Plavix (Clopidogrel) and Surgery

Current Postings (188)

• Devan 313...I am in the very same predicament as you. Please if you get any positive answers on what we can do, let me know.
Mares, Retired, Pittsburgh, Pennsylvania, USA, August 8, 2010

• Worried from Simi Valley -- it seems from your posts that your mother did not get a stent, but a porcine aortic valve replacement (a bit off topic, since this topic is about getting surgery while needing to take Plavix because of a stent placement). It would not seem wise to keep your mother from a cardiologist or cardiac surgeon. After all, she's received a very sophisticated medical treatment -- if she is not well, fainting, etc. she needs to be thoroughly evaluated. Perhaps the valve is not working correctly and needs adjustment. Perhaps Plavix was causing bleeding, thus the low red count. Whatever the cause, we'd urge you to have her get a follow-up with a cardiac professional.
Forum Editor, Angioplasty.Org, July 7, 2010

• (Follow-up to post of May 22) My mother stopped taking Plavix since she had a low red blood cell count and instead takes baby aspirin to thin her blood in addition to drinking plenty of water. She also takes iron plus C from Shaklee so that her body makes more red blood cells to carry oxygen. She wasn't getting any oxygen to her brain!
Worried, Simi Valley, California, USA, July 7, 2010

• devan313 -- the recommendation from the major cardiology and surgical societies is that the surgeon and cardiologist talk to each other in cases like this,. It is definitely NOT advised to stop Plavix only 3 months after a stent, if it's a drug-eluting stent. It may be that when the surgeon understands the risks of stopping, he/she may devise a way in which the procedure can still be done. Read through other responses in this topic for more info.
Forum Editor, Angioplasty.Org, July 7, 2010

• I need a spinal injection for spinal stenosis. I have nerve damage in my leg due to this problem. I had a stent put in in April. My cardiologist will not let me come off of Plavix to have the procedure done, my cardiologist (do you mean "surgeon"? - ed.) will not do the procedure while I am on Plavix. The pain is unmanageable, the doctors are unmovable. What alternatives are there??
devan313, Somerset, New Jersey, USA, July 7, 2010

• Tim -- this is a question for your interventional cardiologist -- odds are that he/she will not want you to stop Plavix at all, since it is often given as a drug during stenting procedures to keep the blood from clotting. But check qith your interventional cardiologist (the one who will be doing the cath).
Forum Editor, Angioplasty.Org, June 20, 2010

• How long do i need to be off plavix before heart catheterization to check my stent -- Bare metal stent placed in on march 2009 -- due to ongoing chest pain off and on.
Tim In Florida, Walton, Florida, USA, June 16, 2010

• My mother had a porcine valve put in to replace her aortic valve in 2000. We had problems with cardiologist later and to make a long story short when she fell over recently I took her to the emergency room and insisted that she not get a cardiologist. I think they were ignoring my request and preparing her for an echocardiogram and gave her Lovenox. I stopped the process after the echo and was preparing to take my mother home. They suggested I leave her in the hospital for the weekend and now she gets tired just going to the bathroom which is right next to her bed. I typed the terms into the search engine to find that Lovenox doesn't go well with Plavix. Any help out there?
Worried, Simi Valley, California, USA, May 22, 2010

• Art -- 12 months is the recommendation of the FDA panel that studied stent thrombosis in Dec 2006. A major study, called DAPT, has just started enrolling and that may give some answers. However, there are two studies being done with the Endeavor stent, called OPTIMIZE and SEASIDE) that are testing shorter periods of 3 and 6 months -- but only with this stent, since there is some evidence that the Endeavor "heals" more quickly than others. Read this entry, "Plavix After Stents: How Long?", from our Editor's Blog for more detailed info.
Forum Editor, Angioplasty.Org, May 21, 2010

• What study recommends 12 months of Plavix following stent to avoid thrombosis? Is there a study that it is generally safe to go off Plavix after 12 months?
Art, New Jersey, USA, May 18, 2010

• Paulette and Dave -- if you had a drug-eluting stent placed, the guidelines recommend at least 12 months of Plavix. The reason is to prevent stent thrombosis -- the blood clotting inside the stent. If you had a drug-eluting stent, then it would be wise to wait the short time until a year is up. But you should definitely run all this by your cardiologist. Patients should not go off Plavix without talking first with their cardiologist -- not their surgeon, their cardiologist -- some surgeon are not as aware of the risks involved in stopping Plavix prematurely. And Dave, why would you need to go off Plavix to get shots for nerve pain??
Forum Editor, Angioplasty.Org, April 23, 2010

• I had a stent after suffering a heart attack in July 2009. I want to have weight loss surgery but am taking Plavix. Question is: is it safe to go off Plavix for the 6 or 7 days prior to surgery? To me, the benefits of getting the surgery are great as it will help with my heart and diabetic problems. Thoughts?
Paulette, Manteca, California, USA, April 23, 2010

• HJG -- we also do not know of a study on enoxaparin (Lovenox) as a bridge therapy. No elephants in Ohio aside, this is a difficult problem with no clear answers or evidence-based medicine to guide one. A future hope is that trials with ticagrelor will pan out, and that the FDA will approve it. It works as well, if not better, than Plavix, and does not depend upon being metabolized -- thus it can be turned on and off quickly, making it ideal for the patient undergoing surgery. Your advice about staying on low-dose aspirin seems wise as well.
Forum Editor, Angioplasty.Org, April 14, 2010

• I have yet to come upon a definitive comment on using Lovenox for bridging to surgery in order to stop plavix 5-7 days before surgery, with the plan to reload with plavix the evening after surgery is completed or first thing the morning after. As far as I know there are no studies that look at this specific question, ie: no evidence based medical opinion. As a cardiologist I have been doing it with great success (no stent thrombosis) but it also may be a case of it also keeps the elephants away (as I live in Ohio and not Africa, or near the zoo). I have advised my patients to stay on 81 of ASA straight through. I have a case now of a patient with three overlapping BMS in the LAD with a separate DES more proximally in the LAD, and another stent or two, not overlapping, in the RCA and PDA. Last stent was placed over two years ago. I am reluctant to stop plavix here because of the complex multiple stenting. We are discussing whether to operate on Plavix, stop Plavix and bridge with Lovenox, or to bring him in early and as we come off plavix, start him on a IIb/IIIa infusion, to be stopped six hours before surgery. Your thoughts. Thanks.
HJG, VA, Columbus, Ohio, April 12, 2010

• i just a week ago had two medicated stents placed. i need shots every month for severe sciatic nerve pain. what are the risk of getting off plavix for 3 days prior to?
Dave, Marlboro, Massachusetts, USA, April 7, 2010

• Lina -- why is your mom taking Plavix. If it's because she's gotten a drug-eluting stent, current U.S. guideline are for twelve months of Plavix and aspirin (and aspirin thereafter). Stopping Plavix prematurely is always a risk. You need to discuss this with your mother's surgeon AND cardiologist.
Forum Editor, Angioplasty.Org, March 17, 2010

• My mom has stopped plavix 7 days prior to surgery. What about an optimum time to get back on it. Is total of 14 days away from Plavix too much, or what is the trend, since orthosurgeons like to stay away from plavix 5-6 days after surgery.
Lina N., Pharmaceutical company, Amman, Jordan, March 13, 2010

• The main complication from anticoagulation drugs (like Plavix) is bleeding. So the risk/benefit of bleeding/clotting must always be weighed -- and this is a difficult call.
Forum Editor, Angioplasty.Org, February 15, 2010

• my husband had 13 cardiac events in 2009 was placed on many meds a pacemaker defibrillator and of course Plavix...today he was admitted with an upper gi bleed of unknown etiology and his cardiologist is gone until next wednesday..the pcp and surgeon is holding the anti coag meds and doing an EGD in am...His last cardiac event was October..The rush is to id the source of the bleed quickly as to decrease the risk of clot while off of plavix..do you agree with this reasoning Thank you
SW, Dubuque, Iowa, USA, February 11, 2010

• Sorry -- not sure which study you're referring to. If it's the Plavix "rebound" effect VA study out of Colorado, we don't know of a British study like it.
Forum Editor, Angioplasty.Org, January 8, 2010

• I was on your forum yesterday. I'm a Plavix patient (10 years) facing a needle biopsy. I found a link to a British study of 3000 patients which came to a similar conclusion to the American JAMA veterans study, and now I cannot find the link to that British study. Please help me if you can - my doctor wants the reference. Local options are limited.(An email response rather than posting would be fine).
Shirley L., retired, Saint Thomas, U.S. Virgin Islands, January 4, 2010

• To all posters with questions -- if you browse through these posts, you'll see that many many patients and their physicians are struggling with the same questions. We have referenced position papers throughout, but the bottom line is that you need to be proactive in these situations and get your interventional cardiologist and surgeon to talk to each other and resolve the issue, specifically with you in mind, because every patient's clinical pciture is a bit different and that will affect the course of therapy.
Forum Editor, Angioplasty.Org, December 29, 2009

• My mother is a diabetic, with many issues present/past. In 10 days she is due to have her gallbladder removed. She does have a heart stint [stent] and is on plavix. The doctors say she need to be off the medication prior surgery. She had so many ups and downs due to diabetes. She's had 1 leg removed. She's been in and out the hospital for 1 reason or another. She's had a stroke x's 2, been on a feeding tube..which later gotten infected at the site, had to go under the knife, because the problem was worse. However, my concern is the diabetes and going off of plavix and complications of Gallbladder surgery.
S. Gibbs, El Paso, Texas, USA, December 26, 2009

• I had two Promus Everolimus Eluting Stents put in a month ago and am taking Plavix and 85mg aspirin . I had two bone grafts for tooth implants done 5 months ago and now I am in Thailand to have the implants installed but the Doctor wants to give me Via K to help before. I feel OK about having the implants installed. He will do one first then the other later. Has anyone else been through this?
David Taylor, Phoenix, Arizona, USA, December 7, 2009

• I am 50 years old and pre menopausal with fibroids, I had a heart attack 7/09 had 2 drug eluting stents and an angioplasty. I am on plavix and baby asa. My problem is bleeding due to fibroids, I have been hospitalized twice for transfusions (3 units the first time and 4 the second for a HCT of 18). I have received depo provera shots x2 and am taking oral provera daily. I have had vaginal bleeding every day/all day since 8/6/09. My gyn wants to do a hysterectomy since medical management is not working, my cardiologist says the plavix cannot be discontinued for 1 year. but the surgery could be performed while on plavix, has anyone had surgery while on plavix? and for any women with similar problems, did any drug therapy work for your bleeding?(I've already had an ablation procedure and they cannot do it again). Thank you.
Laurie B., Severna Park, Maryland, USA, November 11, 2009

• What is the risk of giving a patient Plavix after a gall bladder surgery? My mother, a stent recipient, had routine gall bladder surgery and at time of release from hospital was given Plavix, aspirin, toprol, and vicodin. She is now in ICU with internal bleeding, which seems to be unstoppable. Does anyone have any idea if the plavix dose would seem to be the catalyst for these issues?
Jim, Rockville, Maine, USA, November 8, 2009

• Eight months ago ,I had a drug-eluting stent put in. I am on Plavix and aspirin. The cardiologist said I cannot, under any circumstances ,stop the Plavix for at least a year - maybe two. I also have a torn meniscus, though recently diagnosed, it happened eight months ago ,as well.Is it possible to undergo arthroscopic surgery on my knee, without going off the Plavix? I am 55 years old.
Shelley, Tel-Aviv, Israel, October 29, 2009

• my mother is known patient of diabetes, hypertension and obstructive sleep apnoea.she is suffering from osteoarthritis of both knee joint and in need of bilateral total knee replacement surgery.we are planning for coronary angiography and if required than angioplasty.so would it be possible to have his knee surgery after angioplasty.if possible then when ?
Manazir I, N.G.O, INDIA, October 14, 2009

• have 2 bare metal stents in 2001.have 1 drug eluting stent put in 4/09 {this year} Oral surgery necessary!,need 7 teeth extracted. Dentist says i bleed so much that no way can operate with plavix.had a coronary but am doing well .back to aggressive exercise ...am a diabetic,..thank you!
Frank P., Carmel, New York, USA, September 16, 2009

• My husband has been recently told that he has to have (for now) his right lobe of this thyroid removed. He is on the drug Plavix. The doctor has told him he needs to be off the Plavix for at least 10 days. Can he just quite taking the Plavix or should he see his cardiologist. It has been two weeks since he was told and the doctors office is suppose to be getting an appt. from the cardiologist, but we still have not heard a thing. That's why we didn't know if he could just quit taking it or does the dr. (cardiologist) have to say so. The throat dr said he needed the surgery asap. Just wondering.
Tina F., Charleston, West Virginia, USA, August 24, 2009

