, October 14, 2010
My now 21 year old son has been on Plavix for
4 years after his two left main arteries spasmed and collapsed during
a low risk procedure - catheter ablation for SVT. Haven't the stents
grown over by now that he can come off the Plavix?
Val H., Minnesota, USA, October 12, 2010
I also have been on Plavix for five years, but
you only go off of it, if your counts are good. My cholesterol total
is fine, but my lipids are still up and my weight is still up and my
LDLs are not where they are supposed to be, all these things are taken
into account when you are prescribed this drug. I never had a heart attack,
we caught me just in the nick of time. To the man who won't take a beta
blocker, if you had a stent for a blockage and DID NOT have a heart attack
that might be okay, otherwise I thing you better fill your prescription.
The beta blocker makes you heart work less hard. I take b/p medications,
etc. etc. I exercise 4 days a week, two with a trainer. I'm 65 in a couple
months. The swelling some of you are getting could be lack of exercise,
you MUST exercise while on these fancy drugs. Yes, I have side effects
but I am also alive to fuss about them. . . .
LeeoTampa, Tampa, Florida, USA, October 11, 2010
Ravi -- we've written about this before -- there
is currently no definitive randomized study showing a Plavix "rebound" effect
-- the published studies are all observational. The authors of the most
well-known studies have told us that there is no evidence that "weaning" off
of Plavix is valid. On the other hand, they've said there is no evidence
of harm either. Plavix and aspirin in the U.S. are recommended for at
least 12 months post DES. Before deciding to go off Plavix, consult your
cardiologist. He/she may have other reasons for you to be taking the
drug.
Angioplasty.Org Staff, Angioplasty.Org, October 11, 2010
I have been on Plavix and aspirin for more than
3years following two DE stents. Have been wondering whether I should
wean myself off by reducing Plavix to half (cutting the tablet in to
two) for six months. Will this reduce the risk of rebound; is it safe?
Ravi J., London, England, October 7, 2010
Lumar -- Perhaps your husband may be feeling "sick" from
one or more of his medications. An example is that if he has no high
blood pressure, then why would he be on a blood pressure medication?
Perhaps his blood pressure is now too low. If you are not happy with
the answers you are getting, ask for a second opinion. The end result
of getting a stent is that you are supposed to feel better, not worse
-- so some adjustment is needed. But make sure not to "self-prescribe" --
consult a cardiologist!!
Angioplasty.Org Staff, Angioplasty.Org, October 5, 2010
Hello All, my husband is the epitome of health,
so we thought. 111 cholesterol, 117/70 blood pressure, 6-2 tall and
185 lbs never smoked or drink- And one day walking he felt pain on
his chest. We went to the Dr. and had a blocked artery HOW DOES THIS
HAPPEN No history of heart disease in his family. Now he is taking
5 prescribed medicines including PLAVIX and Aspirin, and a blood pressure
pill and a cholesterol pill but he has no cholesterol and no high blood
pressure and the medicine is making him sick. What do you suggest answer
from our Dr. He is now the history what an answer any how GOD BLESS
ALL - a concern wife of 26 years.
Lumar, California, USA , September 27, 2010
yvandy in New York -- when you refer to your
husband's "doctors", do you include his interventional cardiologist
-- the one who implanted the stents? It might be worth discussing this
situation with him/her, if you haven't.
Angioplasty.Org Staff, Angioplasty.Org, September 27, 2010
talkalotgal --
My husband had a medicated stent implanted four years ago. Almost immediately
afterwards his hemoglobin went down significantly. When fecal patches
confirmed intestinal bleeding, he was given a push enteroscopy. A bleeder
was found and cauterized in his small intestines, and he decided to go
off Plavix and aspirin. But since then he has kept getting these bleedings,
has had about 5 more cauterizations -- the last one 2 days ago -- and "died" once
in the emergency room, when his hemoglobin was 4.9 and they let him lie
there 6 hours without any care. After resuscitation, transfusions, and
another cauterization he was fine. We don't know if the massive doses
of Plavix and aspirin given during and after the implant procedure have
caused a permanent weakening of the walls of his blood vessels, but we
are at our wits ends. The doctors say they don't know why this is happening.
He never had any such problems before this. He has always been extremely
healthy and active, but after each episode it takes longer and longer
for his body to build up its strength again. Has anybody else had similar
experiences, and if so, have you found a solution to the problems?
yvandy, New York, New York, September 26, 2010
Lisa Marie -- skin rashes such as hives have
been reported by other patients on this Forum. It may be due to Plavix
and may some time to resolve. There are alternatives to Plavix which
your doctor may recommend.
Angioplasty.Org Staff, Angioplasty.Org, September 24, 2010
Has anyone had any allergies to either the plavix
or aspirin? I had stents put in for leg pain in Aug. Nothing for the
first 2 weeks and then I began getting hives. Everyday now for the past
2 weeks. They took me off of the plavix and increased the aspirin to
a full dose instead of the low dose. Been 2 days and still getting hives.
Now I wonder if its the aspirin. Doctor has not been very helpful.
Lisa Marie, Florida, USA, September 22, 2010
Floridatexan -- all antiplatelet therapies (Plavix,
aspirin, and related drugs) carry a known risk of internal bleeding.
Whether blood tests are done regularly to catch this adverse event would
depend on the protocol of the specific physician or hospital.
Angioplasty.Org Staff, Angioplasty.Org, September 20, 2010
My husband underwent angioplasty w/stent in
Sept, 2008. He took the Plavix for a year, along with a 325 mg. aspirin
per day. He developed severe anemia. His cardio nurse just told me that
it is not routine to monitor hemoglobin levels with this combination;
his was 5.6. I believe it was from a stomach bleed, for which he received
medication from his primary physician. Is the Plavix/full dose aspirin
a safe combination? Shouldn't his cardiologist have been monitoring his
hemoglobin/hematocrit via CBC as a matter of routine?
Floridatexan, Pensacola, Florida, USA, September 16, 2010
SMA -- your meds seem to be the standard medical
therapy for a patient with coronary artery disease (CAD). A 40% blockage
is usually not treated with stents, unless it can be documented that
it's causing ischemia.
Angioplasty.Org Staff, Angioplasty.Org, September 16, 2010
I have been pass through an angioplasty in July
2010 in my LCX Had 02 drug eluting stent (cypher) put in. Doctor advised
me below medicines (which are continue till to date)
1-Plavix 75 MG 0ne per day
2-Juspirin (Acetylsalicylic Acid) 81 MG one perday
3-Zantac 150 MG EFF TAB 30 one per day
4-Lipitor 40 MG one per day
5-Coversyl 05 MG half per day
6-Concor 2.5 MG 02 per day
LCX was blocked 99 % in between OM2 & OM3 & put 02 stent LAD is also 40 % blocked
but left as such. I need the expert opinions about my medicines & also other
necessory guide by all friends.
SMA, Jubail, Saudi Arabia, September 14, 2010
John I in Australia -- you might want to look
at other topics in this Forum (your question isn't exactly "on topic")
-- but to give you a quick answer: before placing a stent, the cardiologist
does an angiogram (often part of the same procedure) and from that may
determine whether a stent will be helpful, depending on the percentage
blockage. Anything over 75% is usually treated; in some cases 50% may
be the cut-off. We have written many times about the use of Fractional
Flow Reserve (FFR) or Intravascular
Ultrasound (IVUS) as an extra tool for measuring the need
for stenting. You should ask your interventional cardiologist for more
information and write back if you still have questions.
Angioplasty.Org Staff, Angioplasty.Org, September 13, 2010
Hi. I had an angioplasty 6 months ago with 3
stents and now i am on plavix/aspirin/crestor. I now find i am very tired
with increase in arthritic pain and not feeling as well as previous.
The question is, the cardiologist said i had a 60 and 80 blockage. I
am 66 years of age, never smoked, had 2 to 3 glasses of alcohol a week,
never o/weight with blood pressure of 125/75, pulse approx 50. I only
had chest pain [only after a short fast bike ride] once, for a 3 hour
period, never breathless, and i could not emulate the chest pain again
with 1 and a half hour bike ride and other exercise over a period, prior
to seeing the cardiologist. The cardiologist fitted the drug eluting
stents with no test whatsoever to determine angina was present. Is this
normal procedure, the only negative in reading the causes of angina was
my cholesterol which at 6.5 with high HDL, but I was reducing this with
more exercise and certain food intake. I still have slight residue of
chest pain in exertion but gradually disappears as I ride or work. Have
I had stents fitted by default?
John l, Noosaville, Queensland, Australia, September 12, 2010
Patsy in Vienna -
first let me explain that I have no medical training, but am a scientist.
I've been reading the literature since my MI and am shocked at the competence
of medical research. While their studies are often conducted with rigorous
protocols, many are clearly not, by Jove ;) I
took a risk based on many hour of reading research. The risk is based
on the fact I could find no studies that tested the effect of a diet
intended specifically to be blood thinning and anti-inflammatory. By
the medical research protocols, this means it is not possible to claim
that antiplatelet therapy has any efficacy for adherents of my diet.
Cardiologists and physicians in general have woefully inadequate training
about diet and its effects on metabolism. Beats me how they can continue
to practise in such a state of ignorance
Dave, Sydney, Australia, September 10, 2010
Ed from Bristol -- Yours is a complex situation.
Placing a drug-eluting stent means a year of antiplatelet therapy, yet
you have issues with your platelet count. Has your cardiologist discussed
the possibility of CABG (coronary artery bypass grafting) with you? Both
bypass surgery and stenting aim at the same target -- revascularization,
or opening up of blocked arteries. Bypass surgery is more invasive, but
in some cases may be a more effective solution. We're not recommending
either -- but this is something you should discuss with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, September 9, 2010
I had a cardiac cath in June revealing
3 blockages, 2 in the main cardiac artery and 1 in another, all 3 blocked
approx. 80%. The cardiologist decided not to do the angioplasty and
stent placement due to low platelet count 103 (minimum avg should be
400) and white blood count of 2.5 (should be > 4). I have 4 stents
already in my heart, the last placed 8 years ago. I started experiencing
symptoms about 4-6 months ago which have gotten worse, pain on minor
exertion. He also found a blocked renal artery but told me that would
be dealt with later, my blood pressure is running about 170/75 on an
average. I will have to have medicated stents due to past history of
restenosis. I have taken Humira for about 8 years for arthritis but
have discontinued it in June of this year, the platelet count has come
up to 103 from a count of 82 at the time of the cath. He wanted to
wait and treat the problems with medicines but it does not seem to
be working, I am having pain more often. I talked to him last week
and he wants me to see a different hematologist for his opinion. He
thinks we need to go ahead with the cardiac cath and stent placement.
What is your opinion please. I am 64 years old.
Ed from Bristol, Bristol, Virginia, USA, September 4, 2010
I have been on Plavix and 82mg aspirin
for 2-1/2 years after have 4 stents. I mark up on my hands and arms
occasionally and bleed if I nick myself. I get tired and sometimes
can't fall asleep as quickly as I'd like. But overall I feel good and
get my aches and pains in the muscles like most. My Cardiologist has
kept me on Plavix, aspirin,Metoprolol,Avapro,Amlodipine,Doxazosin,
and Tricor. Oh and I am 74 and am active everyday. Good luck.
Dolphin, South Florida, USA, September 4, 2010
stopthemeds in New Jersey -- believe you are
referring to the SEASIDE trial being conducted at Scripps Clinic. Read
the Editor's Blog posting from August 10 titled, "DES
'n' DAPT: The OPTIMIZE Trial and Drug-Eluting Stents" for
more information. The three month period is part of the OPTIMIZE trial,
being conducted only in Brazil. SEASIDE is testing six months vs. twelve
and this is only for patients with the Endeavor stent, made by Medtronic
-- because studies have shown that the Medtronic stent heals completely
by six months, so the FDA has agreed to the trial.
