Plavix and Major Back Surgery

Hello, I have 5 medicated stents which were placed in the last 5 years. I had 2 with thrombosis after stopping Plavix. I now need to have major back surgery, 2 fusions. My neurosurgeon says I need to go off Plavix for 6 weeks prior to surgery. I am very concerned about going off Plavix since past thrombosis and nearly dying. Can someone tell me the risk percentages for thrombosis if you had it prior. My wife would like for me to hold off of surgery until absolutely necessary or they come up with more info on Plavix. Thank you for your help.

[MamaBush]

Since Plavix is a blood thinner, of course any surgeon would like for you to be off it and it out of your system completely before performing any kind of surgery, including something as minor as having your teeth cleaned.

I don't know enough obout thrombosis to answer that part of your question, but I do understand a doctor/surgeon wanting you off the Plavix.

Have you asked the neurosurgeon about your history of thrombosis and what happened when you stopped taking Plavix in the past?

[kenkeith]

As stated in prior post, restenosis is in the low single digits for the general population for drug eluding stents.

As an idividual with a prior history of restenosis. obviously the probability is higher on that basis. I don't believe there is an answer to your question as there are considerations on an individual basis that may or may not be statistically relevant to the general population as risk factors are not evenly distributed to the population in question.  Factors to be considered such as size of the lumen and size of the stent, skill of the interventional cardiologist, the anatomy and general health of the artery (degree of arteriosclerosis, etc.), blood pressure under control, other medication, etc. There is no control group with the general population statistic.
For some insight. drug coated stents prevent restenosis by inhibiting abnormal cell growth within the stent. However, the drugs used to coat these stents also inhibit the growth of a layer of normal cells (called endothelial cells) that would prevent the bare metal of the stent from being exposed to the blood. So, when anti-platelet drugs are stopped, platelets in the bloodstream may be more likely to "stick" to the stent, and to begin forming a clot that could block blood flow within a matter of several minutes. At this point, late occlusion of drug coated stents still has not been carefully studied, so its actual incidence is not known. Even with this "new" phenomenon, however, the overall risk of stent restenosis still appears substantially lower with drug coated stents than with bare metal stents.

The risk of late occlusion is very small (apparently, approximately, 1 in 200), especially compared to the risk of early restenosis with bare metal stents (which can be as high as 15 - 30%), but when it occurs it can happen quite suddenly, and can rapidly lead to heart attack or death.

The prolonged use of clopidogrel (Plavix) greatly reduces the risk of late thrombosis in DES, but clopidogrel itself poses problems. Aside from the expense and the risk of bleeding posed by the long-term use of this drug, using clopidogrel (because of the pronounced bleeding tendency it causes) essentially precludes any invasive medical procedures whatsoever. The drug must be stopped for several days prior to any such medical procedures, and some cardiologists are now very reluctant to allow their patients to do so, for at least a year or two after the DES is implanted. The risk for restenosis is very low after about a year and studies have shown the benefit/risk for excessive bleeding exceeds the risk for stenosis.

[bosgirl]

I can only tell you that my husband was given cardiac clearance to have  L5-S1 spinal fusion. At that time he had a DES placed in his right coronary artery.
Immediately following surgery he went into cardiac arrest but thanks to quick actions by the staff he was brought back around. He was taken back to the Cath lab and had th clot removed and another stent put in. (This time bare metal stent)
My husband almost lost his life by going off of plavix and aspirin one year after his first stent. He went without Plavix and aspirin for  7 days. I can only imagine how much pain you are in. I would really think about the risks. From our past experience I would say it is very, very risky. Late stent thrombosis may happen rarely but it certainly does happen.
Good luck to you and your wife.
P. B

[ed34]

If the last stent was inserted over six months ago then the risk is significantly less. I had to come off plavix and aspirin for a tooth extraction. My GP told me that I should stop
the medication for 5 days prior to the surgery, but my Cardiologist went crazy saying it
actually only takes 24 hours to clear out of the system, hence taking them on a daily basis. Why would the surgeon ask you to stop them 6 weeks prior to surgery? that does
seem a very long time.

[RJF614]

Thank you for your comments. I had a diagnostic angiogram done yesterday and one of the stents in RCA has 40 percent scar tissue. Cardio said I should be okay for back surgery. I go back to neuro on Monday to discuss with him again. I will ley you know what he has to say. Thanks RJF614

[RJF614]

My take on the neurosurgeon wanting to wait six weeks is so that you get past the 7-10 days which is when Thrombosis usually occurs. If you wait six weeks, it will probably not happen. Although you may then have the plavix rebound effect. Thanks,

RJF614