• My 3 original stents were placed in 2004 (1 LAD, 2 RCA), I then had to have another put in due to artery spasms downstream from the 2 in RCA (2005). Then 3 months later one of the original stents in RCA had LST and was an emergency. My cardiologist seemed very concerned about the surgery. He did mention that they have been in for a long time and should not be a problem, however data may be skewed due to everyone staying on plavix longer than a year or forever. The surgery is not life threatening, it is a quality of life and work issue that I may have to live with for awhile. If I had thrombosis again, it may be fatal or require bypass due to bifurcation stent in LAD, or inability to place another stent in RCA. I had read an article that actually states the higher risk for thrombosis is actually during the surgery, not necessarily the timeframe before? I will discuss further with my family doctor, but I am leaning towards trying to not have to have surgery until they possibly come out with the new platelet drug. Have you heard of it? I do not want to end up a statistic. Thanks for your help, it is nice to have this forum available for patients. You guys are great. (RTS -- the new antiplatelet drug I believe you are referring to is Prasugrel -- and thanks for the compliment! -- ed.)
RTS, Florida, USA, August 18, 2009

• RTS in Florida -- How long ago did you get the drug-eluting stents implanted? Most recommendations are for a year minimum and possibly longer, but the evidence that two years is better than one, or even that one year is better than six months is still not proven unequivocally. You reported that your "stent-within-a-stent" was used to treat a thrombosis or blood clot in the existing stent. Yes, this is an off-label indication for stents, but there really is no other way to treat this -- we assume it was an emergency situation. Are you sure it was a thrombosis (clot) in your stent and not restenosis (which is the tissue regrowing inside the stent)? Also, a bifurcation lesion is difficult to stent because of the anatomical characteristics of stenting two vessels at a branch -- yes, this also is technically "off-label" and also at a higher risk for restenosis. "Off-label" means the device has not gone through the extensive randomized trials specifically for that particular usage and presented to the FDAv-- although there have been many studies of stents used in this way. We recommend doing what you are doing -- work closely with your interventional cardiologist and let him/her discuss the back surgery with your neurosurgeon. How immediate is the need for the back surgery? Can it be put off? Etc. Stent thrombosis is very serious -- an immediate blocking of the artery by a blood clot is what causes a heart attack.
Forum Editor, Angioplasty.Org, August 17, 2009

• Just returned from cardiologist in regards to my back surgery. Cardiologist stated that there is a low risk (5-10 percent) of Very Late Stent Thrombosis due to my previous thrombosis. I have 5 Stents (3 taxus, 2 Cypher) 2 stents that are considered 'off label' one is stent within a stent due to late thrombosis and one which was a LAD bifurcation? He said he would prefer I have surgery as last resort and if I had to have it he would recommend diagnostic angiogram prior. He is going to send a letter to neurosurgeon to discuss further. The neurosurgeon would prefer 6 weeks off of plavix (due to his own practical experience with plavix) but cardio says no longer than 2 weeks. Cardio did mention a new drug coming out in a few years that will be used with plavix to enable surgery without such a risk. It starts with a 'K'? Do you know what this new drug is? Also why is LAD bifurcation considered 'off label'? Thanks for your help!
RTS, Florida, USA, August 17, 2009

• Lynn D. -- Plavix is an anti-thrombotic drug, designed to keep the arteries open. There have been studies showing a connection between gum disease and coronary artery disease -- the same bacteria are found in both plaques.
Forum Editor, Angioplasty.Org, August 8, 2009

• What studies are being done for patients on plavix and their dental conditions. Isn't there a risk of plaque breaking off in large amounts due to the plavix medication and possibly causing strokes or heart attacks?
Lynn D., unemployed, Florence, Kentucky, USA, August 5, 2009

• Ben -- you are welcome. Regarding MRI and the Endeavor stent, we are cross-posting your query on the Stents and MRI topic. By the way, re: your concerns about stent thrombosis -- in our interview with Dr. Giulio Guagliumi, he discusses how the Endeavor stent (zotarolimus) acted differently from the other DES, in that, while it allowed the tissue to grow a bit more than the others, the tissue regrowth was very smooth and uniform and all the stent struts were covered at 6 months -- better than the results with the bare metal stent. This does not in itself mean that the Endeavor will have lower stent thrombosis -- but it's an interesting direction for further study.
Forum Editor, Angioplasty.Org, August 2, 2009

• Thank you once again for providing information (and for me a sense of knowing a little bit of what is going on). One final question, this concerning MRI, which is a separate Forum topic. A previous post has indicated that "the U.S. FDA approved both Boston Scientific's Taxus and J&J's Cypher for immediate MRI." I have a Medtronic Endeavor DES. Is there an FDA approval for MRI with this stent? Thanks once again.
Ben H., Massachusetts, USA, August 2, 2009

• Ben H -- your questions around surgery, radiation and prostate cancer treatment are beyond the scope of this site, but here are a couple thoughts. While it is known that anesthesia can affect ejection fraction, there are techniques and protocols that lower risk -- also while 40% is lower than "normal" it is well above what many studies usually call "low" which is around 25%. Some studies define "preserved ejection fraction" as "equal to or greater than 50%" -- but some use 40% as the cut off. As for concern over stent thrombosis, more and more evidence is accumulating to show that the mechanisms for acute thrombosis (right after stenting) and late stent thrombosis after a year or more may be different, so the fact that you had acute ST may not impact the risk as heavily for late ST. Also the fact that you successfully stopped Plavix previously is good.

However, these are complex questions and only MDs who specialize in these areas are qualified to answer them. Sounds like your cardiologist and surgeon are talking to each other (if not, invite them to have a beer with you!) -- it's important that all specialists who will be involved in directing your treatment (including the anesthesiologist) are informed about your specific conditions -- that's a good route to a successful outcome -- and in these days of somewhat fragmented communications, patients can help themselves by facilitating it. Your main question of whether your heart condition would be a reason to eliminate surgery as an option is a difficult one. Perhaps consulting more than one surgeon/cardiologist would be helpful. Again this is NOT medical advice from a doctor, but we hope this is of some help.... Let the Forum know any updates.
Forum Editor, Angioplasty.Org, August 1, 2009

• From Ben H in Massachusetts:Re: my prostate cancer: The "Watchful Waiting" period is in the past. I need intervention at this point - either surgery or radiation (I have Gleeson scores of 7 and 8). For the most recent biopsy (and a colonoscopy a day earlier) I was off Plavix for ten days; presumably, the absence of Plavix for a second time will not be problematic. My principal concern is my EF of 40 together with fact of the "acute stent thrombosis" a few days after the initial stent placement (July, 2008). The question I wanted pose is whether there are any studies which link these two factors to a greater risk of complications resulting from 1) blood loss resulting from prostate surgery (in my case, laparoscopic) and 2) the anesthesia required for such surgery. Any published information (or personal observations) would be helpful. Thank you.
Ben H., Massachusetts, August 1, 2009

• Ben H -- one question for the cardiologist is whether you should go off Plavix -- something you'll have to do to get the surgical option. You're a year out which is the recommended point to consider stopping Plavix after stenting, but you did restenose right after the stent placement (known as "acute stent thrombosis") so you may be more "thrombogenic" or prone to blood clotting -- in which case continued antiplatelet therapy is a factor to be considered. However, none of this should be viewed as medical advice long-distance to you. Your doctors are the best guides here, and there are a number of approaches to prostate cancer, including watchful waiting. Let us know which route you take.
Forum Editor, Angioplasty.Org, July 31, 2009

• After a "massive" MI on 7/10/08 I had a DES placed in the LAD. Four days later a restenosis occurred. I am now stable, taking Plavix, aspirin, doing regular exercise, healthy diet, BP of 120/70. EF is 40. I have now been diagnosed with prostate cancer; one option for treatment is surgery under general anesthesia (the other is radiation therapy, requiring no anesthesia). Are there any stats on whether there is a higher mortality rate for surgery with my history and EF? The surgeon and cardiologist say I shouldn't worry, but I find this less than reassuring. Any comments or observations? Thanks.
Ben H., Massachusetts, USA, July 30, 2009

• Just came back from neurosurgeon. Need to have a four hour lumbar fusion due to stenosis. However, he will not do the surgery until I am off Plavix for 6 weeks. I have 5 medicated stents, originally started with 3, but 2 closed after late thrombosis. I cannot work with the stenosis, but do not want to risk heart attack without plavix. Will go to see Cardiologist for his opinion, but neuro said not Dr in his right mind would do the surgery without being off for 6 weeks.
JoeD, Dunedin, Florida, USA, July 6, 2009

• Robert T. I feel your concern. I have torn ACL in right knee. Been like this for 5 years now. I fell off Treadmill in cardiac rehab 10 days after I receive DES stents and placed on Plavix. Still no surgery but have had cortisone placed in the knee and Synvc (maybe spelled wrong) Cardio says NO SURGERY! OS says Surgery and to be off Plavix for 5-7 days.....I listened to my Cardio and am waiting for new data that says, "after 5 years on Plavix. it is safe to go off Plavix for a certain time for elective surgery". Have not heard that statement yet. I wish you better days ahead....
Macy, Sugar Land, Texas, USA, July 2, 2009

• Joseph -- see our response to Bobbie from June 10.
Forum Editor, Angioplasty.Org, July 2, 2009

• I have a very serious Hernia problem for over 6 months now. It had gotten so bad that it impacts my mobility and an operation maybe required. I have been on Plavix for over 2 years for heart problem (Angina). Questions: 1.can patients who are on Plavix undergo surgery if Plavix is not stopped prior to surgery? 2.What are the risks and prevention measures? 3.Would athroscopic surgery be a better choice for the Hernia?
Joseph M., Toronto, Ontario, Canada, July 2, 2009

• Alicia -- as noted throughout this Forum Topic, these questions are best resolved by your cardiologist and surgeon talking to each other. If his stent was in October, that's eight-plus months and is past the critical six-month period of antiplatelet therapy -- but every patient is different. Ask the docs to talk to each other.
Forum Editor, Angioplasty.Org, July 2, 2009

• My husband is 48 and had his second stent for a 90% blockage in October, he is an x-pro nfl player and needs to have his left rotator cuff and bicep reattached, he was in great shape until 2 years ago when he had to give up running due to an old back injury that had progressed to a degree of no return, according to dr. Barth Greene. He has the normal NFL problems, enlarged organs including heart, never took any drugs until all that he has to take now due to high blood pressure and cholesterol, as well as the stent. He is in pain from the shoulder and wont take pain med's which leads to the pain causing the blood pressure to remain high. He needs to be on the Plavix but can he be off for a few days to have the surgery since he has been on consistently for almost 6 months?
Alicia N., Florida, USA, June 30, 2009

• Bobbie -- are you taking Plavix because of a drug-eluting stent implantation. That's the situation in which it may be dangerous to stop Plavix -- if so, when did you have your stent?
Forum Editor, Angioplasty.Org, June 10, 2009

• I had a minor stroke in December/January I am currently facing hysterectomy and bladder repair. Doctors are really harping on me about stopping Plavix prior to surgery. Surgeon will not touch me if I don't go off and neurologist says I could have a more serious stroke. I am so confused; don't know what to do. Help, please! Bobbie (67 years old)
Bobbie C., Akron, Ohio, USA, June 9, 2009

• I need surgery. I have 3 medicated stents and 1 metal stent. I have a retroperitoneal mass that needs to come out. I am also on Plavix and Coumadin, clotting issues. The last medicated stent was placed 4/7/09. I have already had x2 needle biopsy which were inconclusive and was on LOVENOX and had a major reaction to. So I am up a creek without a paddle. Can anyone give me advice?
M, North Carolina, USA, June 4, 2009

• Ang -- key information is when your father got the stents, and what kind were they? Taxus? Cypher? Endeavor? Xience? Or bare metal?
Forum Editor, Angioplasty.Org, May 25, 2009

• my father has been diagnosed with bowel cancer. Definitely needs operation. Has been waiting 4 weeks for an ultrasound (and at same time, a biopsy) to check a 'fatty deposit' in his tummy to check it is not suspicious. If found to be cancerous, this would be operated on at same time as bowel problem. Has been told today that hospital is not willing to carry out test because of risks involved. He is on plavix and aspirin and has 6 stents fitted. Consultant told us 4 weeks ago, that he would stop plavix 10 days before operation on bowel. How high are the risks involved. Not that there are too many choices re: surgery, as he needs operation. ???? What is the way forward?
Ang, London, England, May 25, 2009

• Robert T. -- all recommendations we've heard are to delay elective surgery as long as possible, so you don't need to go off Plavix. Plavix was originally recommended for 6 months -- now no one is sure how long, but a year is what's recommended. See if you can get the surgeon and cardiologist to work this out together -- so you're not caught in the middle. Perhaps there's a temporary solution where you don't have to go off antiplatelet therapy entirely.
Forum Editor, Angioplasty.Org, May 21, 2009