Angioplasty.Org Staff, Angioplasty.Org, September 3, 2010
somewhere in this site I remember reading
about a study in Scripps Ranch, CA of how people with DES do with stopping
plavix in 3 months instead of the whole year. I hate plavix, (I hate
the stents too for that matter) and want to see if I'm a candidate
for the study. But - I can't find that post. Any info on that would
be much appreciated. Thanks in advance.
stopthemeds, Atl Hlnds, New Jersey, USA, August 29, 2010
Justmeint in Australia -- what type of stent
did you receive? Bare metal or drug-eluting? If drug-eluting stents (DES)
it is recommended that you take aspirin and Plavix or an equivalent (Effient
is a new and more powerful antiplatelet drug) for a year to prevent clots
from forming inside the stent. If bare metal, then 4-6 weeks is sufficient.
Angioplasty.Org Staff, Angioplasty.Org, August 29, 2010
Tasmania Australia - unable to take statins
of any type, unable to take aspirin as have salicylate issues. Unable
to take medications containing gluten or milk products - cardiologist
said TOO BAD - take them or die! 5 months ago three stents implanted,
makes a total of five in all now. Having brain fog issues, having muscle
pains, burning skin feeling, balance issues... am putting these down
to PLAVIX...... had the same problems after first stenting 9 years
ago! Cardiologist told me to take effient(?sp) but had major diarrhea
and bowel bleed, so went back to plavix. Am on prescription avapro,
somac and plavix... also take daily CLO and Krill oil plus C and magnesium.
Have spoken with GP about coming off plavix and trialing serrapeptese....
once I reach the six month timeframe this is what I intend doing, as
I cannot function at less that 40% of normal - I am not 57 yet and
feel 90! I can't walk properly, I have to hold onto furniture.... and
yet no tests which have been done, show what the problem is --- I feel
so certain it is the plavix!
justmeint, Australia, August 28, 2010
Dave
in Sydney - I've been on Plavix about 2 weeks, and
have no energy. I agree with you 100% about the doctors, but
how did you get off Plavix? (My doctor insisted on Lipitor also
and got very huffy when I refused.) All categories of my cholesterol
were normal, by the way.
Patsy, Vienna, West Virginia, USA, August 26, 2010
Tyro -- your doctor prescribed the "usual
meds" for a patient with coronary artery disease. We suggest that
you discuss any changes in your regimen with that doctor -- we cannot
advise you on these matters. But we can say that Plavix and aspirin (dual
antiplatelet therapy or DAPT) are definitely necessary for a year after
drug-eluting stents.
Angioplasty.Org Staff, Angioplasty.Org, August 25, 2010
I had 2 coated stents put in 8-19-2010,
the doctor who I had just met prescribed aspirin, a beta blocker, plavix,lipitor,
and lisinopril for blood pressure. my problem is, my regular checkup
with my usual doctor, said my cholesterol levels were excellent and
my blood pressure was low. so I refused to take the beta blocker and
have filled but did not take the lisinopril which if started would
be for life. I took the lipitor for a few days and decided the side
effects were not worth it, since my cholesterol levels were good. I
was a heavy smoker (three packs a day) for 25 years, but haven't smoked
in 30 years, I guess it finally caught up with me. I exercise regularly
and am going to really concentrate on diet. I understand the need for
Plavix, but at least it is for a definitive time. does this seem like
a reasonable solution? by the way I am 70.
Tyro, Bella Vista, Arkansas, USA, August 24, 2010
I am a 43 year old man who had two stents
put in this past May & July. Was wondering if anyone had the same reaction
to the Plavix that I am having. I feel like I have been swimming all
day and cannot catch my breath. Even at rest. Has anyone else experienced
this?
43stent, Florida, USA, August 23, 2010
Patsy from West Virginia -- this topic deals
with stent patients who are on Plavix. We assume you are not a stentee,
but you should discuss these issues with the doctor who prescribed the
drug. As for questions and answers, we do not and cannot give medical
advice -- this is only something that can be done by a patient's MD --
but we do try to steer posters to appropriate resources.
Angioplasty.Org Staff, Angioplasty.Org, August 23, 2010
I'm seeing lots of questions but no answers.
I've been on Plavix for 10 days now after a TIA. Carotids clear, blood
pressure and cholesterol normal. No evidence whether TIA (which didn't
show up only in a MRI) was from a bleed or a clot. Should not have
started it, and now very anxious to get off! How?
Patsy, Vienna, West Virginia, USA, August 22, 2010
Can I cut my 75 mg Plavix tablet in half
to save money? I have problem with cost and also have some bleeding
problems and bruise easily.
William, Manila, Philippines, August 20, 2010
Janama from Australia -- We would urge
that you also read our
comments to Dave from Sydney. Stent patients
should not stop taking any meds without discussing this with their
cardiologists.
Angioplasty.Org Staff, Angioplasty.Org, August 18, 2010
Jeannette -
I hear you - I have same lack of energy, can't handle statins, bloated
stomach. I had my 1 stent in july 08. I've dropped most of the pills
and I'm now on aspirin and somac. I think it's either or both of these
that cause the bloating and tiredness as I still have both. I'm going
to take Dave
from Sydney's advice down the page . (april
2010)
Janama, Australia, August 17, 2010
Oldie from Guatemala -- see our Forum
Topics on "Dental
Work, Plavix, Antibiotics and Stents" and
also the topic on "Plavix
and Surgery". You should definitely
discuss this with your dentist before the teeth extraction so he/she
is prepared -- but definitely do not stop taking your Plavix.
Angioplasty.Org Staff, Angioplasty.Org, August 16, 2010
Had one stent three months ago in RCA.
Taking plavix and aspirin. Now I need to have four teeth extracted.
I won't stop plavix but is there much risk with teeth pulling?
Oldie, Vill Nueva, Guatemala, August 14, 2010
To Hercules,
California. I am not advising you one way
or another, but if at some point you do decide to stop plavix, I did
it after 18 months, it was very, very gradual, over a three months
period. That was four years ago. Best wishes!
Tom, Encinitas, California, USA, August 12, 2010
Tom from North Carolina -- Ibuprofen (Motrin,
Advil) can actually negate the antiplatelet effects of aspirin, depending
on when each is taken. Some doctors advise waiting for two hours after
taking aspirin before taking ibuprofen. Also ibuprofen is an NSAID (non-steroidal
anti-inflammatory drug) and this class of drug has been shown to possibly
have adverse cardiac effects. You should definitely consult with your
cardiologist about your side effects. There is a new antiplatelet drug
called Effient (prasugrel) that may not cause you the side effects of
Plavix, although it is more expensive and also may have a somewhat higher
risk of bleeding in certain patients.
Angioplasty.Org Staff, Angioplasty.Org, August 12, 2010
I have two Xience drug eluting stents.
These were implanted after an acute heart attack in June 2010. I am
on Plavix and aspirin. Now, two months later my entire body has started
to have severe side effects. I have become susceptible to unusually
easy bruising, joint pain and muscle aches, and unusual swelling of
my hands and feet. I have two questions. 1. Are these rare but known
side effect from Plavix? 2. Can I safely take ibuprofen with the Plavix
and aspirin to reduce the swelling and relieve the aches and joint
pain. I have tried meloxicam and Tylenol (acetaminophen) and they are
not effective in my case.
Tom Knight, Asheville, North Carolina, USA, August 12, 2010
Michelle -- this is a topic of much discussion
among cardiologists. Here's a study published in Circulation in 2008,
called "Initial
aspirin dose and outcome among ST-elevation myocardial infarction patients
treated with fibrinolytic therapy" and
it found that and initial dose of 162mg of aspirin was just as effective
as 325mg with less bleeding complications. But your husband is beyond
the initial period and is looking at long term DAPT (dual antiplatelet
therapy) which is usually 81mg of aspirin and 75mg of Plavix. This
is pretty standard -- the purpose of it is to reduce the risk of a
blood clot in the stent itself. But you should ask your husband's interventional
cardiologist (the one who put in the stent) for his/her explanation,
so you can become more confident, relax and move forward.
Angioplasty.Org Staff, Angioplasty.Org, August 12, 2010
Question :(need answer asap) Is there
a best dose of aspirin to take after placement of medicated stent.
My spouse was put on 81mg aspirin and 75mg plavix after a STEMI and
medicated stent placement 10 days ago, but we talked to someone who
was put on 325mg aspirin for the first month with the 75 mg plavix
, then reducing to 81 mg aspirin. Which is best for long term results??
has this been shown, or are both good?? doesn't seem to be a clear
cut consensus that i can find on the internet which is kind of worrying
me. please help. not sure what to do, and not something we can ask
anyone else about.
Michelle, Burnaby, British Columbia, Canada, August 11, 2010
Plavix and aspirin from Hercules, California
-- glad to hear that your stents eliminated your angina. As for your
question, it's the big question for everyone and all we can do is refer
you to our
posting from June 7, 2010.
Angioplasty.Org Staff, Angioplasty.Org, August 11, 2010
I have
a double taxus stenting at the origin of the ramus intermedius. It
eliminated completely severe angina, post 10 year triple bypass. I
am on Plavix and aspirin,and completed 12 months today. I can't decide
to continue the therapy or not and the literature also is mixed. My
cardiologist agreed to extend to 18 months. What would you do if it
was you with this scenario?
plavix and aspirin how long to take, Kaiser Permanente, Hercules, California,
USA, August 11, 2010
Thank
you very much. As far as the anemia being caused by bleeding.......I
have been scoped upper and colon twice, barium follow ups, the *camera*
pill...The results have been moderate/severe gastritis, hiatal hernia,
reflux and a small avm in my small bowel. (told there could be more
avms *hiding* No signs of recent bleeding when tests were done. All
fecal occult tests done in a series of 3 days are positive. Last colonoscopy
prep I went to ER because of rectal bleeding. Feel I have had good
GI workup at Cleveland Clinic and my local GI. Have also been told
50 per cent of all small bowel occult bleeding (if this is what I have)
is never found or if found difficult to reach. GI dr. at Cleveland
says he could scope me again but is sure he will find nothing. But
yes, I am going to get a second cardio opinion. Thanks again.
talkalotgal, Ohio, USA, August 10, 2010
talkalotgal from Ohio -- Thank you for
following up and reporting on the latest discussions between your doctors.
We would like to think that, if your anemia is caused by some type
of internal bleeding, it could be diagnosed directly. The role of aspirin
in bleeding is well-known. For example, see this Danish study from
a decade ago: "Risk
of upper gastrointestinal bleeding associated with use of low-dose
aspirin". On the other hand, there
have been several studies showing that stopping aspirin may contribute
to late stent thrombosis. We certainly cannot make recommendations
or give medical advice. Perhaps a second opinion from another cardiologist
might help in terms of how to "go off" aspirin more safely
than just stopping for a month.
Angioplasty.Org Staff, Angioplasty.Org, August 9, 2010
Re: earlier
post. My GI dr. talked to Cardiologist last
week and called, told me cardiologist preferred I stay on the aspirin
and that, he, (GI dr.) didn't know what to tell me. That I probably
had two options, one.....continue on course....two...go off aspirin
for one month and if hgl came up I'd prove them wrong. I feel certain
I am dropping blood as chest burns, hurts, throat burns even when I
walk around slowly, out of breath, difficult to do any physical activity.
For now am going to wait till blood work results this week. I seem
unable to get any info from cardio's office except nurse says dr. says
I have to stay on the aspirin. Am at my wits end. don't have clear
understanding of how much risk I am taking, if I go off aspirin but
living like this is hard. Live alone....want to know from card. office
if I could take it 3 or 4 times per week and see if it helps. I'll
never know for certain if aspirin is the cause of the low hgl unless
I go off.
talkalotgal, Ohio, USA, August 9, 2010
HAVE 1 STENT.
ON PLAVIX ASPIRIN. COULDN'T TAKE 5 DIFFERENT STATINS. BACK PAIN.. LEGS
HURT BURN; STOMACH BLOATS FOR NO REASON. hAVE NO ENERGY. HAD STENT JULY
8 2009. HAVE GONE FROM ACTIVE TO INVALID. ALSO ON LOVAZA.THE SIDE EFFECTS
OF BOTH OF THESE IS HELL. HATE IT.
