Plavix, aspirin AND coumadin

[mrag]

I am currently taking plavix, 81mg aspirin AND coumadin on a daily basis. I had a stent put in in July 2008 and triple by pass in 2006. I'm 64 and had my first MI at 33. My father died of an MI at 46, my EF is under 30%. My EP (at one hospital) just suggested I eliminate the plavix while my CHF specialist (at a nearby major research university) said I would be on plavix for a "long time" (forever?).

I have just read several articles noting alleged benefits of plavix AND aspirin for those NOT tolerating coumadin, but I'm wondering if there is a more specific or definitive answer regarding taking ALL THREE medications. I've not noticed any side effects in taking any or all of these drugs (I also take, Toprol, Klor Kon, Lasix, Ramipril, Simvastatin)  

[kenkeith]

The recommended treatment  for DES implants is dual therapy of aspirin and plavix up to a year. Combining plavix and aspirin increases the risk of bleeding vs. aspirin alone in patients treated for more than a brief period of time. That is the regimen followed for my DES implant.

f you are in this category a prior MI and unstable angina:" In the CAPRIE trial, clopidogrel (plavix) was equivalent to aspirin for patients with a recent (but not acute) MI.  Some subgroups of patients with cardiovascular disease in this trial seemed to benefit more from clopidogrel than from aspirin: those with a history of bypass surgery, a prior stroke or MI, arterial disease in two or more areas, diabetes, or high cholesterol.  Clopidogrel may be a reasonable choice for these patients. Patients with a past history of MI within the prior 5 years don't seem to derive any more benefit from dual therapy.

In some disease states, clotting occurs when it shouldn’t. If you have been diagnosed with a Pulmonary Embolism (blood clot to the lung), Deep Vein Thrombosis (blood clot in the legs), certain cardiac disorders (artificial valves or arrhythmia’s) or clotting disorders, your physician may prescribe a regimen of Coumadin as therapy.

1.Use low-dose aspirin (81-162 mg/day) in these patients:
◦no known vascular disease but at high risk because of age and/or risk factors
◦stable angina
◦MI over 1 year previously and not at high risk of vascular events (none of the following): bypass surgery, events involving multiple vascular beds, >1 ischemic event, diabetes, or high cholesterol
◦stroke (acute or remote) but no other reason for having a high risk of vascular events

2.Use clopdiogrel (Plavix) alone (75 mg/day) in these patients:
◦allergic to aspirin (note: patients with a history of aspirin-induced gastrointestinal bleeding should receive aspirin plus a proton-pump inhibitor)
◦prior MI (over 1 year previous) or stroke, and at high risk of vascular events
◦peripheral vascular disease that is symptomatic or was surgically corrected.

.Use clopidogrel (Plavix) (75 mg/day) plus aspirin (81-162 mg/day) and re-assess after 1 year in these patients:
◦acute MI within past year
◦coronary stent insertion within past year.

Coumadin is another anti-platelet medication and is recommended for individuals that valve replacement.  

It seems to me you are at a highly increased risk for excessive bleeding, and that may exceed the risk of clots, etc., but your doctor may consider you at a high risk for blood clot?!