• Had a coated stent 12/08. Need knee replacement, quite painful. Typical problem, Surgeon "Go off plavix for 5 days" -- Heart doctor "NO". Question: Any data on danger of going off Plavix for 5 days? Heart doctor "Stay on plavix for 12 months". I fear that even after 12 painful months he will say "Stay on Plavix forever".
Robert T., Indian Head Park, Illinois, USA, May 20, 2009

• Nancy -- one-third of patients referred for invasive angiograms are considered negative for coronary artery disease -- they don't have it! And the numbers of false positives are higher in women. Unless there is an emergency situation, there is no reason to convert a diagnostic angiogram into an intervention (i.e. a stent, etc.). Data has shown that in arteries greater than 3.0mm in diameter, there is no advantage of a drug-eluting over a bare metal stent..
Forum Editor, Angioplasty.Org, May 18, 2009

• I am scheduled for a cath on Thursday after a stress test shows possible blockage in right cardiac artery. Dr said - well DES of course, don't consider the bare metal stent. I am terrified at the thought of being on Plavix for who knows how long. Does this mean I have to stop running around the woods with dogs? What about surgeries? My husband had a plain metal stent in 2003 and has had zero problems. I am reading the DES if they do clot tend to go "WHAM" whereas the plain metal, change in occlusion is seen over time. What to do? where to look? I only have a few days. Also I take 40mg of nexium [2 twice a day] for LERD [worse than GERD] and he did not even mention that!
Nancy, South Carolina, USA, May 18, 2009

• Yes, it is a drug eluting stent. We received a phone call from the Orthopedic Surgeon last night letting us know that this coming Tuesday (May 19) there will be a meeting held between the Hospital, Cardiologist and the Orthopedic Surgeon to come up with some kind of decision on how to proceed. My husband is so nervous, irritable and not even to mentioned in so much pain now that the pain meds are not even helping anymore. You would think in this day in age, that there would be some kind of solution for this mess.
Deb, New Jersey, USA, May 18, 2009

• Deb -- sounds like a meeting or consult among the surgeon and cardiologist is the correct way to proceed, recommended by all the major professional medical societies. This is a complex situation -- what type of stent did your husband have -- we assume it was a drug-eluting stent. Most cardiologists keep patients on DAPT (dual antiplatelet therapy of aspirin and Plavix) for at least a year -- aspirin for life -- assuming there are no adverse effects.
Forum Editor, Angioplasty.Org, May 15, 2009

• My husband was scheduled for surgery yesterday, May 11th for a total hip replacement which was cancelled on May 10th. We were told that the cancellation was due to my husband taking Plavix due to a stent that was placed 1 year ago. His Cardiologist refuses to take him off the Plavix however did take him off the aspirin but the hospital, anesthesiologist and the blood bank have refused the Orthopedic Surgeon to do the surgery. We were told by the Cardiologists that if he comes off the Plavix, the blood will thicken and then may clot and cause a heart attack. As of right now, all people involved are supposed to be having a meeting to come to a decision on how to proceed.
Deb, New Jersey, USA, May 12, 2009

• Susie of Denton, TX: My sibling has had basically a similar situation. He is now in the hospital and is trying to fight the staph infection which has set in. How is your husband? The doctors are communicating with one another but they are very wary of doing surgery unless absolutely needed due to the Plavix/Stents issues. Hope your husband is alright. Found out from others that whenever there is a knee replacement that antibiotics should be used, even for teeth cleaning. Maybe more common than we know.
HH, Atlanta, Georgia, USA, May 2, 2009

• Shirley and Thelma -- we can't give medical advice to specific patients, nor should any internet site, but we can refer all readers to the 2007 Joint Science Advisory on this topic, "Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents". We covered this in our article titled, "New Advisory: Will Stent Patients and Their Doctors Get the Message?". Bottom line: Plavix and aspirin are important to take for one year. The jury is out on how long it's necessary -- the biology of why very late stent thrombosis occurs is still not completely clear -- and it is a relatively rare event. Your cardiologist may have you on Plavix for other reasons as well. We can only state that it is important to discuss these issues with your doctor, and we encourage having your surgeon and cardiologist discuss these issues with each other as well.
Forum Editor, Angioplasty.Org, May 2, 2009

• Can anyone give us some advice. My mother had a drug eluting stent placed 3 years ago and has been on plavix since. At that time she need to have major back surgery but her doctor told her that he wanted her to be on plavix for 4 years before going off of it for surgery, not even for the one week needed. But she is now having difficulty walking and the consequences of her weight gain, possible diabetes and lack of exercise, not to mention the horrible pain, is going to be more debilitating than the low risk of going off of the plavix for one week to have the surgery. Is there any evidence to show us actually how what her risk would be if she where to have this surgery now. Again she had a drug eluting stent put in 3 years ago and has been on plavix for 3 years? I needs stats to convince her cardiologists that his concern is crippling her. Thank you so much.
Shirley B., Ohio, USA, April 21, 2009

• What were the results from Dr Waksman at the ACC meeting at the end of March? I will be needing surgery for cancer at nine months.
Thelma B., Ohio, USA, April 20, 2009

• A Canadian study just published online in Circulation is titled, "Safety of Short-Term Discontinuation of Antiplatelet Therapy in Patients With Drug-Eluting Stents" and looks at the issues everyone on this Forum is concerned with. The authors studied Medline reports of confirmed stent thrombosis from 2001-2008 and they conclude that it may be safe to discontinue Plavix or related antiplatelet meds, as long as aspirin is continued. However, several cardiologists, commenting on this study on theheart.org, are circumspect about these findings and think that the study's approach is too simplistic. There is broad disagreement about these issues in the cardiology community -- more data is needed, but one thing many do agree on is that the tendency toward thrombosis varies from individual to individual. Which is why it is important to discuss this with your cardiologist who knows you. Perhaps there will be more accurate tests in the future that can predict this. Dr. Ron Waksman of Washington Hospital Center specifically stated that his team will be presenting papers at next week's ACC meeting on this subject, so stay tuned....
Forum Editor, Angioplasty.Org, March 22, 2009

• Ira -- any blood in urine, especially when you are taking blood-thinners, should be reported to your doctor right away. Make sure both your doctor and surgeon are aware of your drug regimen (noth prescription meds and over=the-counter), and don't start or stop medications without their knowledge and approval. Let us know how things progress.
Forum Editor, Angioplasty.Org, March 21, 2009

• I RESTARTED TAKING MY PLAVIX THE DAY AFTER HAVING A TRANSURETHRAL BLADDER TUMOR RESECTION TWO WEEKS AGO? I'VE BEEN URINATING LOTS OF RED BLOOD AND BLOOD CLOTS SINCE THEN. SHOULD I NOT HAVE RESTARTED THE PLAVIX?? THANKS FOR YOUR HELP.
Ira R., retired professor, Canada, March 20, 2009

• I am 46 years old. I had DES-stents placed in mid LAD and proximal first diagonal in January 2005. I started taking Aspirin/Plavix every day since then. My cardiologists always tells me to take it forever. Because of financial problem, about nine months ago I stopped plavix for 5 weeks and then restarted it again but taking it every other day. Now I want to stop it completely. What are the risks of stopping plavix given my history and the fact that I am taking it every other day. If I stop it today, how many days later I could have a surgery. I already appreciate your help. Thanks.
Alex, Los Angeles, California, USA , March 19, 2009

• Hello, this is BobF, I originally had 3 Taxus Stents in June 04, then another Taxus in Apr 05. Then one of the Taxus closed up in June 05, in a matter of days. They then put a Cypher inside or overlapping one of the Taxus. I understand that the surgeon and cardiologist should speak about it. I guess my question is, where do I play a part in the decision? I am the one that would be affected if one closed again. My wife is very concerned and does not want me to have any surgery unless it is a medical emergency. My cardiologist has recommended I stay on Plavix for life. I came very close to having a fatal MI last time it closed. My cardiologist stated I could have a stress test prior to coming off plavix, but what about after? That is when it would close. My opinion is not to have surgery unless life threatening. Thanks for your help, you guys are much appreciated for your work! Thanks.
Bob F, Tampa, Florida, USA, February 25, 2009

• Bob F. -- when did you have your most recent drug-eluting stent (DES) implanted? And which DES was it? Taxus? Cypher? Xience? Endeavor? (You should have a card with that info.) The recommendation by all the professional organizations two years ago was to have your surgeon and cardiologist (not your family doc, but the interventional cardiologist who implanted the stent) discuss with each other the pros and cons of stopping DAPT (Dual AntiPlatelet Therapy).
Forum Editor, Angioplasty.Org, February 20, 2009

• Hello, I am a 47 year old male who had 3 medicated stents placed in 2004, then went off plavix and had to have 2 more stents due to medicated stents closing. Due to back problems, neurosurgeon would like to do discogram and would like me to come off of Plavix for testing. I am very concerned about this. The last time the stents closed up within days and almost suffered Heart Attack. What are the recommendations for coming off of Plavix for surgery/testing. My family Dr does not recommend it, says the risk is too high. Thanks.
Bob F., Florida, USA, February 20, 2009

• Cassandra -- we do not and cannot give medical advice, but we can suggest that you follow your doctor's advice. Yes, the guidelines state that 4-6 weeks of "dual antiplatelet therapy" with a bare metal stent should be sufficient, but every patient is unique and your cardiologist obviously has concerns. Lap Band surgery is elective -- if it is not an emergency situation, why not wait a few months to be safe?!
Forum Editor, Angioplasty.Org, February 3, 2009

• Help: I am a 50 year old female who had a non medicated stent placed in Nov. 2008. I am over weight and would like to have the Lap Band surgery. My Doctor said she wants me to stay on the Plavix and aspirin for no less than 6 months. I read on your post that Plavix is needed for six weeks with non medicated stent, what do you think?
Cassandra, Suffolk, Virginia, USA, January 25, 2009

• We cannot stress enough that surgeons and cardiologists need to communicate about these issues -- this was the recommendation by all the professional organizations two years ago, yet this still seems to not be happening everywhere. There is also some data suggesting that there may be, at least in some individuals, a Plavix rebound effect, where platelets are overly-activated for a period of 30 or so days after stopping Plavix -- thus causing clotting and heart attacks. This is only observational so far and some cardiologists have suggested tapering off the dose, but none of this has been tested or proven yet.
Forum Editor, Angioplasty.Org, January 19, 2009

• My husband had a stent in July of 2008. He had Knee replacement in 2006. Our cardiologist knew this when they did the heart cath. When they told us he needed a stent we where not told of any other types of stents. Also,they knew with a replacement he needed his antibiotics before any procedure. He has acquired a staph infection in the knee and it needs to be removed and the infection take care of then have another knee put in. I asked the cardiologist why they did not give him his antibiotics knowing he had an artificial knee. All other surgeries he had all the other doctors gave him antibiotics. Due to this -- the staph. The cardiologist told us that he never gives antibiotics before a procedure, will never give antibiotics before a procedure and he did not give him the antibiotics. They work in a sterile environment --- end of discussion. He has been on Plavix and aspirin for 6 months. The infection and his mobility is extremely bad. he is diabetic which complicates the matter. The orthopedic and cardiologist are not communicating. We need guidance on this. Our cardiologist told us that he may approve the surgery by putting him on integrilin 5 days prior to surgery and continue after the slowing introduce the plavix back. Any one experience this --- Please need help in Texas.
Susie, Denton, Texas, USA, January 18, 2009

• My husband had angioplasty & 2 stents Oct. 6 He is on Plavix; He started to bleed internally and they stopped the Plavix to remove polyps; he then had a heart attack; The had to suck out clots around stents; waiting to remove polyps till end of April. Now they found a lesion on his kidney and it needs to be removed; Will taking him off plavix again cause another heart attack?
Debbie B., Ontario, CANADA, January 8, 2009

• Renee -- read our article about these problems of Plavix and Surgery but, all recommendations are that surgery, if not emergent, should be delayed. By all means discuss the situation with your interventional cardiologist -- the one who placed your stents. Maybe he/she can devise an interim strategy with your surgeon, if you must have the operation.
Forum Editor, Angioplasty.Org, November 20, 2008

• I had a colostomy on 12/5/07 due to an abscess diverticulitis, while waiting for a reversal, I had a heart attack on 5/6/08, they put 3 drug eluting stent in my left artery, I am on plavix, it has been 6 months since the heart attack and 1 yr since colostomy, my surgeon will not operate on me while on plavix and heart doctor will not take me off. What do I do?
Renee, North Carolina, USA, November 14, 2008

• If you do not have a stent, and your doctor has prescribed Plavix, then you don't have the concern about stent thrombosis that most posters here have shared. But any change in your medication, stopping, reducing, should be done only after consulting and discussing this topic with your cardiologist. If you must have surgery you need to discuss this with both the surgeon and your cardiologist.
Forum Editor, Angioplasty.Org, November 5, 2008