JEANNETTE, Tampa, Florida, USA, August 9, 2010
stopthemeds in New Jersey -- we also asked Julian
and Judy back in March for a link to the study they quoted, but we have
never received it. Furthermore, we are unaware of such a report about
Plavix. But we definitely hear you about not being told you'd need to
take at least a year of antiplatelet drugs (Plavix and aspirin) BEFORE
getting your drug-eluting stents. We are hoping that this situation is
changing because these drugs are very expensive and cardiologists need
to be sure their patients can remain compliant before placing these devices.
It is also critical to know whether patients may be needing non-cardiac
surgery in the near future, because they may need to stop taking Plavix
before surgery -- and this puts them at risk for stent thrombosis. All
the major cardiology associations have put forth such recommendations,
but they unfortunately are not always followed. We hope that sites such
as Angioplasty.Org can help inform patients directly about these issues.
Thanks for your post.
Angioplasty.Org Staff, Angioplasty.Org, August 9, 2010
to
Julian & Judy in Florida - can you provide
me with links on the class action suit against plavix manufacturers
and the report re: plavix with high cholesterol please. They put drug
coated stents in me w/o giving me the info about having to take this
drug, fear monger about going off it, it feels like the latest greatest
pharma cash cow and I'm devastatingly concerned about what it's doing
to my poor body. Before this, I never even took aspirin. I HATE Plavix.
stopthemeds, New Jersey, USA, August 7, 2010
To
Richie P., YES World, East Stroudsburg, Pa Ten
days ago I had a drug eluting stent put in and was prescribed the 3
meds that you mentioned...plavix, aspirin, zocor. I am also on other
meds for an Afib condition. This morning I woke up itching and breaking
out with small hives here there and every where....but no boxing gloves
or additional joint pain to my already existing joint problems. Stopped
by the drug store earlier and pharmacist suggested Benadryl so tonight
I will give that a try. You on the other hand are being treated by
your dr and you should follow his plan to the letter...I am extremely
hypersensitive to drugs. No advice just to let you know you are not
alone w/the itchy/hive drug reaction. Be well.
Pat M, New York, USA, August 5, 2010
talkalotgal from Ohio
-- Antiplatelet medicines such as Plavix and aspirin can cause bleeding
complications -- and for heart patients a delicate balance must be struck
between enough antiplatelet action to prevent blood clotting in the artery,
which can cause a heart attack, and any bleeding complications, which
you are certainly experiencing. We would recommend that your primary
care physician discuss this issue with your cardiologist. Luckily(!)
you got a bare metal stent for which you only needed to take Plavix for
a couple months to get past the period where stent thrombosis is most
likely to occur. Please let the Forum know the outcome.
Angioplasty.Org Staff, Angioplasty.Org, August 6, 2010
I am 76 yr. old female, had bare mental
stent put in 4/20/2010. Have chronic, blood loss from occult bleeding,
for which I take iron 3x per day and have not had blood transfusion
since first diagnosed 4 yrs. ago. Source unknown. After stent used
plavix and 81 aspirin for 1 month, dropped plavix after 30 days (was
anemic by end of month) and hgl shot up to normal. Within 2 wks it
started dropping again and anemic (that is with max iron) GI dr, primary
and I think it is aspirin as I've never been anemic since diagnosis
4 years ago till now and would take me off. Cardiologist says I MUST
taken aspirin the rest of my life, but I am headed for transfusion
dependency I am afraid, and a life as semi invalid with the bleeding
problem. Anyone else ever experienced this? Between a rock and hard
place....take aspirin and possibly be constantly anemic or go off and
have a larger risk factor of stroke. One stent in left anterior descending
artery, no other heart disease, heart strong. What IS the risk factor
Can find No info that really tells you. Thanks.
talkalotgal, Kenton, Ohio, USA, August 5, 2010
Taxus2 -- Late malapposition of drug-eluting
stents has been the subject of several studies and is thought to be
one of the factors in causing very late stent thrombosis. Sounds like
a possible explanation for what happened to you. A small
2009 study from Bern, Switzerland demonstrated
that a hypersensitivity reaction, most likely to the polymer on the
DES, may well be the cause of this malapposition -- and that treatment
should be exactly what your cardiologists did. What happens is that
the arterial wall moves away from the expanded stent and a space opens
up between stent and wall -- providing an ideal spot for platelets
to gather, causing a blood clot, a.k.a. thrombosis. It is infrequent,
but does happen -- and seems to happen in drug-eluting stents. Second
generation DES, like Medtronic's Endeavor and Abbot's Xience, have
different and more compatible polymers -- the Endeavor's specifically
has been shown to be more biocompatible and OCT imaging studies, specifically the
ODESSA Trial, show that it in fact heals
much sooner than other DES.
Angioplasty.Org Staff, Angioplasty.Org, August 4, 2010
2 Taxus des, 5 days apart after 99% blockage
and MI Dec 2005. In sept 2009 I was weaning of Plavix due to slight internal
bleeding. On the 17 day of starting Plavix every other day, I developed
chest pains with severe sweating shortly after my cardio exercise. Heart
rate reached 98% at the end of session. 3 shots of nitro, then called
ambulance. Given aspirin and oxygen and taken to outpatients. After 8
hrs and 2nd blood work, troponin level of 0.67. Normal is <0.04. Next
day (36 hrs later) angiogram did not show any blockages or reduced blood
flow, but did reveal malapposition of stent struts. Angioplasty to "relocate" struts.
Release couple days later. No concrete explanation as to exactly what
happened other than malapposition could have caused a temporary blockage
that possibly the nitro or aspirin had cleared. Back on daily Plavix
since then.
taxusx2, Ontario, Canada, August 4, 2010
Fahad -- do what you can to lower your risk
-- if you smoke, stop! Lose weight if you need to. Take the prescribed
medications, such as statins, etc. that your cardiologist has recommended.
And discuss your question with your cardiologist. He/she knows you best
and knows how you can lower your risk factors best. Many people have
taken this negative event (heart attack) and changed their lives (diet,
etc.) and they end up feeling better than they have in a long time. Your
cardiologist can also help you with your gastric problems, a side effect
of Plavix and some of the medicines you may be taking. But don't stop
taking anything, especially Plavix and aspirin, without discussing this
with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, August 3, 2010
i am 26 year old and last feb 2010 i suffered
with MI and my LAD was blocked 80% and i have a DES i i am on plavix75
and aspirin 150mg. i have gastric problem as well please guide me that
do i continue my life with this medicine or i have listen that patient
has to repeat the angioplasty after some year i am so young and soon
getting married please guide me and give me some advice for my better
life.
Fahad, Hyderabad, Sindh, Pakistan, August 2, 2010
To Luckyone, Anne marie and Orlando.. I have
been weaning from Plavix after 13 mths by taking a dose every other day
for a month. I am currently 1 week into taking one dose every third day
and plan to continue that for 7 weeks. I still take 325 Aspirin daily
with 40 Pravastatin daily. I have noticed NO let up in bruising or bleeding
yet. I expect that will continue as long as the Aspirin dose is 325.
After I get off the Plavix I will evaluate the Aspirin if the bruising
continues. Not much help to you now but maybe later!
Paul, Constableville, New York, USA, August 2, 2010
Luckyone , it could be it took a long time in
your case for the therapeutic effect to go away from the medication.
How long is one dose in your body due to half-lifes 75 mg to start day1,
then 37.5 mg day 4, and then 18.75 mg day 7.
Volcano, Garden Grove, California, USA, July 31, 2010
once again I am asking if anyone on 75 plavix
and 81 aspirin after a carotid stent ever tried taking the plavix every
other day rather than every day due to constant black and blue marks
luckyone, West Palm Beach, Florida, USA, July 30, 2010
I am a 56 year old certified aerobics instructor
and special ed teacher in a high school. I am a diabetic on a pump, had
diabetes 45 years and "healthy". I had six DES implanted in June 07.
I have been on 75mg Plavix and 325mg aspirin for three years. Last week
when I told my cardiologist that the bruising all over my legs are worse
than ever, or my glucose sensor due to severe bleeding at the electrode
sight, he put me on 81 mg aspirin which I am thrilled about. I know there
is aspirin withdrawal symptoms when going completely off of it, but I
feel like I am going through some with one fourth the dose? Is such possible?
Also, I did read a response questioning Plavix causing growths in lungs.
My CAT scan recently showed two small nodules in one lung that on previous
tests were not there. Can Plavix cause it? I never smoked in my life
and eat healthy, have good BP, excellent weight, and look younger than
my age. I am tired more now than before but attribute it to the other
drugs like Toprol XL, Diovan, Protonix (yes, my question too), etc. Anyone
out there having similar questions, please let me know. Thanks and God
Bless All of You!
Ann Marie, Milford, Massachusetts, USA, July 30, 2010
I have a carotid artery stent. Am on Plavix
and 82mg aspirin. As most people my black and blue marks erupt often.
Has anyone tried half a plavix, with doctor's orders, to prevent such
black and blue marks?
luckyone, West Palm Beach, Florida, USA, July 29, 2010
Orlando in Florida -- Coumadin, Plavix and aspirin
all affect the clotting of the blood, but in different ways. The combination
of all three in a patient increases the risk of bleeding complications.
However, this is a complex area, highly dependent on each individual
patient's clinical situation and it is one you should definitely discuss
with your cardiologist. After a drug-eluting stent, it is very important
to stay on aspirin and Plavix (or an equivalent antiplatelet drug). I'm
sure others reading this Forum would be interested in what your cardiologist
advises.
Angioplasty.Org Staff, Angioplasty.Org, July 29, 2010
I have been on Coumadin for AFIB for 13
years and decided to try the Ablation technique and had it done 7-15-10.
They said to continue the coumadin till my next checkup 8 weeks hence.
However the next week I suffered a coronary blockage and had another
stent replace in my LAD artery . That along with two stents I had in
2005. The problem now is I need to take Plavix with 81 mg aspirin for
the stent and coumadin for the ablation. There is a difference between
both Drs. Cardiologist and the Dr. who did the Ablation. Any answers?
Orlando, USMCORPS, Palm Beach Gardens, Florida, USA, July 29, 2010
TD from California -- Check out the Forum
Topic, "Not
Feeling Well After Stenting". There
are a number of posters who report similar discomforts post-stenting
-- which seem to disappear within weeks or a few months. There is also,
as you write, the possibility that you may be experiencing symptoms
of GERD (reflux). Discuss this with your cardiologist. Remember, the
jury is still out on whether or not Proton Pump Inhibitors (like Prilosec)
reduce the effectiveness of Plavix (it's a controversial topic in the
cardiology circles) -- but there are other meds, such as H2 inhibitors
like Tagamet and Pepcid, which can help alleviate symptoms.
Angioplasty.Org Staff, Angioplasty.Org, July 21, 2010
I had a drug-eluting stent placed in my
posterior descending artery on May 15, 2010. I have worked my way back
to fairly strenuous, regular exercise since then with no pain or shortness
of breath during or following . However, I have episodes of minor chest
pain or pressure while at rest, completely unrelated to exertion. It
does not feel like the angina I experienced prior to the placement
of the stent. My cardiologist does not think it is big deal. I am wondering
what is causing this tightness/pain and is there an acceptable amount
of pain following a procedure such as this. For the first month following
the stent I continued taking Prilosec OTC for reflux . I stopped when
I read about some of the studies referenced in this forum.
TD, Chico, California, USA, July 20, 2010
LWA from Missouri -- Aspirin is known
to heighten tinnitus or ringing in the ears in some patients. If you
Google "Aspirin
and Tinnitus" you'll find numerous
references that you can show your cardiologists to help them understand
that this is a real problem. Perhaps a lower dose of aspirin would
alleviate the ringing, yet still provide the antiplatelet effects you
need after DES. That's for your cardiologist to decide -- and remember,
don't alter your post-stent meds without discussing it with your cardiologist
(some general practitioners may not be aware of the importance of continuing
Plavix plus aspirin).
