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Plavix, Effient, Aspirin and Stents (2010 archive)

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

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Archived Postings from 2010 on This Page (217):

• 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 which point I will go back to aspirin only. I've had only minor side effects from the 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

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 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 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 Reye’s 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

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

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

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