Persantin, Plavix, Acenocoumarol and Ascal???

Posted by Mariette  on August 06, 1999 at 14:19:28
Dear Doctors,
First of all thanks for this excellent service. It must cost you a great deal of time. I try to be short.
I suffered DVTs and PEs 8 times despite the acenocoumarol.
I also suffered three minor CVA's, one under Ascal as well.
Now they discovered that I have Factor V Leiden, as well as platelet activity. The AMC here in the Netherlands is also stuying on a new factor, which would indicate activity in the blood.
They proposed to take not only the acenocoumarol and the ascal but also persantin as well as plavix. (hope I am right, it is about dipyridamole and clopidogrel)....
Are they nuts? I am only 32 years old and am not looking forward having a bleeding instead of a clot somewhere...
What would you suggest> Any experience with this? Are there new clotting factors disocered in the USA recently??
Thanks, Mariette

Posted by CCF CARDIO MD - DLB on August 06, 1999 at 15:16:51
Dear Mariette
As you probably know, the Netherlands is where Factor V Leiden was discovered. You have some of the leading investigators in the field in your own country. No new clotting factors have been discovered recently. You are right that taking all 4 medications will increase your risk of bleeding and you will need to be especially careful. However, you state that you have had several minor strokes despite being on therapy, and potentially the next stroke may be a catastrophic one. Thus, I think your doctors have a valid point in adding new therapy. Also, it would be worthwhile to have an echocardiogram to make sure that you do not have any abnormal connection between your right and left sided heart chambers.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by Mariette on August 06, 1999 at 16:07:39
Thanks for your answer. They indeed ruled out an VSD or ASD. No-one can think of another reason for alle this to happen..... Well, I guess I have to think about the meds....
Thanks again, Mariette

Posted by CCF CARDIO MD - DLB on August 06, 1999 at 16:19:39
Dear Mariette
It sounds like your doctors have been thorough. I am assuming your coumadin dose was in a therapeutic range when these clotting events occurred.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.