Angioplasty.Org Staff, Angioplasty.Org, July 20, 2010
Hi, after reading all the posts I don't see
were any one is having problems with ringing in their ears from taking
so much aspirin along with plavix, I have a DES put in in April, 2010
and have to be on plavix and aspirin for a year, I had a bare metal stent
put in in 2006 and was plavix for 1 month and aspirin ever since but
I have this problem with the ringing in my ears and since I been on plavix
and 325 mg of aspirin the ringing has increased to the point that I can't
get any sleep at night because of the noise in my ear, heart racing and
blood pressure going up. I tell my doctors but they don't believe that
this is happening to me. I need sleep can any one HELP!!!
LWA, St. Louis, Missouri, USA, July 20, 2010
Daniel -- read the post and our reply to/from
JR of Nevada back on June 10 & 11.
Also read the earlier exchange from May
16.
Angioplasty.Org Staff, Angioplasty.Org, July 20, 2010
Is fatigue a standard reaction to Plavix?
I have been taking Plavix for 11 months and am wondering if the fatigue
will go away when I stop taking the drug in another month. I am a 58
yrs old MI in May 1995 and in August 2009 but the fatigue seemed only
to start after the Plavix.
Daniel, Toronto, Canada, July 20, 2010
Ksmith -- Sometimes blockages and ischemia
don't manifest themselves as pain, angina or other symptoms. We assume
that a stress test, or or pressure measurement, confirmed that these
blockages were actually causing reduced blood flow and reduced oxygen
to the heart -- but a blockage of 90% or more would almost certainly
do so. As for your husband's medications: drug-eluting stents take
time to "heal", a process during which endothelial cells
cover the metal struts. Until the healing is complete, there is an
increased risk of blood clotting inside the stent, a.k.a. stent thrombosis.
Aspirin and Plavix are antiplatelet drugs and help prevent this from
happening. Both are recommended for a year or more for drug-eluting
stents. It is very important to continue taking these drugs and not
to stop unless you first discuss it with your cardiologist. (We have
numerous articles on Angioplasty.Org about this issue.) Crestor is
a statin which will lower your husband's cholesterol level, which is
high (see AHA article on "What
Your Cholesterol Levels Mean"). Finally
the beta-blocker has a number of cardioprotective properties -- your
husband's cardiologist can give you more information about why this
has been prescribed. Just curious, were you and your husband not told
the reasons for all these new medications? It's really important for
patients and their spouses to understand these things, so they remain
compliant.
Angioplasty.Org Staff, Angioplasty.Org, July 19, 2010
New Heart Patient. My husband just had two drug
stents put in for 90% blockages that we had no clue he had...He never
had any symptoms...The doc put him on Plavix, Crestor, and a beta blocker
called Metoprolol, in addition to aspirin He does not have high blood
pressure, cholesterol was 247. I don't like the amount of meds or the
side effects listed. Why these drugs for someone who has never had any
indication of heart problems? Since we are new patients i'm not certain
if this is typical.
KSmith, Lake Orion, Michigan, USA, July 19, 2010
Had a medicated
stint [stent] put in 3 weeks ago-was put on 75 mg. plavix, 80 mg. zocor
and 325 mg. aspirin. 2 wks after starting these meds, severe itching
on hands and by night time hands were swollen like boxing gloves. Hives
came out on top of swollen hands and next day bottom of feet itchy as
well as genital area. dr. stopped zocor and was put on prednisone for
swelling and itching. I still have itchiness and now severe joint pain
intermittently in fingers and wrists. Anyone have any similar symptoms,
what was it? They want to switch me off plavix and put me on the effient
but we don't know if the zocor, plavix or aspirin has caused this reaction.
I have taken aspirin all my life no problems and was taking 81 mg. up
until the day of procedure 6/25/10. HELP - any info. would help relieve
these awful symptoms. Drs. don't seem to have the answers. THANK YOU!!!!
Richie P., YES World, East Stroudsburg, Pennsylvania, USA, July 18,
2010
Sam in New Hampshire
and Paul W from Constableville and others -- we've spoken with the authors
of the February 2008 study about a possible Plavix
Rebound effect and, while they have documented even more
observational evidence of an increased incidence of adverse events in
the period right after clopidogrel (Plavix) cessation, they still cannot
say that there is a rebound effect -- something that can only be proven
with a randomized clinical trial. In fact, a small
trial from Munich was published earlier this year, and it
showed no rebound effect. Drs. Ho and Rumsfeld, who published the original
observational study, told Angioplasty.Org the following, regarding this
German study:
Certainly, this was an important, logical study
to be done following publication of the observational studies. However,
it is equally important to note that this was a small study, and
clinical events were not assessed, so the findings will require a
larger study to confirm. Open questions still remain about whether
there is or is not a rebound phenomenon with abrupt clopiodgrel cessation,
at least in some patients. Finally, until there is further confirmatory
evidence of a lack of a rebound phenomenon, there is no obvious down-side
to tapering clopidogrel off once patients have taken their prescribed
course.
So that's the opinion of the Plavix rebound study authors.
Angioplasty.Org Staff, Angioplasty.Org, July 16, 2010
Have drug eluding [eluting] stent in left anterior
descending artery and 100% occluded rca (with excellent collateral flow)
since June 2007 angio treatment. Taking Plavix/aspirin regimen since.
Cardiologist considering stopping plavix due to Plavix/PPI issues and
stomach side effects. Concerned about "Plavix Rebound". Any updated info
since the Feb 2008 study in Journal of the American Medical Association
on "rebound" of extended Plavix use?
Sam, New Hampshire, USA, July 15, 2010
Lee Ann from Georgia -- no reason to think it's
a drug reaction, but you certainly should discuss these symptoms with
your physician. Did you have a cardiac catheterization? Sometimes leg
pain follows. Or your symptoms may be signs of peripheral arterial disease
(PAD).
Angioplasty.Org Staff, Angioplasty.Org, July 13, 2010
I am on plavix starting on June 15 2010. I
am also on pravachol 20mg in the last past 2 days i have been in severe
pain under the bottom of my right foot.and sometimes it travels to my
big toe. and up my leg when i walk, sit, and even wakes me up help me
please. I am only 43.
Lee Ann, Georgia, USA, July 12, 2010
I am an active 79 yr old male, 140 lb with no
health issues other than Coronary Artery Disease (CAD) caused by 48 yrs
of smoking. In 1993 I had double By-Pass after a failed Angioplasty.
In 2009 after 16 yrs with no Meds both grafts became 95% closed and caused
a mild MI. Three DES stents were used to reopen the grafts. I was prescribed
DAPT and 5 MG Lisinopril even though my blood pressure is 120/80. After
feeling lousy& listless (mentally and physically) for 11 mths I changed
my Med routine and found out Lisinopril was causing my discomfort and
not the Plavix that I had suspected. I discontinued the Lisinopril and
immediately got my life back and feel great. I have been on DAPT 12 mths
and desire to wean from Plavix. I am a loyal follower of this forum but
see so little about tapering from Plavix to avoid rebound. I intend to
take one Plavix every other day which I will do for 1 mth. Then take
one Plavix every 3rd day for two mths. I will continue with 325 MG Enteric
Aspirin daily and decide what to do after 3 mth of taper. I would really
appreciate any comments or suggestions you could offer me? This rebound
is very elusive! Thanks
Paul W, Retired, Constableville, New York, USA, July 10, 2010
Ruby -- Sorry to hear about your problem, Did
you get a drug-eluting stent? Did the physician at the hospital who took
you off Plavix understand that you had gotten a stent? You should discuss
this medication change with your cardiologist -- not just a GP. Patients
with stents need to be on dual antiplatelet therapy for a certain period,
as protection against blood clots in the stent. If you are having adverse
reactions to Plavix (clopidogrel) perhaps your cardiologist can put you
on a different medication, such as Ticlid (ticlopidine) or Effient (prasugrel).
Angioplasty.Org Staff, Angioplasty.Org, July 7, 2010
My name is Ruby I had a stent put in and the
DR gave Plavix and I started to have mild chest pains form about two
seconds. They did not tell me the side effects Boy i wanted to the hell
out of that hospital. Well I still had chest pains and the DR he said
it was gas. I ended up in a major hospital, they took me off the plavix.
Now i just take aspirin, thank GOD Im still alive. I still side effects.
RUBY, Handyman, Dickinson, Texas, USA, July 7, 2010
Read this entry, "Plavix
After Stents: How Long?", from our Editor's Blog
for some perspective on this issue.
Angioplasty.Org Staff, Angioplasty.Org, July 7, 2010
I have been on Plavix for four years after having
2 coated stents implanted. My GP wants me to quit taking Plavix. Says
it is dangerous to take so long. Cardio says not sure. Any response would
be appreciated.
Linda, San Ramon, California, USA, July 6, 2010
I am 65, had two prior MI's and had a CABG
in 2006 with an ICD implanted and began taking 81mg aspirin and coumadin.
In June 2008, I had a drug eluding [eluting] stent placed and plavix
was added to my daily regimen. So I have been taking all three: 81mg
aspirin, 75mg plavix AND coumadin, for now over two years. Is there a
reason to continue the plavix (which is also very expensive to me)? Is
there a preferred method on how to stop taking the plavix?
mrag, Kennett Square, Pennsylvania, USA, July 5, 2010
Larry and many other earlier posters -- we (or
any web site) cannot advise patients about what medications they should
or should not take because, among other things, every patient has different
clinical needs, medical history, etc. You need to ask these questions
of your cardiologist. That being said, what we can do is let readers
know what the guidelines are, or the latest news about a medication in
hopes it will further the dialogue with their healthcare provider and
make calls or visits more efficient.
Larry, one concern would be whether your cardiologist
knows you take two Anacin two-three times a week. Aspirin (the major
ingredient in Anacin, as you point out) is an anticoagulant. Plavix,
Warfarin and that much aspirin in one day seems like a lot of anticoagulation
medicine, and that could have the side-effect of bleeding. But aspirin
AND Plavix are prescribed together after stents (although only for 4-6
weeks after a bare metal). Discuss all your drugs with your cardiologist,
including over-the-counter drug and herbal supplements. These can all
have potent effects, even though they are not prescription drugs.
Angioplasty.Org Staff, Angioplasty.Org, June 30, 2010
I am a 70-yr-0ld male heart patient (3 by-pass
surgeries in 35 yrs., [12 by-passes, total, and because of A-fib, have
had pacemaker-15 yrs.]; last surgery, 1997. I had a bare metal stent
implanted last week. Am home and doing well taking 75m Plavix, 5m Warfarin
(INR 2.5), 20m Omeprazole X2/da, 75m Arthrotec, 5m Lisinopril, .4m Flomax.
I was told to add a baby aspirin. In the past, I have been taking 2 Anacin
(325m aspirin+?caffeine, ea. for headache 2-3 AM's /wk. At what peril
can I continue to take Anacin? (Tylenol does me NO good at all.)
Larry, Yalaha, Florida, USA, June 29, 2010
I had an angioplasty last Sept 8 2008 and right
after the procedure and I take Plavix 75mg Aspirin EC 100mg,Diovan 160mg,Simvastatin
( Zocor 20mg)Metphormin 500mg, Piazone 30mg Dilantrend 6.25 mg Daily.
and Just a 3 months ago my Cardiologist reduce my Plavix to 1/2 tab daily
while the rest of my medicine remain the same. Although I did not feel
any side effect of all the medicine i take but I'm afraid the this might
comes someday. My Blood chemistry are mostly normal especially my Cholesterol
only my sugar are sometime above the normal but i was able to reduce
by diet.my concern is do I need to continue to take all this medicine
especially Plavix? or have another angiogram to check the condition of
my Heart?
jun, Cagayan de Oro, Philippines, June 23, 2010
Guidelines state that after a drug-eluting stent,
the patient should be placed on aspirin and Plavix (or similar drug --
Efficent is one) for 12 months or longer. Both prevent blood clots inside
the stent, but via different mechanisms. Discuss the GERD issue with
your cardiologist, but don't stop taking anything without his/her advice.