• I have takotsubo syndrome, i'm a 46 year old women with no high blood pressure, stents, clogged arteries and healthy as a horse. My cardiologist put me on Plavix, Aspirin, Coreg, Simvastatin, Ramipril and Amlodipine Besylate. I work out everyday eat healthy and my heart is stronger then ever. I am schedule to have plastic surgery, but one problem, I'm on Plavix and aspirin. I am seeking a second opinion. How long could I have surgery when I stop the Plavix and aspirin. Thank you
Vera, New York, USA, October 28, 2008

• I do not have stents. I just wanted some information on how long to stay off of Plavix before the breast biopsy.thank you. With atrial fibs, just so frightened to stay off of the plavix. 6 days seems too long; and with the rebound effect that I have learned about it - scares me more. I think for a lung biopsy I had it was 5 days. seems like for breast biopsy would be 3-4 days. thanks for your help.
Martha Smith, Atlanta, Georgia, USA, October 5, 2008

• Martha -- are you taking Plavix because you have a stent? If so, when was the stent implanted? This is really a question that needs to be worked out between your surgeon and cardiologist. And this reply can be generalized to most of the questions that are submitted to this Forum Topic. In our article from January 2007, titled "New Advisory: Will Stent Patients and Their Doctors Get the Message?", we reported on the latest guidelines addressing antiplatelet therapy. These guidelines were issued jointly by six of the major physician organizations in the U.S. -- including surgeons, cardiologists and dentists. The specific points regarding Plavix and surgery are summarized here:

• For patients who are likely to need surgery in the next 12 months, consideration should be given to use of a bare metal stent, or balloon only, with stent if needed;
• Healthcare professionals should make a greater effort to educate patients on the importance of continuing antiplatelet medications prior to discharge;
• Patients also should be instructed to contact their interventional cardiologist before stopping antiplatelet therapy, even if stopping is instructed by another healthcare professional;
• Healthcare providers (surgeons, dentists, etc.) need to be made aware of the dangers of asking stent patients to stop antiplatelet therapy and should communicate directly with the patient's prescribing cardiologist;
• Elective surgeries where there is a significant risk of bleeding should be postponed for 12 months after the stent implantation;
• If an unexpected surgery must be done that requires cessation of therapy, aspirin should be continued if possible and full antiplatelet therapy should be resumed as soon as possible after the surgery;

Forum Editor, Angioplasty.Org, October 4, 2008

• I am having a breast biopsy; how long do I need to stay off of Plavix. I have atrial fibs off and on; more on than off, and have enlarged heart; and have had blood clot before in abdomen. Surgeon says 7 days - cardiologist has not gotten back with me after two calls. 5- days ?? I am really frightened to stay off of Plavix for any amount of days. please advise how many days - usually does one stay off for breast biopsy - thanks
Martha S., Atlanta, Georgia, USA, October 2, 2008

• HI, My mother was on coumadin for numerous years due to clotting problems. She had a scheduled gall bladder operation and was instructed to stop taking the coumadin 10 days prior to the surgery. My concern is if she is off the medicine for that period of time isn't she in danger of having a clot travel. Possible stroke? It just seems like a long time to be off the medicine.
C., Florida, USA, September 19, 2008

• I had a prostatectomy scheduled for yesterday, but 4 days before, it was cancelled because it has only been 10 months since stent implant and start of Plavix. I am curious why both the cardiologists consulted by the surgeon say that with stent/plavix, it is all or nothing. By this I mean why can't the Plavix dose be reduced, have some reduced effect, but also reduce the probability of uncontrollable bleeding. Additionally, it is ridiculous to me to think that magically at the one year point and not a month sooner, the risk is significantly reduced. I am more concerned about the cancer spreading than the bleeding risk. Tell me how wrong I am, please.
Richard Nester, Temecula, California, USA, August 14, 2008

• I'm a 49 year old male - four years ago I had 12 (yes, twelve) drug-eluting stents inserted over a 9-month period, including a stent in the left coronary artery. I've been on plavix since them, and understand that I will always be. Now, I have an inguinal hernia and need surgery to correct it. The surgeon tells me that the one and only thing that "makes the hairs on the back of his neck stand up" is when patient is on plavix. He is now conferring with the cardiologist. Any latest/greatest developments on this issue? The choices behind both doors number one and two do not sound inviting to me. Any thoughts or suggestions would be greatly appreciated.
Art, Massachusetts, August 14, 2008

• I was re-stented this past June 24th, 2008. I had a bare metal stent (placed in Dec.2006) and a drug eluting stent placed inside it. I need knee replacement surgery badly. My cardiologist won't take me off Plavix. My orthopedist is willing to do surgery with me on Plavix. I am concerned with the risks for bleeding. So far, I am not having any other problems.
Kay, Nebraska, USA, August 12, 2008

• I am a 53 year old female I have two heart stents of 15 months. I have been on Plavix and 81mg aspirin daily since. I have now been diagnosed with a contracted gallbladder. Does anyone out there have a comment on the risk of this surgery and if so what do I do if I have to go in as an emergency patient.
Tony, Alabama, USA, August 10, 2008

• I was told I had to be on Plavix for a year before I could have hip replacement surgery since I had a stent put in a year ago. Is there any way I can have hip replacement surgery before a year is up?
Mike, Vermont, USA, July 11, 2008

• Can I have oral surgery after a month on plavix? I need a tooth removed and have had 3 stents put in a month or so ago? Need to have tooth removed but scared and different advice from medical professionals??
Cori, North Dakota, USA, June 15, 2008

• I have had 4 stent heart implants since may of 2007. At that time and since then I have been on aspirin 325..and plavix. A year ago I needed a new partial. In that area I previously had a post which the dentist refused to remove because of plavix. Instead, he fitted the partial over the old post. Now, I have an infection surrounding the post...I am going to see about it tomorrow. My comment is: If they had removed the old post, this infection never would have taken place. Needless to say, I am disgusted. I wish the cardiologist and dentists would put their heads together and come to some sort of an agreement on what is best for each individual patient.
Joan, Massachusetts, USA, June 9, 2008

• My 74 yr old husband started on plavix 9/07. Since that time he has had a very painful knee s/p tka, infected same knee after infection spread to knee prosthesis from infection of sternal incision s/p cabg x4 . He had i&d , knee prosthesis was removed. Ab spacer placed, then after several mos. Another tka was placed, then kneecap slipped, needing an additional surgery necessary to repair kneecap. After a few mos. It was necessary to place 2 stents in the bypasses of 2 yrs .prior. After all this now the knee prosthesis is suspected to be loosened. It has been 8 mos. Since stents were placed. Will it be possible to have the surgery to repair the knee before the 12 mos of plavix is completed ? We already are aware the he is high risk and were told that he must go to a university hospital for treatment . Please give us any advice. Thank you.
Sarah, Erie, Pennsylvania, May 27, 2008

• I need left knee replacement surgery ASAP due to no cartilage in the knee. I had two Taxus stents on April 1, 2008. Both cardiologist and surgeon are worried about what may happen if I stop the Plavix and aspirin. Any insight will be appreciated.
Laurie, Chandler, Arizona, USA, May 26, 2008

• I had a Taxus stent placed August 2007. I needed surgery for a torn meniscus in March 2008. Cardiologist wouldn't let me go off Plavix. Knee surgeon ordered blood tests and found my bleeding to be o.k. even though on Plavix. I had the surgery and everything is perfect. Just wanted to let some of you know you CAN have surgery while on Plavix!
Dave, Sacramento, California, USA, May 23, 2008

• Current guidelines suggest that in patients who have a high likelihood of needing surgery in the next year, the alternative of a bare-metal stent should be considered, so that a year to life of Plavix is not required. There are some protocols for substituting Plavix when surgery IS required (see Jerome's post from May 13, for example) but these are something that your cardiologist and surgeon need to discuss with each other. (See our article from January 2007, titled "New Advisory: Will Stent Patients and Their Doctors Get the Message?")
Forum Editor, Angioplasty.Org, May 16, 2008

• I had a Taxol [Taxus] cardiac stent placed this past February, 2008. I am on a regimen of Plavix and one baby aspirin a day. I now need a shoulder replacement because of excruciating pain. I have been told that I would have to be on the Plavix/aspirin regimen for one year. My orthopedic surgeon thought that I could be on Lovenox for several days prior to surgery and that the Plavix/aspirin would be restarted the same day following surgery. I am so upset over this. It was never explained to me that because of the Plavix unless something life-threatening happened that required surgery, I would have to wait until the year is up or possibly never have any pain relieving surgery. Does anyone have any comments on this. I am extremely upset and depressed and taking pain pills every day of my life is not the way I chose to live my live. Many thanks.
Judith B., Pennsylvania, USA, May 16, 2008

• I am a 55 yr old male that had a Cypher stent put in on Feb.18,2008 after a heart attack. I was recently in a car accident and need surgery on my knee for a torn meniscus, and have herniated discs and torn discs in my neck, which may also need surgery. I am on plavix and aspirin, how many days before surgery do I go off plavix and aspirin? How soon after surgery do you go back on? will it increase my chance of a heart attack, to keep going off plavix for surgery?
Rick A Misnik, West Seneca, New York, USA, May 15, 2008

• I recently ruptured the tendon at the distal end of the bicep muscle in my right arm (a complete avulsion). After a consult with an orthopedic surgeon I thought I could have it repaired surgically. I am on Plavix as a result of receiving a DES in my right coronary artery eight months ago. The surgeon doesn't want to operate if I stay on Plavix and my cardiologist is adamant about keeping me on Plavix for life due to the risk of stent thrombosis. After pressing the cardiologist for a way out of this dilemma he reluctantly offered a procedure using the drug Integrilin. The use of Integrilin pre-op evidently takes the place of Plavix for the period of time required for the body to expel the effects of Plavix, then when Integrilin is stopped (it clears the body in 4 to 6 hours), surgery can be performed and the patient is returned to Plavix post-op. However, this is not risk free and is only indicated for emergency surgery, e.g., gastric bleeding. Without actually saying it directly I definitely got the impression that both the surgeon and the cardiologist thought I should pass on the surgery and accept the diminished strength provided by the bicep. I am 73 years old but in good health otherwise. I work out regularly since the stent implant and am active with woodworking and other physical activity. After reading a lot of data on stents, Plavix and surgery, I am leaning towards passing on the surgery even though I will regret the loss of strength in my arm. Any comments?
Jerome Nowak, Lee's Summit, Missouri, USA, May 13, 2008

• I had three DES implanted on 04/03/08. Now I have an inguinal hernia which seems to be getting worse by the day. MY cardiologist's PA said "see your primary care physician". Did that and he set up an appointment with a surgeon. This surgeon wasn't the first choice. The first choice was one very experienced in laparoscopic repair. The surgeon I'm scheduled to see is in the field of oncology and I have a very bad feeling about this. I seriously doubt he has a laparoscopic approach to surgery. I did contact a surgeon from a place that supposedly specializes in laparoscopic repair and he said that laparoscopic repair is not advisable while on platelet therapy. That was not good news. From what I have read going off the therapy is much more dangerous than having surgery while on it. Although I read somewhere that it makes little difference if the surgery is performed too soon after the stenting. It took every bit of strength and reserve of courage to submit to the stenting. And now I don't know whose opinion to trust. The fact that the PA of my interventional cardiologist seemed so cavalier, diminishes my confidence in the cardiologist who performed the intervention. Especially since I specifically made it a point to tell him I did not want any DES because of their risks. I believed that if stenting was necessary, it would be bare metal. Didn't know about the DES until after the procedure.
Bill L., New York, USA, May 11, 2008

• Bob -- your story represents the big Catch-22 of drug-eluting stents and Plavix. The concern has been that patients with drug-eluting stents need to be on Plavix for a year or more before going off, so as to help prevent late stent thrombosis, exactly what happened to you after TWO years of Plavix. This means problems if you need surgery. One new finding that we reported on a couple months ago was the possibility of a rebound effect with Plavix (see "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents"). There seems to be a 90 day window after stopping Plavix where patients have double the risk of heart attack -- and this is important -- whether or not they have a stent! The patients who had no stent experienced the same increased risk as those that did. This would indicate that some of the infarctions caused by blood clots are related to Plavix cessation, not the stent. This was only an observational study and the theory has yet to be proven, but we keep thinking that this is an incredibly important finding. The cardiologists who conducted the study postulated that there may be a safer way to stop Plavix, such as tapering off the frequency and dosage. Nothing here is proven or recommended, but you might want to bring this study to your cardiologist's attention or even contact the authors -- it was done in at the Denver VA Medical Center, right in your own back yard!
Forum Editor, Angioplasty.Org, April 29, 2008