Angioplasty.Org Staff, Angioplasty.Org, June 23, 2010
I had a drug emitting [eluting] stent inserted
in March. I am on effient and 82 mg coated aspirin. BUT, I have severe
GERDS and have a trouble tolerating the aspirin. What is downside to
discontinue the aspirin or go to 1 every other day?
dave in NY, New York, USA, June 23, 2010
DLC from Oklahoma -- you're not alone in experiencing
side effects, as you can see from other posts. Try to discuss these issues
with your doctor in terms of can he/she prescribe something to help with
the side-effects -- bruising is one of Plavix side effects but it is
unfortunately a very important drug to take (along with aspirin) post-DES
(Drug-Eluting Stent).
Angioplasty.Org Staff, Angioplasty.Org, June 22, 2010
Had a coated stent put in two weeks ago, (my
6th) was put on Plavix 75mg, 81 mg aspirin, 1 25mg metoprolol 2xs a day.
Now have upset stomach, constipation and bad bruising for no apparent
reason. Had triple by-pass surgery last year. Was told by Heart Surgeon
I had a terrible buildup of Calcium in my blood but was not told what
to do about it. Got on Parathyroid.com and found it is the parathyroid
that regulates how much calcium is taken out of the bones and put into
the blood. Blood tests show this is the problem. Will be taken care of
as soon as I can get to proper Doctor. But what to do about the side
effects of Plavix or Metoprolol? My Cardio Doctor does not listen to
me when I tell him my allergies or side effects. I can't change Doctors
very easily.
dlc, Oklahoma, USA, June 20, 2010
My husband had 2 stents in Nov. 09. He has had
most of the negative symptoms from Plavix (fatigue, insomnia, depression,
some confusion). The one I am currently concerned with is heart palpations
when he exercises. He rides his bike and it happens. Is this also somewhat
common with Plavix users? Also,when a patient comes off Plavix do the
symptoms really subside and how long is the average for that to happen?
seacoast light, Chuluota, Florida, USA, June 12, 2010
JR in Nevada
-- very interesting that you don't have these reactions with Effient.
It's a new drug, only
approved a year ago -- and people's
experience with it is important to report. We're glad that you've solved
your problem and would ask others who are on Effient (Prasugrel) how
they're doing. The biggest concern with Effient was a possible increased
risk of bleeding (greater than with Plavix) but certainly Plavix can
cause a number of adverse side effects and, as one can see from this
Forum Topic, they have a great impact on patients well-being. Thanks
for the update -- also our point about depression is a valid one, and
one that is all too often passed over by medical professionals and
patients alike.
Angioplasty.Org Staff, Angioplasty.Org, June 11, 2010
I
previously reported I was having the typical
reaction to taking Plavix. You responded -- Depression is not an uncommon
reaction after stenting -- it's less to do with the stent (and possibly
the medications) and more to do with coming to grips with the fact
that you have coronary artery disease and had a heart attack. Let me
respond - BS. I have discontinued Plavix and now take Effient. All
of my leg pains and feeling like crap has gone away. Maybe you should
consider that some people do not do well on Plavix and should look
for a replacement. This should not be a forum to keep people on Plavix
no matter what.
JR, Henderson, Nevada, USA, June 10, 2010
my dad has had a drug eluting stent in sep 2008
electively post a mild symptoms of shortness of breath, the LAD artery
was totally occluded although he didn't suffer from any MI,his cardiologist
told him that collateral arteries were sufficient to prevent acute clinical
manifestations!! ,, he's on Plavix and aspirin , crestor for dyslipidemia
, he don;t have any other problems ,, he is completing his 2 years period
on PLAVIX next Sep ,, shall he continue or can he D/C the drug and stay
only on 81mg aspirin ??
Medical Student, Amman, Jordan, June 9, 2010
Karen --
you've hit on the Big Question! Read our Editor's recent blog about
this issue: "Plavix
After Stents: How Long?". We've posted
many such articles on Angioplasty.Org about the duration of Plavix
and aspirin after drug-eluting stents. Every cardiology meeting have
panel discussions on this question. So your cardiologist, like everyone,
does not have a definitive answer. The rule of thumb is that if patients
are tolerating Plavix well, keep them on it past a year. But other
physicians think it's not necessary. The conundrum here is best characterized
by an exchange that occurred during the 2006 FDA stent safety hearings.
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 $64 question 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. Stent thrombosis is a serious event -- number, length and location
of stents are all risk factors that might make a cardiologist want
a patient to stay on Plavix. There are platelet reactivity tests and
genetic tests to see how well the Plavix is anticoagulating but unfortunately
no way to definitely say, you can stop now without risk. A big trial
is currently underway (the DAPT Trial) testing 12 months vs 30 months,
but the results will not be known for quite some time.
Angioplasty.Org Staff, Angioplasty.Org, June 7, 2010
My husband had 6 stents put in a year ago and
has been on Plavix and Aspirin since. We were always under the assumption
that he could get off the Plavix at the one year mark but his Cardiologist
told him that he needed to stay on it for another year and possibly for
life, due to a 1% chance that a clot could form and he could have an
MI (which he did not have before). We are extremely healthy and have
completely altered our lives, nutrition, etc. We are almost Vegan, exercise
regularly, are not overly stressed and have had no adverse signs or problems
since the procedure. My husband even ran a marathon in February. His
labs are at optimal levels and he looks ten years younger than his 53
years. I feel the Dr. is only saying this to cover himself and has done
no testing yet to know if he should stay on Plavix. We were very disappointed
because our goal is to be off of all medication and we hate Plavix and
how it makes him bleed for forever with a little cut. Has anyone out
there have any advice? Any natural alternatives? Does fish oil work at
all? He did not have an MI but was blocked up. I almost feel like too
many stents were put in him and they are all drug eluting. Thank you!
Karen M, Mandeville, Louisiana, USA, June 6, 2010
Tez, Chacha and Emily from Texas -- read through
the various posts here and you'll find our comments. We cannot give medical
advice but guidelines state that after drug-eluting stents, patients
should take dual antiplatelet therapy (Plavix or equivalent, like Effient
or Ticlid, plus aspirin) for 12 months minimum unless they have serious
side effects. For bare-metal stents, the period is 4-6 weeks. The concept
is that these drugs help prevent blood clotting inside the stent while
the stent is healing -- being covered over by the body's endothelial
cells. Plavix and aspirin both are antiplatelet drugs, but they work
in two different and complementary ways, which is why they are prescribed
together.
Angioplasty.Org Staff, Angioplasty.Org, June 6, 2010
had a stent put in 12y ago and never even took
an aspirin. its still ok. i had an irregular heart rhythm two weeks ago
and ended up with another stent being put in and doctors said i must
take plavix,lipitor,aspirin nd metoprolol. the last three nights i am
unable to sleep and have continuous muscle pain and a cough. i stopped
taking the tablets two days ago but the pain is still unbearable. what
do i have to do to get rid of the pain and what possible damage have
the tablets done to me. can i manage my own treatment by diet and fish
oil and flax oil etc. are there any other people that have managed without
the drugs. does it matter if the stent is drug eluting or bare metal.
i think that the one i had 12 years ago was bare metal.
tez, Sydney, Australia, June 6, 2010
had 4 stents placed last week.. at 42 - young
age for this I guess. following are my prescriptions ? does this look
ok..Lipitor, Metoprolol, plavix, Aspirin (adult) & Ramipril (for some
sort of leak I think )
Chacha, New Jersey, USA, June 2, 2010
My son is 43 and suffered a heart attack 2 months
ago. He was stinted [stented] and is on plavix and 2x81 aspirin daily.
His entire body is covered in black and blue bruises. Does this sound
normal? It seems excessive to me. Until his next appointment, we decided
to cut out the aspirin. My question is this.....isn't plavix and aspirin
basically the same thing. We worry about cuts and other open wounds he
might receive as he works in construction. He could very well bleed to
death because there appears to be no clotting activity. any help will
be appreciated. thanks
Emily Wilson, Texas, USA, June 1, 2010
Becky from Alabama -- there are many studies
because one of the main reasons Plavix (clopidogrel) is used post-stent
is specifically to prevent ischemic events caused by thrombosis (blood
clots). All guidelines state that stent patients should be on dual antiplatelet
therapy (DAPT) consisiting of aspirin and Plavix (or an equivalent drug
such as Ticlid or Effient) for 4-6 weeks following a bare metal stent
and a year following a drug-eluting stent.
Angioplasty.Org Staff, Angioplasty.Org, May 31, 2010
My husband had an ischemic stroke after stent
placement. He was not on plavix ..only aspirin. Is there any studies
that you know of refering to the use of plavix with stents preventing
strokes.
Becky, Semmes, Alabama, USA, May 30, 2010
Wow UP Mike -- your story is one of those "observational" cases
that caused Drs. Ho and Rumsfeld to research and publish their 2008 study
on a possible Plavix
rebound effect. This has still not been verified in a randomized
trial, but they and others continue to work on this odd connection to
Plavix cessation (after a year or more) followed by an ischemic event
within 30-90 days. Dr. Rumsfeld told us, by the way, that he reads this
Forum and sees a number of cases like yours that help them in their study
of this phenomenon.
Angioplasty.Org Staff, Angioplasty.Org, May 29, 2010
I had a DES deployed in march 2006. I stayed
on a regime of Plavix and .81mg aspirin until late April 2009.On May
29th 2009 I suffered full cardiac arrest fortunately this happened in
the ER at a small community hospital where they administered a clot buster
and airlifted me to my cardiac center where they concluded my stent had
cleared but I will be on plavix for life with significant loss of ejection
fraction. Stay on Plavix!!
U P Mike, Green Bay, Wisconsin, USA, May 28, 2010
Ireoluwa -- congratulations on turning
this around. Between modern drug therapy and interventional devices,
heart disease is no longer the end of things -- as you've shown, patients
can overcome the problems, make changes and move on. As for tests to
perform, any symptoms would be key -- not having any? Excellent! But
if you or your doctor become concerned, there are a variety of tests,
detailed in our Imaging
and Diagnosis Center.
Angioplasty.Org Staff, Angioplasty.Org, May 26, 2010
In March of 2008 at 39 yrs of age I was diagnosed
with unstable angina (80% blockage)and single stented (bare metal) in
my LAD. I was prescribed 1 tablet daily with breakfast of: Toprol-XL
95 mg (controlled release; Atacand 32mg; Plavix 75mg; and Cartia 100mg(aspirin)
and at night with dinner 1 Lipitor 40mg. After 6 months my Cardio took
me off the Plavix but has kept my sentence for the rest of my medication
for life. Over 2 years after I am okay and I have had no obvious side
effects apart from sporadic itching. I lost 5 kgs, changed my diet and
I exercise 3 or 4 times a week. What diagnostic tests can I perform to
proactively check for heart blockages and organ damage???
Ireoluwa, Sydney, Australia, May 26, 2010
In fact. the actual AHA/ACC guideline is "For
all post-PCI stented patients receiving a DES, clopidogrel 75 mg daily
should be given for at least 12 months if patients are not at high risk
of bleeding". For those at high risk of bleeding, such as those on warfarin,
there is no guideline. In general DES is not recommended for such patients.
Too bad my cardiologist didn't know that, or at least discuss his intention
with me. I lasted 5 weeks before GI bleeding that required 4 units of
blood.
kipper10, Florida, USA, May 26, 2010
Norman -- Plavix (also known as clopidogrel)
and aspirin are both antiplatelet drugs -- they keep the blood platelets
from clotting. But they work in different ways, so doubling the aspirin
is not the same. However, perhaps the aspirin alone is enough. The fact
that at 83 your major arteries are clear and you only have a small blockage
in a minor artery is very good news. After all, small blockages don't
necessarily need to be stented -- in fact using a stent where it's not
needed may be a negative. But this is NOT medical advice and you should
definitely discuss this issue with your cardiologist, who knows you and
your clinical situation. Thanks for writing in and let us know what you
find out.
Angioplasty.Org Staff, Angioplasty.Org, May 16, 2010
Having had a catheter inserted in my arteries
one month ago, one small blockage was found in a minor arteries, no stint
[stent] was inserted as the blockage was not accessible. all other arteries
showed clear. It has been suggested taking one 75 mg. plavix daily for
one year along with ONE low dose aspirin. which I am taking at present,
as this prescription is so very expensive for me, my question is, if
i take TWO low dosed aspirin daily without taking the Plavix give me
the same coverage as taking Plavix and ONE low dosed aspirin daily? thank
you Norman. 83 years old.
Norman, Retired, Qualicum Beach, British Columbia, Canada, May 16,
2010
JR -- Guidelines state
for drug-eluting (coated) stents, patients should be on dual antiplatelet
therapy for a year: that's Plavix (or equivalent) AND aspirin. Also,
there have been several studies implicating omeprazole (and possibly
other Proton Pump Inhibitors) in reducing the effectiveness of Plavix,
but there is conflicting information on this, with one randomized study
showing no interaction at all. Have you discussed your medication regimen
with your cardiologist? Depression is not an uncommon reaction after
stenting -- it's less to do with the stent (and possibly the medications)
and more to do with coming to grips with the fact that you have coronary
artery disease and had a heart attack. One positive thing you can do
is to use this event as a catalyst to change your lifestyle and reduce
your risk factors through exercise, diet and stress reduction. People
who have done this have reported that they actually feel better than
they did before the heart attack. Keep in touch and let us know what
happens.
Angioplasty.Org Staff, Angioplasty.Org, May 16, 2010
MI in March 2010. Three coated stents implanted.
Standard list of drugs after the procedure. I am off of Aspirin, Coumadin,
and everything else except Carvedilol, Lovaza & Plavix. I have the standard
reaction to Plavix (Fatigue, weak, depressed, irritable, just feel really
bad all the time) - I find that the reaction is reduced when I take Omeprazole.
Maybe there is a positive interaction.
JR, Henderson, Nevada, USA, May 16, 2010
Hilary -- Bleeding complications are a known
adverse reaction of clopidogrel (Plavix). In stent patients, the cardiologist
has to weigh the negatives of bleeding with the antiplatelet benefits
of Plavix. Previous guidelines were for 6 months of dual antiplatelet
therapy -- 12 months came about after the FDA held a two-day
panel in 2006 to discuss the issue of late stent thrombosis.
Is your husband still having bleeding? Can the prostate operation be
delayed safely? You should look at our related topic, "Plavix
and Surgery" -- many patients have requested that their
cardiologist and surgeon consult with each other about the risk/benefit
-- an action endorsed
by all the major cardiology and surgical organizations.
Angioplasty.Org Staff, Angioplasty.Org, May 15, 2010
My husband had a drug-eluding [eluting] stent
placed as of 12/25/2008. He has been taking Plavix ever since. He has
to have an operation for an enlarged prostate. He has been off Plavix
since bleeding in his urine as a result of an injury from catheter (May
12, 2010). The cardiologist does not advise going off Plavix for the
operation. Isn't the risk of bleeding excessively while on Plavix a contraindication
to continuing taking the Plavix?
Hilary, New York, New York, USA, May 15, 2010
Vishal -- in the U.S., guidelines are for 12
months of dual antiplatelet therapy (Plavix and aspirin) after a drug-eluting
stent (4-6 weeks if the stent is bare metal). Some cardiologists recommend
Plavix for longer periods, if there are no complications or adverse reactions.
Before Plavix (clopidogrel) came on the marekt, Ticlid (ticlopidine)
was the antiplatelet drug used. In fact in Japan they don't use Plavix
much -- only Ticlid. Ticlid tended to have more adverse reactions in
patients but cardiologists we've talked to whose patients have reacted
poorly to Plavix, sometimes do better on Ticlid. Not sure why you are
thinking of switching back to a drug that has caused allergic reactions
in the past. What does your cardiologist say, because he/she should be
the point of contact here.
Angioplasty.Org Staff, Angioplasty.Org, May 15, 2010
My father, 63 years old had a heart attack,
has two stents put in 2009 March (Operated at Memorial Care, Laguna Hills
California) and is on Aspirin 81 mg twice daily, metoprolol (LOPRESSOR
25 mg) twice daily,ZOCOR 40 (Simvastatin 40 mg), LOTENSIN 40 mg (Benazepril)-
half tab daily. Apart from this, post surgery and prior to discharge
he was put on antiplatelet, medicine PLAVIX 75 mg. Within 2 days, he
developed severe rashes on whole body except face, red colour lesions.
Eventually PLAVIX was stopped immediately and replaced by TICLID ( Ticlopidine
250 mg) twice daily. Its over an year, now and we are contemplating to
put him back on PLAVIX 75 mg ( Clopidogrel). My question remains firstly,
how long one should give Ticlopidine or Plavix post surgery after stents
are installed. Secondly, what will happen, if I put my father back on
PLAVIX and stop Ticlopidine In the event, he develops rashes again, can
I give him ZINCET to combat rashes or allergy side effects of PLAVIX?
Vishal Kumar, Son of Patient, New Delhi, INDIA, May 12, 2010
LP -- Current guidelines call for 4-6 weeks
of dual antiplatelet therapy (Plavix and aspirin) following implantation
of a bare metal stent which is what you got. Your interventional cardiologist
and surgeon are to be commended for discussing this issue beforehand
-- that's why he/she used the bare metal type -- drug-eluting stents
require 12 months or more. Afterwards, aspirin is usually reduced to
low-dose (81mg) -- you should have your new cardiologist discuss this
with your surgeon.
Angioplasty.Org Staff, Angioplasty.Org, May 13, 2010
I had a Multi-Link Vision stent implanted on
April 19, 2010. Two weeks before I had been scheduled for robotic radical
prostatectomy on June 15, 2010. My doctor told me that I would need to
be on Plavix and 325 mg aspirin for four weeks, I actually have six weeks
available to give me 15 days off medication before the procedure. Both
doctors discussed the problem and concluded that no other adjustments
were necessary. I had to change my cardiologist due to insurance problems
and the new one I just visited told me he is not comfortable stopping
the treatment so soon. Does anyone have been through a similar situation?
LP, Miami, Florida, USA, May 13, 2010
B Riedley -- the "rebound" effect
for Plavix is based on an "observational
study", meaning that patient records were looked at
after the fact. The same Denver-based group recently published another
study confirming their observations. However, a small study (69 patients)
by Sibbing et al out of Germany was published earlier this year in which
patients were randomized -- and no evidence of the rebound effect was
found. The authors of the observational studies, Dr. John Rumsfeld and
Dr. Michael Ho have stated to Angioplasty.Org the following about the
Sibbing study:
"Certainly, this was an important, logical
study to be done following publication of the observational studies.
However, it is equally important to note that this was a small study,
and clinical events were not assessed, so the findings will require
a larger study to confirm. Open questions still remain about whether
there is or is not a rebound phenomenon with abrupt clopiodgrel cessation,
at least in some patients. Finally, until there is further confirmatory
evidence of a lack of a rebound phenomenon, there is no obvious down-side
to tapering clopidogrel off once patients have taken their prescribed
course."
There is currently a much larger study (3,000 patients)
being conducted in Germany, called "Abrupt
Versus Tapered Interruption of Chronic Clopidogrel Therapy After DES
Implantation (ISAR-CAUTION)", that may answer our questions.
However, the results won't be known for more than a year. Hope this helps.
Angioplasty.Org Staff, Angioplasty.Org, May 12, 2010
Please help!. My cardiologist tells me that
I can discontinue Plavix after being on it for several years. I have
read the articles posted and they all talk about the rebound effect and
the changes of a heart attack being doubled during the first 90 day period.
Now I am so scared not to take this med. Please help!. I was told to
take aspirin instead. I am having major panic attacks now!
B Riedley, Louisville, Kentucky, USA, May 12, 2010
AJ -- you should discuss these issues with your
cardiologist -- if you are not feeling well, perhaps your meds need adjusting.
Angioplasty.Org Staff, Angioplasty.Org, May 11, 2010
I had a stent placed on 1/18/2010 and I have
been pretty feeling pretty awful ever since. I take 75mg Plavix, 50mg
Metoprolol x2 day, 20 mg simvastatin & 81mg aspirin My heart will, all
of a sudden, start racing and beating hard. Sometimes it wakes me up
in the wee hours of the morning. I usually take all my pills in the morning
at the same time but, I was wondering, if it would be better to take
Plavix later in the morning? Maybe not at the same time as the Metoprolol?
Has anyone else experienced these effects?
AJ, Lemon Grove, California, USA , May 4, 2010
There's nothing we've found about insomnia or
sleep disturbances when taking Plavix (a.k.a. clopidogrel) -- but check
with your cardiologist about your fatigue. Plavix (especially when taken
with aspirin) can result in bleeding in some cases -- and significant
fatigue can be a symptom of that. We're not saying that's what is happening
-- but you might want to check it out -- just to be safe. But do
not stop taking either drug without first consulting with your
cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, May 3, 2010
A short while after I take my Plavix, I start
to get very tired. Is it safe to take Plavix at bed time or would it
interfere with my sleep?
Norma A. Smith, Red Hill, Pennsylvania, USA, May 3, 2010
Susan -- bruising is a known side-effect of
clopidogrel (Plavix) but, assuming you were given 1 or 2 drug-eluting
stents, the recommendation is for Plavix and aspirin for a year, unless
there are bleeding or other complications. It sounds like you are getting
attention, but just make sure that you consult with your cardiologist
BEFORE reducing or going off clopidogrel -- the reason for taking it
post-stenting is to keep the blood from clotting inside the stent --
until the stent struts get covered by endothelial cells.
Angioplasty.Org Staff, Angioplasty.Org, May 2, 2010
I had an angioplasty in Mar and they put in
2 stents (2 different ones) and put me on Plavix and 325 mg aspirin.
I started bruising and the doc decreased my asp to 81 mg. 2 wks ago I
had 44 bruises of differing sizes. They were not sore and were diff colors.
I called cardiodoc who sent me for CBC that showed no problems and referred
me to my internist who took me off fish oil. I have an insulin pump,
am on crestor, accupril, atacand, toprol, as well as meds for depression
and asthma. I have also developed some aching lower back pain that comes
and goes. Internist did Xray and I don't know the results. She suggested
heat patches and or ointments. My mom has stents, dad and mat grandfather
died of heart attacks. I know I'm at risk for problems due to diabetes.
Have a personal trainer the past 6 months and working on food. Am 59y/o
female. I'm worried about the bruises and back pain. Working on dealing
with this. Thanks.
Susan, Springfield, Missouri, USA, May 2, 2010
I received a BS Taxus DES in June of 2006 post
MI at 40. I have been on time-release metoprolol (Toprol XL 50mg) Plavix
(75mg) and low-dose (81mg) aspirin for 4 years now. I have no major side
effects, my EV went up from 52 to 56. I am 44, healthy, active and do
both aerobic and anaerobic exercise. My doc is pretty progressive and
went with the drug regimen for life. 4 years in and all is well. Take
the Plavix, just do it, sure i bruise more easily and dental visits are
messy but it beats the alternative, pushing daisies. I for one am grateful
for these things, I could've been done at 40, my daughter was 9 then,
I was given a second chance, take the meds. No, I am not in the medical
field, I am in IT
Wes, Black Diamond Services, Broward County, Florida, April 30,
2010
Shelley -- having a stent put in, suddenly starting
on new medications AND stopping smoking after four decades -- these are
all life-changes that are enough to make anyone restless and sleepless.
It can take a while to normalize after such changes -- practice stress
reduction and don't stress out unnecessarily. If this continues, your
doctor may be able to prescribe something for sleep, but mostly it's
understanding that this is normal and there are many patients who feel
the same things. Does your hospital by any chance have a rehab program
where other stent patients get together to talk. This might help.