• Gee, I thought I was the only one with Plavix/Aspirin problems. I was scheduled for cervical surgery on 2/27/08. I was reluctantly allowed to go off Plavix and Aspirin about 4 days prior to the surgery. The surgery was postponed due to 101 temp. On March 1, I awakened with a 104 temp. Since I could not drive, I called an ambulance. While transporting me to the hospital, I suffered an acute M.I., later determined to have been caused by a blood clot lodged in one of the Cypher stents implanted during one of two M.I. in 2006. Bottom line is my cardiologist advised my other doctors that I could never go off Plavix prior to surgery. I still need the cervical surgery and also have bladder cancer which they advise they cannot remove for the above reason. First of all, I refuse to die of bladder cancer having watched my dad do it. Can I just sign a waiver and have them at least do the bladder resection (TURBT). Any ideas? I have numerous medical problems, Coronary and Vascular disease, COPD, Type II Diabetes, peripheral neuropathy, PTSD, ad nauseam. I'm 59 and strongly believe the only reason I'm alive is because God has something else in store for me. In closing, my doctor advised me not to end my life with a .357 or OD on Oxycontin. Said to just quit taking my aspirin/Plavix. Said that should do the trick. (she was just kidding).
Bob Graham, Lakewood, Colorado, USA, April 19, 2008

• After going through two separate stents operations, May 07 and Sept 07, had quintuple by pass on Valentines Day 2008. In last visit with cardiologist yesterday he said I do not need to be on Plavix, stay on aspirin *81), and the whole heart cocktail. Also have Diabetes Type II and cholesterol issues. Will stopping Plavix impact anything in the by pass work or increase risk because of cholesterol. This is a great site but as you know lots of information creates new sets of questions. By the way I am 65 year old man, in acceptable weight range, moderate exercise, lots of stress.
N.S., Arkansas, USA, April 8, 2008

• had a stent 6 months ago and need a tooth extracted. wants me off plavix and aspirin for 3 days what do you think?
Larry Samuels, Boca Raton, Florida, April 7, 2008

• For the past ten years my mother had been taking Plavix and aspirin due to having mini-strokes and atherosclerosis. In September 2007 a small cancerous tumor was found in my mother's right breast. The surgeon took my mother off her medications on September 8, 2007. She refused to allow her back on even though she noted her declining health prior to her surgery on October 12, 2007. The oncologist also refused to allow my mother back on her medications, even though she noted my mother's "chronic shortness of breath" and was made aware of my mother's declining health. My mother had a heart attack in the early morning hours of Oct 30th, her second day of radiation treatment. That night she had a severe heart attack which required me to make a decision to have her put on life support so that the cardiologists could try and save her. They placed three stents in her heart. In the early morning hours of November 5th her aortic valve burst, and that night I called our family around her while I had her removed from life support. She died shortly thereafter. I don't want anyone to have to go through what I went through with my mom, or what she went through - she wanted to live. For my Mom, Plavix and aspirin therapy were life sustaining drugs - for her they were as important as insulin to a diabetic.
Karen Carter, Grass Lake, Michigan, USA, March 8, 2008

• I have to have the kidney stones out. I have been talking to the Cleveland Clinic. About the kidney stones, Do you think this is a good choice? I am John with the two stents overlapping. I would like some input from some one who knows, I know I will have to stop the plavix & aspirin. Thanks.
John G., West Virginia, USA, February 26, 2008

• It's pretty much mandatory for hospitals to have patients sign consent forms before a procedure -- but we at Angioplasty.Org feel it is very important to educate patients BEFORE a diagnostic procedure about their options, if possible (obviously in an emergency, it's not). Recent guidelines have advised cardiologists to consider using bare metal stents in patients where there is a likelihood of surgery in the next year. So, Bob -- you're in the same situation as most who have posted here. The best recommendation is to do what you've already done and have the surgeon and cardiologist to discuss a possible temporary antiplatelet regimen. Sounds like your neurosurgeon is aware of these issues. Good luck and let us know how things wind up. and if anyone has suggestions or similar experiences to share, please do.
Forum Editor, Angioplasty.Org, February 23, 2008

• Hi, I had three Cypher stents implanted (without being consulted beforehand) on 7/7. I am in dire need of a cervical disc fusion c5/c6 as the pain is unbearable. My neurosurgeon is obviously concerned about my being on plavix, and is trying to get a cardio to agree to placing me on heparin prior to and during surgery, and the back on plavix 24 hours after surgery. I cannot live with this pain and the longer I wait the less chance I have of recovering from this herniation and compressed nerve. this is not a good spot to have been put in. I fired the cardio who did this to me and have filed a grievance as he put in the des w/o any consultation. poor form on his part. any ideas out there would be most appreciated. Many thanks!
Bob, Virginia, USA, February 23, 2008

• Patsy -- another way to look at it is that with the availability of interventional techniques and modern pharmaceuticals, the progression of a disease that affects many, and one that was virtually untreatable 30 years ago, can now be managed. Hopefully the stenting will reduce any ischemia, allowing you to function without disabling angina, and allow your heart to get the oxygen it needs. And some day in the not too distant future, we all hope that those genes can be worked with as well! Keep in touch.
Forum Editor, Angioplasty.Org, February 23, 2008

• I have an overlapping stent, bare metal and drug eluting. I was told that I would have to continue plavix for a year with the possible duration of life, I would be on aspirin for life as a preventative med. I am gathering that because I have this disease, which was picked up through genes,and my arteries are in really bad shape, then it would be for my own good.
Patsy Wellwood, Nova Scotia, Canada, February 20, 2008

• John -- can't tell you exactly from what you've reported, but it sounds like you had two drug-eluting stents (not stints) placed in tandem in order to cover the length of what may be a long blockage (longer than the available stent lengths). Kind of an extension. Normally when doing end-to-end stents, the cardiologist creates a slight overlap to avoid a "gap" between stents -- a gap is not desirable since it is an ideal spot for plaque or thrombus to form. That being said, the part where the stent is overlapping has been shown to be somewhat more prone to restenosis. But it certainly doesn't sound like a "busted" stent. (By the way, your records should indicate the lengths and diameters of the stents AND the length of the diseased area covered.) Of course, we're only describing generalities. For specific details, you really need to ask these questions of your interventional cardiologist. Also ask why he/she is prescribing Plavix and aspirin for life -- many cardiologists do, as long as there aren't bleeding risks (Plavix has other benefits for heart patients). Whether or not to go off for surgery is a big question, the answer to which is not yet clear. And coming off Plavix may present problems, as a recent study showed.
Forum Editor, Angioplasty.Org, February 17, 2008

• Got my Medical records today, surgeon put a med. stint in , then another stint through the first stint, that left an overlap. Said they had to try 3 different sheaths to blow the balloon up to 3mm to go through the first stint. #5, 6, & 7. Looks to me like they went backwards, i think i have a pile of scrap metal in my heart. or maybe a busted stint. Is this in your opinion why he never wants me to stop Plavix & aspirin to have surgery, because of the overlapping of the stint, will cause thrombosis. Need some input on this one. Thanks.
John G., West Virginia, USA, February 14, 2008

• What I meant that something might have gone wrong in surgery. At first i had severe burning pain from my chest to the pelvic area. Then the burning pain went to my upper gums, from there to the lower back. The surgeon had trouble with the second stent. The male nurse had to take over & finish the surgery. Has anyone experienced this kind of burning pain?
John G., West Virginia, USA, February 8, 2008

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

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

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

• John G. -- not sure what you mean by your doctor "having done something wrong while in surgery", but your question and concern is shared by everyone else posting to this topic. All the medical societies, AHA, ACC, and SCAI have issued guidelines and advisories about going off antiplatelet therapy for surgery, and they recommend having your cardiologist and surgeon discuss the issue specifically. See our article from January 2007, titled "New Advisory: Will Stent Patients and Their Doctors Get the Message?"
Forum Editor, Angioplasty.Org, February 3, 2008

• Have two DES in same artery. Need kidney stones removed. Have been on plavix & aspirin 325, for 14 months. My cardiologist told to never get off of plavix & aspirin, even for surgery. He has told me this five times. I have another cardiologist now. I know other people who have got off for surgery. I have been told by two other Doctors, he must have done something wrong while in surgery . Any information will help. Thanks, John
John G., West Virginia, USA, February 3, 2008

• Female in Dallas -- yours is the question of the day, or perhaps the year! How long to put a patient on Plavix is a big question. All medical societies at this point recommend a minimum of one year, assuming there are no bleeding or complications. Many doctors, as you have read, say indefinitely. In our main topic on Plavix, we have several postings of patients having problems and heart attacks shortly after going off their recommended duration of Plavix -- something which has concerned us for some time. Discuss this with your cardiologist and keep your eye on the news here at Angioplasty.Org -- we're going to be discussing many of the issues surrounding these questions.
Forum Editor, Angioplasty.Org, February 1, 2008

• my husband had a drug eluting stent placed in 2/07. He has been taking plavix plus 81mg aspirin. His cardiologist has told him to STOP taking plavix after the one year anniversary. He claims that there are studies that say that there is too much bleeding risk. My husband has had no problems with the plavix and aspirin regimen. The stent was not placed in a major artery. He did have a triple bypass surgery in 1998. All is well in the bypassed arteries. So many posts say that one should stay with plavix and aspirin indefinitely. Why would a cardiologist remove this medicine after one year?
Female, Dallas, Texas, USA, January 22, 2008

• The inhibition of Plavix by proton pump inhibitors (prilosec) has been described. Does anyone know if this occurs with H2 blockers (Pepcid)? Need reference. Thanks.
Dan, Atlanta, Georgia, USA, January 20, 2008

• Thanks for the valuable info, Gladys!
Forum Editor, Angioplasty.Org, December 20, 2007

• I am 68 yr old woman with 5 stents and have been on plavix for 4 years, recently I needed a open breast biopsy. My cardiologist refused to let me off Plavix for the biopsy. The nurse at the hospital told me they regularly use ice on the breast to for thirty minutes to slow down the bleeding. It worked beautifully. I lost no blood. My cardiologist was pleasantly surprised and told me he learned something new. I hope this helps someone else.
Gladys, Florida, USA, December 20, 2007

• I had a Taxus drug eluting stent put in Nov of 2006. I thought it was now time to stop taking the plavix, I've been on 81 mg aspirin for years. It has been over a year now and I called my cardio. Dr. and spoke to a nurse. She informed me I would be on plavix for life.
Irv Myers, Patient, Buffalo, New York, USA, December 17, 2007

• Can a 75 year old diabetic with 2 DES who has been on plavix and aspirin for 2 and 1/2 years be cold turkey dropped from the plavix without blood monitoring for sub-optimal platelet inhibition? Are there any precedents?? Any help would be very much appreciated.
Michael, New York, USA, December 12, 2007

• Do endoscopy while on plavix & aspirin. Is it worth the risk? Thanks, John
John G., West Virginia, USA, December 5, 2007

• I had a heart attack 9/07 and received 2 DES. I am on Plavix, low dose aspirin, beta blocker, ACE Inhibitor and Lipitor. This month I had a routine colonoscopy and stopped the Plavix and aspirin two days before. A polyp was removed and I had rectal bleeding for two days then returning to normal. I started Plavix and aspirin five days after the colonoscopy and bleeding almost immediately started again, only worse. I stopped taking these pills and received a blood transfusion. Again the bleeding stopped after two days and I am normal. My GI doctor wants me to stay off Plavix/aspirin for at least a week from now but my cardiologist wants me to start taking them now. I'm between a rock and a hard place. What to do? Any ideas?
Art C., Colorado, USA, November 26, 2007

• I need gallbladder surgery now. Got two medicated stents Nov.5,2006, almost a year. My cardio tells me to never get off plavix & aspirin. To get surgery and stay on the plavix & aspirin. Is this cardio too radical? No surgeon will operate under these conditions. Thanks, John
John Green, Beckley, West Virginia, USA, September 14, 2007

• I am a 38 year old male who had an acute coronary attack 2 and 1/2 years ago. Two drug eluting stents were implanted at that time. I have been on Plavix and aspirin ever since. Last week I hurt my knee (torn meniscus) and now have to have arthroscopic surgery. My orthopedic surgeon told me that I had to go off Plavix and aspirin for 5-10 days before the surgery (and for a couple of days after the surgery as well). Obviously, due to the risk of late stent thrombosis, I am very concerned about going off Plavix and aspirin for any amount of time. My cardiologist thought (1) the risk of late stent thrombosis was small and that I should go off Plavix and aspirin for the surgery and (2) that the studies re late stent thrombosis all looked at long term discontinuance of Plavix/aspirin as opposed to short term discontinuance (a few days). However, I am not convinced the risk is small and even so I may not be willing to take that risk. Another orthopedic surgeon mentioned the possibility of using Lovenox in the days before the surgery (after going off the Plavix) and then resuming Plavix/aspirin after the surgery. Another possibility is to stop the Plavix/aspirin, go on Heparin for 2 days before the surgery, stop the Heparin 6 hours before the surgery and then go on Coumadin after the surgery. I am wondering if anyone has come across any alternatives to going off Plavix and aspirin for such a procedure. If anyone has any real-world experience or thoughts, I'd greatly appreciate hearing from you.
Michael, New York, USA, September 11, 2007

• I also am in need of a knee replacement. I had one DES placed in March 2007 and have done uneventfully fine since. I asked my Cardiologist in July if I could go off Plavix for 5 days in August for my surgery. He agreed it would be ok so long as I understood the risks and felt it was acceptable to me. It is, I have postponed my surgery for other reasons, but expect to have it in October.
Bruce Main, MidAtlantic Nursery, Inc., Washington DC, USA, September 5, 2007

• OK, now it has been 18 months since my stent. I was admitted to the hospital last week for GI bleeding. I was found to have 3 huge ulcerations and 11 small ones. This is no doubt from my Plavix/Aspirin combination. My cardiologist has stopped the therapy cold turkey. I am very scared that my stent is going to clog up. I had 2 pints of blood put back in because I was so anemic and weak. Help!!! Anybody been in my position?
Margaret Riojas, Baytown, Texas, USA, September 3, 2007

• Jerald and RDavis -- two different reasons to be on plavix and aspirin. Jerald, you should discuss your biopsy and surgical needs with the doctor who prescribed Plavix and aspirin. It may be possible to stop temporarily to allow these very important procedures to be done. You don't have a stent, so the stent thrombosis risk is not an issue. But you may have other issues, which is why we do not give medical advice and please don't take this comment as such. Discuss these issues with both your physicians, the surgeon and the prescribing doctor and have them talk to each other. They may be able to meet each others' and your needs.