Angioplasty.Org Staff, Angioplasty.Org, April 27, 2010
My husband had a stent last week. Plavix, Metoprolol,
lasix and aspirin. He feels good but can't sleep. Up two days now with
very little rest. Is this a medicine side effect? Nerves? When he does
fall asleep, he wakes up startled, panting, I'm very worried about his
strength not coming back with no sleep. Was a 38 yr smoker, stopped cold
turkey 7 days now. Has always had mild insomnia but this is crazy. Any
advice?
Shelley, Vallejo, California, USA, April 27, 2010
Alan -- thanks for the post. The optimal duration
of Plavix after DES is a big debate among cardiologists. The one-year
recommendation in the Guidelines is really a guess -- read our
interview with Dr. Eric Topol about this. And there is a
trial right now in Brazil to test whether only 3 months
of Plavix is appropriate for the Medtronic Endeavor zotarolimus-eluting
stent. As for the Plavix rebound effect, we'll be posting an article
shortly with an update on this. Basically, the authors of the
original 2008 study have found the effect is actually more
pronounced than they originally thought, but another recent study has
shown no such rebound effect. It's not salesmanship -- it's a difficult-to-answer
scientific question, and it's a moving target because stents change,
drugs change, patients are all different, stent placement technique varies,
etc.
Angioplasty.Org Staff, Angioplasty.Org, April 25, 2010
Had a des feb 2010-prescribed statin-coreg-plavix-aspirin
for 1 year. Discontinued statin in favor of niacin therapy-doctor concurred.
I am a voracious researcher and have settled on ultra potency omega 3-coQ10-vitamin
d-niacin-aspirin-mini dose of ace and unfortunately the Plavix for 1
year.Read over a thousand posts regarding plavix and concluded the following.
Risk reward favors its use for a time if you can bear the side effects
and they are formidable. I don't believe there is a monetary conspiracy
among docs but I do believe they follow AHA guidelines to avoid liability
and litigation. There is also much distorted info for ex: Mortality rate
for statin use (4 year follow up) 3.1 deaths per 100-no statin it jumps
to 4.4. roughly a 35% statistical increase in favor of the statin. Sold
as a 35% increase, everyone is on board, however, it is only 1 less death
per 100. Considering the side effects and the cost the risk/reward is
seen in a different light. Plavix rebound-1.2% deaths in 1st 90 days
from heart attack taking plavix and 2.4% with cessation. Statistical
percentage significant but only 1 more death per 100. How results are
communicated are deceptive, but that's salesmanship.
Alan, Bend, Oregon, USA, April 19, 2010
I applied directly to the co. of bristol/myers
-- makers of plavix. Hosp. gave me all info. needed. The co. checks your
yrly salary and if you qualify, you can get plavix free or at reduced
price and it's mailed to your phd for pick up. Yes FREE. I'm one of the
pt. who had a med. stent put 1/5/2010. I'm on Plavix 75 & was reduced
to 81mg of aspirin from 325 after 1 month. I've exp. no out of the ordinary
major sym. that I've read as of yet except I've been cold even in the
warm weather and my feet hurt. Sometime I get slightly dizzy for no reason.
Have been told to stay on plavix for at least one yr. Should change my
diet and regular exercise for wt. loss. I'm 57
Cathy Ferraro, Springhill, Florida, USA, April 17, 2010
Aspirin should never be administrated to children
and young teenagers aged under 18, unless the doctor has recommended
it, because it is linked to the apparition of Reyes syndrome, a disease
that appears in the convalescence period from a viral infection.
Irene, Child Wiki, China, April 7, 2010
BB -- were you prescribed Plavix for a stent.
If so, was it a bare metal or drug-eluting stent. This is important because
the guidelines currently call for at least 12 months of plavix after
a drug-eluting stent. Your insurance company should cover that, if that
is your situation.
Angioplasty.Org Staff, Angioplasty.Org, April 7, 2010
i been in plavix for 10 months, my insurance
inform me they don`t cover plavix no more, so my question is if is any
alternative to plavix.
BB, Lemoore, California, USA, April 6, 2010
Dave -- glad to
hear of your recovery from a heart attack. Your "lifestyle changes" are
great. A word of caution to readers -- Dave is just about one year out
from DES implantation and recommendations are for aspirin plus Plavix
for a year. We do not recommend anyone ditching their Plavix prematurely
because Plavix is a powerful antiplatelet and anti-clotting agent and
natural supplements are probably not strong enough to substitute for
it. If you have a DES, you really don't want to play around with stent
thrombosis and early cessation of Plavix has been associated with stent
thrombosis. On the other hand, after one year there's no evidence that
continuing Plavix has any benefit vis-a-vis stent thrombosis prevention
-- although that hypothesis is being tested by the massive DAPT trial
that has just started -- but we won't have results on DAPT for several
years. As for Lipitor, if Dave's cholesterol is under control without
statins, good. Statins do have side effects. We do, however, strongly
recommend consulting with your cardiologist about any changes in medication.
Angioplasty.Org Staff, Angioplasty.Org, April 6, 2010
Familiar story.
MI in June 2009, five DES, released with a cocktail recipe for nasty
side effects (Liptor, Metoprolol, Plavix, Aspirin). Wanted to improve
my health rather than just treat some bits of metal but a good diet (loads
of vegetables, no grain or sugar), supplements (fish oil, ACE, niacin,
CoQ10) and natural thinners (red wine, turmeric, cocoa) compounds the
antiplatelet effect of plavix and aspirin. Over time ditched all of the
meds and all of the side effects with them. I now feel great, with no
pain inhibiting exercise (Lipitor & Plavix were the culprits here) or
extensive bruising following minor trauma (Plavix & Aspirin the culprits).
My bloods are very good - HDL 2.2 LDL 2.1 TG 0.6 BG 3.3 (all mmol/L)
with low platelet and white cell counts. BMI down to 22. Don't think
I would have gotten to here listening to physicians or nutritionists
Dave, Sydney, Australia, April 2, 2010
Ett in Illinois -- if you are 8 weeks out from
a bare metal stent implantation, you are past the recommended window
for needing DAPT (dual antiplatelet therapy, a.k.a. Plavix and aspirin)
-- so the danger of stent thrombosis is by and large over. You never
took Plavix? Well, consider yourself lucky and consider that your cardiologist
did an excellent stent placement job -- not taking Plavix after stenting
doubles the risk of heart attack (from blood clots) -- study just out
this week. Again, you are outside the window where DAPT is recommended
for bare metal stents (drug-eluting stents require a year minimum) but
you might want to ask your cardiologist if he/she feels Plavix would
be helpful in any way for you at this point. As for your PCP, if you
want to be a good proactive patient, you should definitely inform him/her
that the recommendation not to take Plavix was wrong and that all guidelines
state Plavix (or a similar drug like prasugrel or ticlopidine) plus aspirin
for 4-6 weeks minimum after bare metal stenting, and for one year at
least after drug-eluting stenting. You'd be doing your PCP's other heart
patients a service!
Angioplasty.Org Staff, Angioplasty.Org, April 2, 2010
I had an angioplasty and had two bare metal
stents put in the major artery after the doctor found 90% blockages.
I was told by the doctor who did the procedure that I needed to take
Plavix for 4-6 weeks afterwards. When I went for the follow up with my
PCP, he said since I was taking aspirin and there was no blockage now,
I didn't need the Plavix. When I followed up with the cardiologist 4
weeks after the procedure, he said my PCP shouldn't have told me not
to take the Plavix. Here's my problem: The procedure is almost 2 months
old. I haven't taken aspirin consistently and I haven't taken Plavix
at all. Does that mean I'm forming blood clots around my stents? What
can be done at this point? Is a heart attack or stroke inevitable?
Ett, Frankfort, Illinois, USA, April 1, 2010
I had two stents implanted in my LAD artery
in July 2004. My cardiologist still has me on Plavix & Aspirin Coreg,
and Simvastatin it has been 6 years and he insist that I should take
these medications for the rest of my life. Is this the normal practice?
Kalip, Trinidad and Tobago, March 31, 2010
CMN -- we're sorry for your loss. Your story
is important because early cessation of thienopyridines (antiplatelet
medications, one of which is clopidogrel or Plavix) is associated with
increased risk of stent thrombosis. Three years ago, the only alternative
to Plavix was ticlopidine -- it is similar and is used less because it
seems to have more side-effects, but some patients tolerate it better.
But stent patients should never stop taking prescribed drugs, especially
Plavix and aspirin, without first discussing it with their cardiologists
-- and to double check with their cardiologists even if another medical
professional gives different advice, including general practitioners,
dentists and surgeons. Lovenox is a blood thinner, but not specifically
the type of antiplatelet agent that would prevent stent thrombosis, although
some have reported using it as a "bridge" if they have to stop
Plavix for surgery, etc. But it's not labeled for post-stent use (well,
technically, neither is clopidogrel, but that's another story). Today,
there IS another drug, just approved last summer, called prasugrel (Effient)
-- it's slightly more prone to bleeding complications in some patients,
but also may not cause the same type of allergic reactions as clopidogrel.
Angioplasty.Org Staff, Angioplasty.Org, March 31, 2010
My 69 yr old father had a heart attack; stented
with Taxus; took plavix; got a rash 6 days later; dr in home town took
him off plavix as he suspected allergic reaction; put on lovenox in hospital
for 3 days; got back home and that night suffered stent thrombosis; home
town er gave "clot buster" IV; back to large medical center; told er
doc no plavix for 3 days; 600mg plavix stat; OK 10 hours later; no further
heart damage; stroke right in front of my eyes; major bleed; never came
home; died 7 days later; what role did lovenox play? did it do anything
at all to keep the stent from clotting? i don't think so but home town
doc says it did; all water under the bridge now (daddy died 3 years ago);
he's fine now; he's in heaven; kick myself everyday because i wish i
had insisted he stay on the plavix; i'm a pharmacist and feel responsible
or irresponsible as the case may be; just want to be advised once and
for all if the home town doc was negligent and that the lovenox could
not play the same role as the plavix. thank you for your time.
CMN, North Carolina, USA, March 29, 2010
i had 1 stent in dec have severe problems with
plavix. WHAT SHOULD I DO?
Lisa, Georgia, USA, March 17, 2010
Nancy -- fatigue is possible from a number of
things, both physician and emotional. Every patient reacts differently
to drugs as well as to the "news" that they have coronary artery
disease. You should definitely discuss his situation with his cardiologist.
Let us know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, March 17, 2010
My husband is on Plavix after having 2 stents
in Nov. '09.The fatigue is pretty significant. Exercise doesn't energize
him at all. He is weak, depressed, irritable, just feels really bad all
the time. We will ask his doctor again @ his next visit. Does Plavix
cause extreme weakness and fatigue? He has experienced some confusion.
It just concerns me. I don't know what is normal and what I should be
concerned about.
Nancy P., Florida, USA, March 16, 2010
G -- obviously you and your cardiologist are
not a good match regarding communications. Guidelines recommend 4-6 weeks
of Plavix and aspirin if you have a bare metal stent and a year if you
have a drug-eluting stent. These times are recommended assuming the patient
is not having bleeding complications. Maybe you should find a cardiologist
you can communicate better with and trust.
Angioplasty.Org Staff, Angioplasty.Org, March 16, 2010
I am taking Plavix and 325 aspirin. On 2/4/10
had one bare metal stent. Have experienced rectal bleeding called cardio
doc who would not come on the phone nurse told me go to emergency room
or my ppi doc. Nurse said doc said no matter what don't go off meds.
I picked bare metal stent because of future surgeries needed which i
have not done before because was taking care of my mother. Waited a long
time for them and want them done now. Cardio docs don't seem to agree
on length of time on meds. First of all i think it's a personal choice
on how much risk you want to take to improve quality of life not theirs.
If i constantly have to go to ER to keep taking plavix and aspirin. it's
not going to happen will adjust the meds myself and see what works best
for me. That BS line about discussing options with your doc who just
orders you around and could give a crap about what you think. I asked
my cardio doc a very important question he did not even give a verbal
response he moved his head side to side to avoid verbal discussion that
might take up more of his time. So is credibility in my eyes is 0 at
this point nuff said
G., New Jersey, USA, March 15, 2010
Kipper -- the OPTIMIZE trial is studying patients
after implantation of an Endeavor zotarolimus-eluting stent, not mitral
valves. And it is being conducted in Brazil only. You can read more about
it in our
interview with Dr. Fausto Feres.