RDavis, pretty much the same advice. Current guidelines suggest that bare-metal stents, such as the one you have, only need 4-6 weeks of dual antiplatelet therapy (clopidogrel plus aspirin) but it may be that your cardiologist is being cautious and giving it to you for 6 months (6 months is the recommended length of time for drug-eluting stents like the Taxus, although most cardiologists now prescribe these drugs for a year or more). Don't do anything without discussing it with him/her! As for MRIs on drug-eluting stent patients, they have been proven safe to do, even immediately after stent placement (see our Forum Topic on "MRI and Stents"). Both the Taxus and Cypher stents were cleared by the FDA in April 2005 for immediate imaging by MRI. Bare metal stents should be no different, although the package inserts may not have been updated, since they were not specifically addressed by the FDA ruling. We recommend to all patients caught in this bind to have the surgeon who will be doing the procedure, whatever it is, to talk to the interventional cardiologist who placed the stent and who prescribed the clopidogrel plus aspirin. Let them discuss the issue and work it out. This is the recommendation of all major medical organizations.
Forum Editor, Angioplasty.Org, August 27, 2007

• Hello, I'm 52 years old & currently have a non DES stent (Multi-Link Vision)which was put in July 2 2007 after having a non Q-Wave Heart attack. My problem lies in the fact I have a bad knee and must have MRI, however when I went for MRI I was told I had to wait at least 8 Weeks, well that was 2 weeks away and I scheduled for it Sept 4th, I called my heart Doctor and ask if it was okay just to be sure. He said no at first but later agreed getting MRI would be okay. But informed me that I couldn't have surgery for at least 6 months because I was on Plavix and would have to come off during surgery which increases mt risk of Thrombosis. This really puts me in a bind because I can barely walk, it not certain I will have to have surgery but very likely. Can I stay on plavix if the surgery is Arthroscopy ? Please Help !!!!
RDavis, Huntsville, Alabama, USA, August 27, 2007

• I have been on plavix and aspirin since 2002 when I had two strokes. Now I have to have a biopsy of my prostate but am told I can't or if there is cancer can't have prostate surgery. Is this correct?
Jerald, Maine, USA, August 23, 2007

• Georgia -- Coumadin is a brand-name for Warfarin -- it is an anti-clotting drug that has been around since the 50's and is used in patients with mechanical heart valves and others who have a high risk of developing blood clots, or thromboses. It has side-effects and interacts with a number of other substances. Patients on Warfarin need to be monitored to make sure the levels are safe. Plavix is a brand-name for clopidogrel, a newer med that is an antiplatelet drug -- rather than interfering with the Vitamin-K clotting factors, like Warfarin -- Plavix keeps the platelets in the blood "slippery", so they don't begin to gather and form a thrombus. Plavix is used in heart attack victims and other patients with coronary artery disease. It is also used after stenting, bare metal or drug-eluting, to prevent stent thrombosis. Much less toxic than warfarin, it still has some side-effects, and some patients develop a rash. Bleeding can also be a problem, especially when it is given with aspirin, but the risk of complication is considered worth it to prevent stent thombosis.
Forum Editor, Angioplasty.Org, August 23, 2007

• what is the difference in plavix and coumadin?
Georgia G., Virginia, USA, August 7, 2007

• Gary -- how long since you had the drug-eluting (medicated) stents implanted? You bring up a very important point -- and to all readers with stents we emphasize that you need to consult with your interventional cardiologist before going off Plavix and aspirin, even if you are instructed to by another doctor. We refer readers to our January 29, 2007 article on the subject, "New Advisory: Will Stent Patients and Their Doctors Get the Message?" Gary, you say you strongly voiced your concerns -- we're curious as to what your surgeon's reaction to the clot was. The above advisory about the danger of clots if a DES patient goes off Plavix was a joint statement from six major physician organizations, including the American College of Surgeons!
Forum Editor, Angioplasty.Org, August 7, 2007

• I've 5 stents (medicated). Was scheduled to have umbicial hernia operation on a wednesday. The prior week tuesday the general surgeon took me off plavix, (after voicing my concerns STRONGLY). needless to say the day before scheduled surgery I had a clot, and almost died. DON'T come off of plavix for any reason.
Gary D., Florida, USA, July 26, 2007

• My mother went in for catheterization for leg blockage using the SilverHawk catheter, she was given Plavix and aspirin for a week before the procedure - therefore she bleed to death. Curious to know if anyone out there has had or heard of any complications using the SilverHawk catheter device procedure. Appreciate a response.
Mary L, Texas, USA, July 23, 2007

• Hello all, I am 40 250lbs and I just had a stent placed in one of my arteries June 19th after a heart attack, I am on Plavix and Aspirin 325mg also taking Crestor, My doctor told me I need to be on Plavix for 2 years, I am going to have my stress test done in 2 weeks, and I am feeling great now, I am walking 3 times a day, 10 mins each time as he recommended. Thank to god I have temporary disability at work and they are taking care of me and my family, but my question is how many of you are able to return to work and how long did it take you for your doctor to ok the return. Thank you all and god bless.
James B., Miami, Florida, USA, July 3, 2007

• I am a 69 year old male that had elective sextuple by-pass surgery in Oct 1999. The VA will no longer prescribe Plavix for me they said get off of it. I cut it out cold turkey, lasted for about 54 hours, got shaky, nervous and sensitive and went back on it. I after a couple of days cut the dosage to 37.5 mg/day and lasted again for just over 50 hours before the same symptoms occurred. In the last 6 months I have had extreme itching on my chest almost of erotic intensity but no rash. How do you get off of Plavix?
Mel Brown, Bass Lake, California, USA, July 2, 2007

• Jerry -- you and everyone else on this Forum would like some reassurances as to the timing of clopidogrel withdrawal, etc. Unfortunately there aren't great studies. A study from Dr. Antonio Colombo's hospital in Milan showed little benefit for clopidogrel past 6 months -- he testified on this to the FDA back in December -- but when doctors in Milan were asked how long they would stay on Plavix, they answered a year or more. Nobody wants to (or can) say you're safe stopping at 6 months, or a year, or two. The cardiology community has joined with surgeons to try and publicize this issue. Read our article on January's joint "Science Advisory" from the major heart and surgical groups and see if your surgeon will huddle with your cardiologist to come up with a solution for you..
Forum Editor, Angioplasty.Org, June 23, 2007

• I am a 57 year old male with coronary artery diseases Oct, 2006 I had a medicated stent (Taxus) placed in a coronary artery. I am currently taking dual antiplatelet therapy, 75 mg of Plavix and 325 mg aspirin. I was just diagnosed with a wide neck aneurysm, (non ruptured and non leaking), coiling is not an option and surgical clipping is my only coarse of action. My surgeon wants me to be off Plavix and aspirin 2 weeks prior to the surgery and 1 week after. My cardiologist has reservations about stopping but can not tell me the real risk I face when interrupting dual antiplatelet therapy. My question his how soon might thrombosis occur after stopping dual antiplatelet therapy, any studies or bulletins on that subject.
Jerry F., New York, USA, June 23, 2007

• I have posted to this forum 2-3 times over past 5 years with my Angioplasty experiences. Just had hand surgery while on Plavix, no problem. I have a 2-inch incision which is healing very well. My surgeon had no problem with me staying on Plavix. I have 3 DES (2- Taxus , 1) Sirolimus) implanted 12-05, in addition to 5 plain metal implanted 1-01. Have been on 75mg Plavix since 12-05 plus 325mg aspirin and prescription Pepcid AC to prevent GI irritation. When cut, I bleed longer than I used to but it hasn't been a big problem. I seem to tolerate Plavix well. Had been on it for short periods before & had GI irritation, so Pepcid stopped that.. I work out 5-6 days a week both cardio & strength training.
Dan A., California, USA, June 7, 2007

• Kim -- great story demonstrating that non-cardiac docs are beginning to get the message about Plavix and drug-eluting stents and are changing their procedures accordingly. Really a must-read for all.
Forum Editor, Angioplasty.Org, May 24, 2007

• Thank you for responding to my post! His Cardiologist insisted that he not go off his medication for any amount of time until he hits the 12 months then only for 5-7 days. I consulted with his doctors at Johns Hopkins and UCI. They both agreed to perform an endoscopy under twilight conditions while on his medication. Dr. Canto at John Hopkins wrote me the following: Doing mucosal biopsy on ASA and possibly plavix is not a problem. It is only if we dilate or do EMR that there would be a risk of bleeding. The American Society of Gastrointestinal Endoscopy has recommended that ASA and NSAIDs do not need to be stopped. We are getting his checkups at UCI, so we don't have to travel to Baltimore every 3 months. The plan was to only take biopsies if they saw something that looked questionable. And if then, only 1-3 rather than 8-15 like they usually do. Everything went well and his esophagus looks clean. Therefore, no biopsies and probably no cancer! But I have to say this puts us in a precarious position. Looking back now, I know why the Cardiologist looked alarmed when I told him about his cancer treatments, the first time I met him in the operating room after the surgery. He told me he did not know about it. It should have been in his chart. It was the ER but we had been in there only a couple of months before because he could not swallow, results of the PDT (cancer treatment) scaring - somewhere things did not get communicated. The Cardiologist is one of the best doctors around, I am told. But knowing that EMR or dilations are a problem is worrisome as my husband has had EMR and PDT for his cancer in August 06 and as had 9 dilations from December 06 to March 07. Now we just have to wait and PRAY for the next 10 months that he stays cancer free and he doesn't need to be dilated! [Cross posted from the forum topic on Stent Thrombosis.]
Kim, California, USA, May 24, 2007

• Kim -- our comment on your question is posted over at the Forum Topic on Stent Thrombosis, where you also posted. Sassy -- check out our Forum Topic on Dental Work and Stents for stories of several similar cases. Your dentist is staying informed and has been reading his medical journals. The American Dental Association recommends NOT taking patients off Plavix and aspirin for routine oral surgery. Good for your oral surgeon!
Forum Editor, Angioplasty.Org, May 15, 2007

• my husband needs to have two teeth surgically removed and the oral surgeon that is doing it said he does not want him to stop taking his plavix or aspirin prior to the surgery. being concerned with excessive bleeding i asked questions about this and the oral surgeon replied that he was going to do some cauterization. my husband is nervous about this and i still am concerned as well.any input would greatly be appreciated.
Sassy, Louisiana, USA, May 8, 2007

• My husband had esophageal cancer last year and went through a number of treatments. He has only been cancer free for 6 months. He is required to be checked for his cancer every 3 months. He had a heart attach last month and the doctor put in a Taxus Express 2 stent. Come to find out that now he can not get his check ups (biopsies) for his cancer for a year. This is a very deadly cancer and is known to return. Now, he can either risk having a heart attach or having a very deadly cancer. This does not seem right! We were not told ahead of time that he would be limited in this way.
Kim, California, USA, May 7, 2007

• After speaking to my cardiologist, he had no issue with my having a colonoscopy while staying on plavix and aspirin. He actually supported the idea for my overall health. So I had it done with no consequences. The doctor did extract a polyp while doing the procedure without incident.
John, New Hampshire, USA, May 4, 2007

• Dear John, although this procedure is recommended for people over 50, it certainly isn't a life or death decision, unless colon cancer runs in your family. This is an elective procedure. Why not wait until November, 1 year since you had your stent, and then go off of it for the recommended 4-5 days? I need something similar done and my cardiologist told me to wait 1 year.
Cl., Texas, USA, April 1, 2007

• John in New Hampshire - I had two drug-eluting stents in February of 06. Was placed on Plavix and Aspirin 325 mg. Stopped the Plavix In February of 07. I am also 55 years old and in October of 06 was recommended to undergo a colonoscopy following some GI problems which resolved eventually. I had the colonoscopy scheduled and then cancelled it at the last moment after reading about the risks of stopping the plavix prematurely (less than at least one year). Based on what I have researched and read, unless it is absolutely necessary, there is no reason to undergo an elective procedure if you are on Plavix. Just because you turned 50 does not automatically mean that you have to undergo a colonoscopy unless there is a strong family history of colon cancer. At any rate discuss your concerns with the cardiologist and you will be surprised that he/she will agree that the colonoscopy could wait until you have been off the plavix course (at least one year after the stent placement.) The risks of undergoing the procedure at this time far outweigh the benefits in my opinion. Good luck.
Jason B, California, USA, April 1, 2007

• John...I had a DES implanted 2/06 and have been on Plavix and Aspirin since. In 12/06 my urologist wanted me to go off Plavix and Aspirin two weeks prior to doing a prostate biopsy. However, he ended up doing a T.U.R.P.(Trans-Urethral resection of the Prostate)which has quite a bit of blood loss. Two days after he told me I could go back on it. No problems to date (4/01/07).
H. Percell, Joshua Tree, California, USA, April 1, 2007

• John -- the important thing is that the doctor doing the colonoscopy is aware of the bleeding risks and feels comfortable proceeding. You can discuss this with your cardiologist, but the usual problem (which you are having) is that the doc doing the surgery has instituted procedures to deal with bleeding complications. He/she seems like one of the more enlightened doctors on this subject.
Forum Editor, Angioplasty.Org, March 31, 2007

• I'm 55 and had a medicated stent implanted in Nov 06 and I'm doing well. I'm taking Plavix, aspirin, Lipitor, and Atenolol. My general doctor has recommended that due to my age, I have a colonoscopy while staying on my medications. I expressed some concerns about any bleeding complications but the doctor said that procedures have been developed to mitigate the bleeding (clamps, coagulating, etc) because there are so many medicated stents in the population. Would you have any feedback on this issue? I'm a bit concerned about the risk? Thanks, and thank you for the opportunity to ask my question.
John, New Hampshire, USA, March 23, 2007

• Hi, I had 6 DES 'inserted' just over 2 years ago. I am on plavix, aspirin, and needed to have a tooth extracted about 3 months ago. Was a little concerned, but was reassured by the dentist that all would be well. It was! Dentist administered two small, pain killing injections and extracted the offending tooth. More bleeding than normal - to be expected of course. All that was required to stem the bleeding was two sutures. Left the dental surgery with a little packing and almost no bleeding. No subsequent problems. Would have no hesitation about further extractions if required. Hope this helps.
Ron Walker, Adelaide, Australia, March 21, 2007

• Karen -- this is the big question. The only advice we can give, and this is the same as the major heart organizations have given, is to make sure your surgeon and interventional cardiologist communicate. Each patient's clinical situation is different and needs to be looked at on an individual basis. There is a slight risk of late stent thrombosis with DES. This risk is definitely reduced by taking long-term clopidogrel (Plavix) although not completely -- some late stent thrombosis has been seen in patient who are taking Plavix. Again, however, this number is very small. How long one must take Plavix is the question and it may be that it is different for different patients. Some patients may clot easier (lower thresholds for platelet activation) but there's no clear way to know this at present. Two years out is much better -- perhaps it may be possible to continue aspirin after stopping Plavix, and then start Plavix again right afterwards. Here's our article on the joint "Science Advisory" from the major heart and surgical groups.
Forum Editor, Angioplasty.Org, February 27, 2007

• The question seems so simple but the answer is so convoluted that I can't make an intelligent decision. I have a DES, placed 2 years ago and have been on Plavix and aspirin since. Recently, I have been diagnosed with a cancer that, although it is in early stages, needs surgery. My surgeon has involved my cardiologist who says it should be okay for me to go off the Plavix for several days prior to surgery... but there is still a 'red flag' in my understanding of the whole thing. I've read too much contradictory info about this whole thing. I just don't want to lay down for a routine surgery and not wake up again because of an unexpected blood clot. What's the bottom line?
Karen Nitzel, Silvis, Illinois, USA, February 26, 2007

• I'm 54 and had a triple bypass at age 40. In the resent years I've had 5 drug eluting stent implants. Most recent being August of 2006. At that time they implanted a stent in a stent called a sandwich stent because of a blood clot that formed in the stent. Even though I was on plavix. I'm having a plavix tolerance test done at my request. Why the doctors are so lack in informing one of the risks involved with stents and the use of plavix is disturbing. I was totally unaware of this until August when I experienced this for myself. I was told by my doctor plavix save my life by not allowing the blood to clot 100% - 99% is close enough for me. But, this same doctor advised me I could stop taking plavix 6 months before this thrombosis accrued in August. Knowing this, he agreed with another doctor I could stop plavix 3 weeks after this procedure to try using ultrasound to clot an aneurysm with two fistulas caused by the cath in August. I did go off plavix for 3 days but the procedure didn't work. So, I'm looking at surgery to fix the aneurysm with two fistula. My doctor originally said I could stop plavix 10 days before surgery but later changed his mind. I did confront both doctors with the risks I've been reading about. Who's the doctor here? I have taken a stand that the risk is to high for me to go off plavix and if they want to operate they will need to do it while I'm on plavix. They have both agreed to the surgery being done while on plavix. Surgery still pending until I feel comfortable with everything. The most disturbing things is how little information they offer you and share with one another. I'm finding no "one" doctor wants to make the decision. If they can pass the "responsible" they will. Sad but true!
TLP, Florida, USA, February 16, 2007

• Had two heart attacks, have two Medicated stents one of each kind. On Plavix & Aspirin & Lipitor. I have indigestion & constipation anything i eat, it might be gall bladder. Does any one know a Dr. that will do gall bladder surgery while on Plavix & Aspirin?
John G., West Virginia, USA, February 11, 2007

• Just wanted to call everyone's attention to the joint "Science Advisory" issued last month about the need for continuous and long-term antiplatelet (Plavix and aspirin) therapy for drug-eluting stent patients. There are specific recommendations for patients who may need surgery. That's one of the main reasons why, in addition to the major cardiology groups, the organizations included the American College of Surgeons, American Dental Association and American College of Physicians. You can read the details in our recent article, titled: "New Advisory: Will Stent Patients and Their Doctors Get the Message?".

Karen C., from Canada and all others -- one of the recommendations is that healthcare providers (surgeons, dentists, etc.) need to be made aware of the dangers of asking stent patients to stop antiplatelet therapy and should communicate directly with the patient's prescribing cardiologist.
Forum Editor, Angioplasty.Org, February 10, 2007

• Russ -- welcome to the antiplatelet mess. We have been recommending for some time (and now the AHA, ACC, SCAI, etc. have issued a formal "Advisory") that just as important as knowing how long patients need to take Plavix and aspirin, is CONSULTING with the patients prior to stent implantation. Most of the major cardiologists we've spoken with state that if there is a possibility of necessary surgery in the next year, that bare metal stents or other treatment options should be discussed. Your dad's case is a perfect (well, we guess far from perfect would be more correct) example of what happens when a patient gets a device that requires non-stop antiplatelet therapy, obviating the possibility of surgery without risking the downsides of stopping Plavix. Read the new Joint Advisory, have the surgeons and cardiologists talk to each other -- maybe they can work something out. Also be aware that heart disease and depression are closely tied -- maybe his physician can help find a non-narcotic med that will help the depression. Try to accompany him (if possible) to these appointments to help communicate these facts to his doctors. Also read our article, "You and Your MD". Good luck and let the Forum know how things turn out.
Forum Editor, Angioplasty.Org, February 10, 2007

• My father is 68. He had angioplasty with 5 stents put in 60 days ago. He is on dual therapy Plavix and Coumadin. His Cardiologist won't even entertain getting off the Plavix for a moment which I can appreciate and understand. However, his hips have deteriorated to where bone is rubbing against bone. He desperately needs 2 new hips and he is faced with the possibility of waiting as much as a year before considering it. He is a dancer and tennis player who has lost 40lbs and is at his Junior High School weight.... skinny, emaciated and depressed. With great effort, he gets around with a walker. He fell the other day and was unable to get up which drove him further into depression. He lives alone and is addicted to narcotic painkillers. A year in this state is not an option for him. His "will" has been broken and I don't think he'll make a year. There must be a way to have this hip surgery and at least be on the road to recovery. What if surgery were required.. like a tumor or aneurysm? Their must be something he can do...
Russ H, New York, New York, USA, February 8, 2007

• Had a stent inserted 4 years ago, and now have a prolapsed bladder and surgery is pending, cannot seem to get the correct answer as to how long off plavix for surgery, 5 days, 10 days, please advise! I was told when stent put in that because I am allergic to aspirin and a lot of other drugs, that I should stay on Plavix for life. The surgeon wants me off of plavix 10 days prior to surgery and also after surgery as well. thanks
Karen C., Ontario, CANADA, February 5, 2007

• I just wanted to share my experience. I had a DES implanted in October and I'm on Plavix, Lipitor etc. Last weekend, I broke a back molar and it needed to be pulled. I was concerned with bleeding complications due to the Plavix. The oral surgeon said as long as I was not on Coumadin, he felt comfortable pulling the tooth. So he pulled the tooth. For about 2 hours, I squeezed gauze on the spot where the tooth was pulled and it stopped bleeding. Aside from some swelling from pulling the tooth, all seems to be ok. Hope this information is helpful. Thank you for providing this forum to communicate.
John, New Hampshire, USA, February 5, 2007

• Terri -- thanks for your posts. You are absolutely right and your surgeon is "up" on the latest recommendations made just last week by a consortium of heart, surgical and dental organizations, urging non-cardiac doctors to be aware of the risk of taking patients off antiplatelet therapy.
Forum Editor, Angioplasty.Org, January 27, 2007

• To William E Wilke, Lemont, Illinois, USA, January 19, 2007 I think your doctor is wise in advising you not to stop your plavix and if in a few months you decided to go off beware of the possibility of clotting in the stent. They say it's a .06% but it happened to me. consult with another doctor to see if the surgery can be done while you're on plavix. I have a surgeon that is going to fix a pseudo aneurysm with a fistula approximately an hour surgery while I'm on plavix and aspirin. He said it can be done - more bleeding and bruising but not impossible because they have emergency victims coming into the ER on plavix and require surgery. So, check around with many doctors before making your decision how and when to have the surgery done. I feel for you because of your pain but hang in there until the right decision is made for your health.
Terri, Florida, USA, January 24, 2007

• I am a 54 year young female who's had a heart attack at age 39. A triple bypass at 40 years old. Five stent implants following the surgery. I've been on plavix ever since my stent implants. My doctor said I could stop taking the plavix if I wanted to 6 months after. Due to the great commercials on TV (think aspirin is enough - think again) I decided to continue taking it. Good thing I did. Aug. of 2006, I had a large thrombosis in one of my drug eluting stents. The doctor informed me that most don't survive this. But gave the credit to the Plavix saying it did its job by keeping it from 100% blocking. Yet this same doctor is the one that told me I could go off of it if I wanted to. My advise to anyone with drug eluting stents is to NEVER go off your Plavix. Now I'm scheduled for surgery to repair an aneurysm in groin artery caused by my heart cath procedure. I'm not going off the Plavix to have this done. My cardiologist said not to go off the Plavix but the surgeon wants me off.. I might get sent home without the surgery. My advice is to stay on plavix the rest of your life because it only takes one 100% clot to change your life forever, if you live to tell your story.
Terri, Florida, USA, January 19, 2007

• I hade a stent placed this past September. I was scheduled for a colonoscopy and went off the plavix in December for 10 days. I was not told about the serious complications that could have resulted. I now injured my back and have a herniated disc and terrible pain in my right leg. My Doctor will not do anything for at least another few months. I am taking heavy pain medication but it really doesn't help. What can I do?
William E Wilke, Lemont, Illinois, USA, January 19, 2007

• I just had my surgery in December. I had a Heart Cath about 2 weeks before I had the surgery to be sure the stent was open and it was. I was taken off my Plavix and aspirin for 5 days pre-op and then was given Lovenox shots for about 8 doses after surgery then resumed the Plavix. All my biopsies were negative...so everything worked out for the best. Just decided to let you all know how this turned out. I was in severe pain for 6 months, but I am feeling GREAT now and have started exercising and am up to 2 miles a day walking and weightlifting. Hopefully things continue to go well. Thank you all for all of your responses.
Margaret Riojas, Baytown, Texas, USA, January 10, 2007