Angioplasty.Org Staff, Angioplasty.Org, March 15, 2010
Is the OPTIMIZE trial for both aspirin and Plavix
for 90 days, or Plavix/aspirin for 90 days followed by aspirin for an
extended period? It's not clear from the announcements I've seen. Sure
would like to get rid of aspirin, since I have a prosthetic mitral valve
and need to take warfarin too.
Kipper, Tampa, Florida, USA, March 13, 2010
I have been on Plavix for four years and have
noticed things that I have never associated with the Plavix. I have a
dry cough sometimes for no reason. I also have started having horribly
totally sleepless nights even though I use a sleep aid. This is gross,
but I have also noticed that the Plavix seems to pass through my body
with actually dissolving. Have any other experienced these things. I
did notice others who said they experienced the cough and sleepiness.
I also stay horribly fatigued. I am 61 and not finding my years very
golden. I had a taxus coated stent implanted in 2005.
Anderson, Tennessee, USA, March 12, 2010
Tracy -- your cardiologist is correct that you
are past the recommended minimum for Plavix with a bare metal stent.
As for aspirin, we can't say, but you should have your cardiologist and
surgeon talk to each other. They may be able to come up with a strategy
that works for both and for you.
Angioplasty.Org Staff, Angioplasty.Org, March 12, 2010
I've had a bare metal stent for 6 months and
I am on 75plavix and 81aspirin. I need a lumpectomy/breast cancer surgery
and surgeon says he won't do it since my cardiologist says that I can
stop the plavix but NOT the aspirin. So, do I just keep searching for
a surgeon who will operate on me while I'm on aspirin therapy, or do
i stop the aspirin against my cardiologist's advice???
Tracy, New York, USA, March 10, 2010
Julian and Judy -- we are not aware of this
study or any class action suit that you have referenced. It is well-documented
that Plavix and aspirin are critical drugs for stent patients -- to keep
the blood from clotting inside the stent, which can cause a heart attack
or death. Considering many stent patients also have high cholesterol,
we can't believe that a nurse would advise you to stop taking the drugs.
Bleeding complications are a well-known side-effect of any antiplatelet
drug, which is why you should get regular check-ups when you are taking
them, and report any bleeding to your cardiologist. If patients suffer
untreatable bleeding, they are usually taken off the drug -- it's a matter
of risk-benefit. And we certainly don't agree with your assessment of "most
doctors", kickback, etc. We'd certainly be interested in looking
at the study you noted. Can you send a link?
Angioplasty.Org Staff, Angioplasty.Org, March 10, 2010
My wife had a
stint [stent] put in the last part of Dec. 2009. She was put on Plavix
and aspirin Since the Plavix she has had a persistent cough, has been
spitting up blood and spots have showed up in her lungs. There is currently
a class action law suit against the manufacturer of Plavix because of
these very things. Anyone with high cholesterol should NEVER be put on
Plavix it increases the risk of heart attack by TWELVE TIMES. This is
in a report on the internet. I checked with a friend of mine who is an
RN and she said that info is exactly correct and I had better get my
wife off this drug. Remember MOST doctors are in their practice for the
money and the kickbacks rather than really trying to help the patient
EVEN THOUGH THEY ARE AWARE OF THE DANGEROUS SIDE EFFECTS!
Julian & Judy Cox, Concerned citizens, Lakeland, Florida, USA, March
8, 2010
i had a stroke last May and had 4 weeks therapy
came home felt good was getting my mobility back and recovery was good.
As the months went by I noticed I was getting weaker and weaker. I though
it may be the meds, Plavix 75mg, Aspirin 325mg,and Lexapro 10mg once
daily. Do you think these drugs are right together? 66 y o and 168 pds
female? At bedtime Simvastatin 40mg, and Zeta 10mg.I have spoke to my
Dr. and no answers.
J, Texas, USA, February 24, 2010
MY HUSBAND HAD A STENT A YEAR AGO. DOC HAS
HIM ON IMDUR AND PLAVIX. HE HAS LOTS OF STOMACH PROBLEMS HE DID NOT HAVE
BEFORE. HE ALSO HAD A DOUBLE BY PASS SIX YEARS AGO. DO THESE MEDS CAUSE
OTHER PROBLEMS. THANK YOU.
Beverly, Ohio, USA, February 19, 2010
Frances -- Metoprolol is a beta-blocker, used
to treat high blood pressure. Statins are used to treat high cholesterol.
Both are issues with heart disease, and are often prescribed for heart
patients, but they are not directly related to the stent or the angioplasty
procedure itself.
Angioplasty.Org Staff, Angioplasty.Org, February 18, 2010
Age 81, stent placed 4 months ago. On Plavix
(1) and baby aspirin (1) and Metoprolol (2). After reading your replies
I'm am now more understanding about why I should stay on the Plavix for
a year. I'm curious about why the Metoprolol? I don't see it mentioned
on this site at all. What does Metoprolol do? You also don't mention
any Statins? Are they not prescribed? Thanks for providing this question
and answer site.
Frances, Knoxville, Tennessee, USA, February 12, 2010
will doctors still install a defibrillator
if you only stopped taking plavix three days before?
John F., Newcastle, New South Wales, Australia, February 8, 2010
The biochemical antiplatelet (anti-clotting)
actions of Plavix and aspirin are different, which is why they are prescribed
together. But if you are allergic to aspirin, it sounds reasonable to
increase the Plavix dose, although the "optimal" dose of Plavix
is the subject of much debate. For example, a study presented at this
past summer's European Congress of Cardiology reported that doubling
the dose of Plavix (clopidogrel) significantly reduced stent thrombosis
and heart attacks in patients with Acute Coronary Syndrome (ACS) but
that there was no difference between single and double dosing in patients
who did not have that classification. As to desensitization to aspirin,
that can only be done in specialized centers, and may or may not be successful.
Angioplasty.Org Staff, Angioplasty.Org, January 31, 2010
i had 2 stents put in this past week....and
i am allergic to aspirin. I have been told by my cardiologist to take
150mg of Plavix a day to compensate for the aspirin allergy. Will that
much Plavix cause any side effects? Should I go through the desensitization
for my aspirin allergy?
PJ, New York, USA, January 30, 2010
Stan -- are you on an ACE inhibitor? They are
known to cause coughs in certain individuals.
Angioplasty.Org Staff, Angioplasty.Org, January 30, 2010
I had a cobalt chromium stent implanted
in May of 2009. I had a 95% blockage in on of my arteries. I was put
on Plavix, 85mg of aspirin and simvastatin. I have had a nagging dry
cough since being put on the medications. Anyone else had the same?
Stan H., California, USA, January 28, 2010
Linda, Ron and others -- regarding the cost
of Plavix ($4/day) -- check out our Forum Topic on "Financial
Assistance" where patients have written about various programs
they have found for help.
Angioplasty.Org Staff, Angioplasty.Org, January 27, 2010
I have really found all the comments very
informative. I recently had a heart attack, on xmas as a matter of
fact and spent 2 1/2 weeks in the hospital. I have still having a problem
adjusting to this all. I am 54 yr old female. I have been depressed.
I too am on plavix (an having a hard time getting because of funds)
and aspirin 325. So the info has been very informative. I wish all
of us extended reasonable good health and the best to us all. One heart
to another. Love. (Oh an any help with info concerning getting meds
reasonable, please let me know. I was taking 2 pills now I have 11)
Linda, Gautier, Mississippi, USA, January 26, 2010
My husband had a FPO closure and therefore
he had to take plavix for 1 month. Since he takes the plavix (he also
takes asaflow 160 now for 1 year)he feels miserable.The second day
he had the baddest migraine he's ever had. The first 2 days he had
4 aura's a day with flashes in his eye and he had an enormous pressure
in his chest. He said his sight was very strange and this made him
very scared. Now 4 days later he is still dizzy (its like he's on a
boat all the time) has ear ringing (sleeps with ventilator to not hear
the ringing) feels very tiered so can hardly work. We contacted the
cardiologist and he told us we may stop the plavix, just may take the
asaflow 160 (no problems with asaflow 160).
Sylvia, Belgium, January 20, 2010
PLAVIX COST SO MUCH. WHERE IS THE LOWEST
PRICE IN THE USA TO BUY THIS? NO INSURANCE
Ron, Texas, USA, January 18, 2010
I had taxus coated stent (LAD) in 7/18/05,
Took plavix for 9 mos. and stopped against doctors advice. Then took
325 aspirin once in awhile,sometimes took baby aspirin. No problems.
In 11/09 Took scheduled 2 yr. nuclear stress test. Doctor said test
revealed minor blockage in 2005 (LAD). Needed to be cleaned up .After
cart. cath. done doctor said it was not old stent but (RCA). So another
stent placed on 11/20/09. Back on plavix, very high BLOOD PRESSURE & SEVERE
HEAD ACHES that doctor says is not related to procedure. I have seen
my primary doctor, ent, ,neurologist, & another internist. All have
prescribed meds that did not help. Was discharged from hosp. on 11/20/
09. Had to go to ER on 11/25 09 because of severe headache & high bp.
seeing cardiologist in morning. These problems all started 4 days after
starting plavix again. I am 62 yrs. old & have been suffering these
side effects for 50 sleepless, painful nights. Ambien has been a must
or i would be a zombie. Everyone needs to do more research on plavix!
And how accurate are nuclear stress tests????. Try MULTISLICE CT ANGIOGRAM
INSTEAD. Its not as invasive. Good Luck & hang in there. KEEP THE FAITH.
Landon, St. Louis, Missouri, USA, January 13, 2010
Keres -- check out our Forum Topic on Plavix
and Surgery. We assume that your 6 stents are drug-eluting types
(not bare metal). It would not be recommended to stop Plavix and aspirin
before the year is up, unless you have a life-threatening condition
-- but have your cardiologist and surgeon talk to each other. Surgeons
have found ways of operating (minor surgery) without taking the patient
off of these meds.
Angioplasty.Org Staff, Angioplasty.Org, January 12, 2010
aged 58,next to effort testing, coronography
realised end september 2009, 3 vessels obstructed and hardened,6 stents
implemented,of which 5 active. Plavix combined with Tahor and Kardegic
(aspirin) for at least one year.At the start,one month, double doses
created strange reactions in legs and hands and breast-pain during
efforts. After reduction to half doses, all side effects are gone.
Other effect: constipation while trialing diet to reduce weight from
86kg, to now 81kg, target 75kg.New problem arising: a colonoscopy has
identified some polyps (non-cancerous) to be surged.In search of alternative
medication in order to minimize risks for surgery. Any information
available?
Keres, Paris, France, January 12, 2010
Joe H -- whether or not omeprazole reduces the
effectiveness of Plavix has been the subject of much debate in the medical
community. The FDA issued a warning in November about this, but the story
is pretty complex. You can read about it in our blog posting, PPIs
and Plavix: Confusion Reigns Supreme.
Angioplasty.Org Staff, Angioplasty.Org, January 11, 2010
I have just had (3) three coated stints implanted
on 1/08/2010 and when I checked out the following day I was prescribed
with 75 MG Plavix and 325 aspirin. I am also on 20 MG Omeprazole. Should
I have any concerns with this combination of medication. After reading
the [below] above responses I have the above questions.
Joe H., South Carolina, USA, January 11, 2010
I had a MI in 2004 in my LAD. Had a drug eluting
stent put in. I have been on Plavix and baby aspirin for five years now.
Seems like I should be able to discontinue the Plavix! Isn't this a long
time to be on this med?
Karol, Michigan, USA, January 2, 2010
Fabi -- last summer the FDA
approved Prasugrel as an antiplatelet med (brand name "Effient").
The drug is currently under review by Health Canada, but not yet approved
there.
Angioplasty.Org Staff, Angioplasty.Org, January 2, 2010