• I am a 37 year old with a similar problem I had a heart attack in July and after that in October had 2 Taxus Express2 Stents placed one in my LAD and the other in CFX OM2. Then in November was told I have possible Tumors in my bladder and will have to have a biopsy done to find out if they are cancer. So my cardiologist tells me that I can't come off the plavix until mid January. I schedule all the appointments for my preop and my blood work and the biopsy just so that my cardiologist can change his mind and now tell me he won't take me off plavix until beginning of March. Waiting to find out if you have cancer because you can't take a chance on having a heart attack is enough stress to cause another heart attack in its self. I never was asked if I wanted these specific type of stents. I would have asked for the plain metal ones. There just seems to be more risks with these kind of stents. Good Luck to all of you and take care of yourselves.
Sandra, Connecticut, January 10, 2007

• Caron -- at the FDA panel, 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 labeling on stents for longer periods than 3-6 months. He said there has been no evidence presented that would mandate such a change. But when asked by the Panel chairman, if Dr. White had a DES and was at low risk for bleeding, how long would he take Plavix himself, Dr. White answer, without hesistation, "indefinitely". So the discussion your doctors are having are being had elsewhere. I think most cardiologists think a year is enough, but one might also ask, if you are not having bleeding complications, why not stay on longer -- Plavix also has other benefits. But the bottom line is that there is no bottom line, no sure answer to how long. Good thing is that you are two years out. Hope you're feeling well and that the stenting was beneficial. Since your guess is as good as mine, or theirs, I would ask both docs exactly what their line of reasoning is, and then decide for yourself.
Forum Editor, Angioplasty.Org, January 3, 2007

• i have one doctor telling me to stay on plavix...2 yrs after surgery...and another saying that plavix is not useful after one year...I had a stent put in 2 yrs ago. Please tell me which is the one to follow.
Caron Johnson, Shannon, Mississippi, USA, January 3, 2007

• Al -- thanks for sending in this suggestion! Sounds like a good plan.
Forum Editor, Angioplasty.Org, January 3, 2007

• I had 5 Cypher Stents placed in my coronary arteries about a year ago, 3 in my LAD (which was completely blocked) and 2 in the left circumflex. I am on Plavix, Aspirin 325mg, Advicor, Toprol XL and Lisinopril. My dentist's office recently cleaned my teeth with very little bleeding. The only change to my medication that my cardiologist recommended was to alternate between 81mg and 325mg aspirin every other day a week prior to my dental work and to continue other meds as before. I'm sharing this information here so that others in need of dental work have a starting point for discussions with their cardiologist.
Al, Chicago, Illinois, USA, December 28, 2006

• My wife had angioplasty plus stents in two arteries last August. She was told to take clopidogrel and aspirin for 12 months. She is 82 years old. She was recently diagnosed with breast cancer believed to be in the early stages. A complete mastectomy was considered to be the best course of action, due to take place mid December. The surgeon now wishes to see her we believe to discuss the fact that she is taking clopidogrel.
Alan B., England, UK, December 9, 2006

• At the FDA Meeting last week, a representative from Accumetrics, discussed a simple blood test called VerifyNow that can be used to tell whether or not your Plavix is still affecting your platelets, or if it has worn off. Many people can go to surgery (and stay off the drug) for a much shorter period of time with this simple blood test.
R.H., California, USA, December 9, 2006

• Sheri -- the complication your father is facing is not atypical. If he receives a drug-eluting stent, he is supposed to be on Plavix and aspirin for 6 months minimum according to most current thinking from the top cardiologists, but many are prescribing a year or more. The problem is that most surgeons won't operate ona patient who is on these blood-thinning medications and want the patient to stop prior to surgery. This raises the risk of a blood clot in the heart, which can be fatal. Your father's clinical situation is one that should be discussed in conference between the interventional cardiologist and the knee surgeon. Perhaps they'll decide to do the knee replacement first, or perhaps use a bare metal stent (which only requires 6 weeks of antiplatelet therapy. We'll be curious as to what is decided, please let us know.
Forum Editor, Angioplasty.Org, November 16, 2006

• My father is having knee replacement surgery in a month, know we find out he may need a stent put in his heart, is it still possible to keep the knee surgery or do we have to wait a certain amount of time after a stent is inserted to have a major surgery? thank you
Sheri, Illinois, USA, November 9, 2006

• I am to have a LEEP procedure done and am wondering if this is okay to do given that I have 4 Taxus stents. My ob/gyn and cardiologist have discussed this and say it is fine, however, i thought i remembered reading that because the stents are metal the LEEP could not be done. I can no longer find this info anywhere, I trust both my doctors but neither have had a patient in this situation before. Any advice?
Bobbi Y., Pennsylvania, USA, October 30, 2006

• To all patients: check with your interventional cardiologist before going off antiplatelet therapy (Plavix and aspirin). This would be the doctor who actually put the stent in. There is much controversy in this area and it is important to check with this specialist, because he/she will be most informed about your options. Many interventional cardiologists are working with surgeons so that they understand the risks for stent patients of going off Plavix. Some surgeons are finding ways to do the surgery without taking patients off their meds.
Forum Editor, Angioplasty.Org, October 28, 2006

• I had the last of 4 drug-eluting stents inserted in the LAD in May of 2005. On May 15, 2006, I had a total knee replacement. On May 16,2006, I had a heart attack caused by clotting at all of the stent sites. I had stopped my maintenance dose of Plavix one week prior to the knee surgery. I will forever be hesitant to stop taking Plavix.
J.F. Georgia, USA, October 24, 2006

• I am 57 and had 3 non-medicated stents placed in October of 05 and in March of 06 I had a medicated stent implanted because of scarring. I am to get a hernia repair this Friday, and just heard about this info on the medicated stents. My Cardiologist said I should be off plavix and aspirin for a week before surgery and 3 days after for a total of 10 days. I hope this will be ok, I am very worried about the effects of the clotting. Had I known anything before I would have gotten in touch with my cardiologist. Will this be detrimental to my health being off the blood thinners this long?
Charles Haldema, Kutztown, Pennsylvania, USA, October 24, 2006

• The day before my 70th birthday I had a TAXUS Express 2 stent implanted and was informed to be on Plavix and aspirin for at least six months. About four months later I developed an incarcerated left inguinal hernia which needed surgical repair. The surgeon would not operate unless I was off of Plavix for 10 days prior to surgery plus five days following surgery. My cardiologist somewhat reluctantly authorized the withdrawal from Plavix for a period not to exceed 15 days since I had been on it for at least a minimum of four months. Two months later my first stent was over 90% blocked and I required angioplasty to open up the Taxus stent and to place a smaller stent inside the original stent. A Cordis CYPHER stent was used in order to change the eluting drug. I was then informed to stay on Plavix and aspirin for a minimum of one year and perhaps longer. It has been just one year since the last stent was inserted and I have an appointment with my cardiologist next month. I suspect that I will be informed to continue the Plavix as well as the aspirin. My advice to anyone requiring surgery after receiving a drug-eluting stent is to thoroughly discuss with your cardiologist the implications of going off of Plavix even for a short time. Know your options and consequences.
William B., Ohio,USA, October 24, 2006

• Can anyone shed the latest info on this topic? I am due to have a further angiogram in 2 weeks and am still on Warfarin, Plavix and aspirin. I do not see anyone until next week, 7 days before the angiogram, and getting a bit worried, as no none from the hospital has mentioned anything about it. What would be expected? I had a BM stent put in in Feb this year.
terrym, Portugal, August 30, 2006

• Age 57: male: 1.80m : 190kilos. Guidant bare stent fitted Feb 2006 LAD Other 2 arteries were known to be blocked around 70% but not stented. All well for 3/4 months post op, but now chest pains evident on exercise or stress, so stress test proved positive and further Angiogram scheduled for Sept. Atrial Fibrillation (chronic) for 7 years Current meds Plavix, Aspirin, Sotalol, Warfarin, Simvastatin Plus Cozaar........also a bit concerned about what meds will be stopped or changed before next Angiogram.
Terrym, Portugal, August 3, 2006

• I take warfarin, due to an unexplainable pulmonary embolism a few years ago. Last year I had a heart attack, and when stenting the acute blockage in my RCA, a second, chronic total occlusion was seen in my LAD (heavily calcified and old). We decided not to do anything about that CTO until a few months later, when a nuclear stress test indicated some advantages to re- opening the LAD. To prepare for the angioplasty and stenting of the CTO (two caths, one in each femoral artery), my cardiologist had me do a week of "bridging" anticoagulation therapy. Instead of warfarin, which takes days to clear from your body, I went on twice daily self injected shots of Lovenox (a low MW heparin that clears rapidly from your system). I took the last shot the evening before the procedure, so by the morning, I was clear of anti-coagulant and ready for the procedure. Which was all good, as the catheterization went awry, I started bleeding and developed tamponade, and had to be rushed into surgery for emergency bypass. But, the point of this post, is that there are anti-coagulation techniques to allow cardiac patients to have additional procedures, without exposing themselves to excessive risk of clot formation.
Mike, Virginia, USA, July 18, 2006

• I have two DESs and may face this issue. I am struck by how the doctor community only considers two "states"--either take the medicine and avoid the surgery or stop the medicine, have the surgery and risk the fairly immediate prospect of a thrombosis. This is the only research test conditions and thus the only two "states" the docs can consider. What about modulating the Plavix dose leading into the surgery. When you do an angioplasty, even while on Plavix (which occurs when you do a second emergency angioplasty soon after the first stent placement), they measure your BCT (I think called Blood Clotting Time) before they remove the "sheath" from your artery. Obviously, your clotting time will vary and it seems logical that reducing the Plavix for a time might allow the surgery without running the FULL risk of stopping the Plavix altogether. But nobody has done a clinical on such dose manipulations (or have they?) and thus you get the either/or debate. If faced with non-elective surgery, I certain plan to explore this approach in great detail with the docs. Comments?
Ken C., Ohio, USA, July 16, 2006

• I was scheduled for a larynx biopsy when the stent was put in. Of course I am on Plavix now. What do I do about the biopsy?? What happens when Plavix patients have emergency surgeries or accidents? What about nosebleeds, etc?
J. Dalton , Louisville, Kentucky, USA, July 8, 2006

• Recently I had to have necessary surgery and after 12 stents in the last year (and 1 MI from a thrombosis after 20 days with a newly implanted stent) my cardiologist said I could come off the plavix and aspirin for 2 weeks to have the surgery performed. After the 2 weeks he said I could be off both indefinitely because the last stent had gone in 4 months earlier and he felt I was safe. I'm not sure if he is right but maybe it is an individual case by case decision? (I just hope my dr. is right!)
Brenda, New Jersey, USA, July 3, 2006

• Margaret -- this is a well-documented problem for patients who require surgery after the implantation of a drug-eluting stent, because of the requirement that the patient stay on antiplatelet meds (aspirin and Plavix or Ticlid). Cardiologists are cautioned to weigh the use of drug-eluting stents against the possibility that the patient may require surgery in the next six months, or that the patient may not stay in compliance for one reason or another (see our recent news article about the study from Kansas City). We attended a symposium on antiplatelet therapy at last fall's TCT meeting where a cardiologist spoke about this problem, a discussion he regularly has with his wife, who is a surgeon. There is no quick or "pat" answer. This is something that should certainly be discussed with both the surgeon and cardiologist. For more infomation, you can browse a related Forum Topic about Plavix and Aspirin. As for how long you should stay on Plavix -- a poll on a professional cardiologists-only web site this week is asking just that question. While only around 60+ physicians have voted, and this poll is definitely not scientific, only 2% of the docs answered 3 months and only 25% answered 6 months. 40% said a year. Over a third said "Plavix for life". Obviously, at some point most patients will need some type of surgical procedure, even if it's only dentistry-related. This is why each patient must involve their cardiologist in the decision to stop antiplatelet therapy, even if it's for a short while.
Forum Editor, Angioplasty.Org, June 21, 2006

• I have no answer. I'm concerned too. I had a bare-metal and 2 drug-eluting stents placed March 1, 2006. I'm due for a colonoscopy. (I had benign polyps in the past and have been advised to have more-frequent checks on my colon than those who have been clear of growths.) The doctor who was to do the colonoscopy wanted me to go off Plavix & Aspirin for 5 days before the test. The Cardiologist says to wait a few more months, so I cancelled the colon test...But from what I've read, even going off Plavix in a few more months may be an unnecessary risk, especially since the colon test is really elective.
Tom T., Arizona, USA, June 21, 2006

• I am a 39 yr old female who had a Taxus Express2 stent placed in LAD last month. I have since started having severe abdominal pain which has revealed to be 2 large ovarian cysts, both suspicious looking. They need to come out, but I am only 4 weeks post op from Stent. My cardiologist says I have a choice. I can stop the Plavix and risk re-occlusion of the artery, or I can live with the pain these cysts are causing until December. I can't believe I am on a medication that would put me in this position. We all know I do not want to die, but I don't want to live with the pain these cysts are causing either. Suggestions???
Margaret Riojas, Baytown, Texas, USA, June 18, 2006

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