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Plavix dosing following drug eluting stents
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Plavix dosing following drug eluting stents

Hello, Following an MI and 2 Cypher drug eluting stents in my LAD last year, I was placed on Plavix, Cozaar, Metoprolol, Provachol and aspirin.  I have read all the reports out of the cardiology meeting in Barcelona last month and am concerned about late stent thrombosis.  1) How long does the CC advise patients to stay on Plavix?  2) If a patient stops Plavix, is there a critical window of time when the risk of thrombosis is lessened? e.g. 1 week.  3) If a patient stops Plavix, is there something that can be taken before or after stopping--like more aspirin--that might reduce clotting problems? 4) Is there a blood test to see if a patient is more at risk for clotting problems? 5) Any nutritional suggestions that might diminish clotting problems if Plavix is stopped? 6) Emotional consequences of stopping Plavix are like waiting for the other shoe to drop.  Shouldn't doctors be aware of this and what sort of support should be offered?  7) What should you do if you need surgery? 8) Can aerobic or weight bearing exercise reduce risk of clotting problems--so should more be done after stopping Plavix?  For all of us on drug eluting stents and Plavix--thank you!
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239757_tn?1213813182
glory,

Thanks for the post.

The topic you mention is an important one and one without concrete answers. Drug eluting stents are an important tool in the arsenal to treat coronary disease and thus any potential risk of them, applies to a large number of patients that have or will need them.    
I will give you my personal practice guidelines, but these do vary even with me for different patients.

1) How long does the CC advise patients to stay on Plavix?

I usually treat for a year for a regular patient with a DES. FOr some though, such as left main, bifurcation disease or chronic total occlusions I sometimes use the drug indefinitely.

2) If a patient stops Plavix, is there a critical window of time when the risk of thrombosis is lessened? e.g. 1 week.

No. the risk of thrombosis may be elevated out to over a year. This is why there is concern.

3) If a patient stops Plavix, is there something that can be taken before or after stopping--like more aspirin--that might reduce clotting problems?

No answer. Generally, patients need to stop plavix because of bleeding problems which would entail stopping all blood thinners.

4) Is there a blood test to see if a patient is more at risk for clotting problems?

There are lots of test looking at clotting and thrombosis. Even ones looking at effect of aspirin and plavix. There is no evidence that these test are helpful.

5) Any nutritional suggestions that might diminish clotting problems if Plavix is stopped?

Everyone has their own beliefs. There are a lot of people who suggest supplementing with different vitamins and oils. There is no evidence of benefit.

6) Emotional consequences of stopping Plavix are like waiting for the other shoe to drop. Shouldn't doctors be aware of this and what sort of support should be offered?

Doctors are aware of the problems. If you have coronary disease, you are still more likely to have a de novo heart attack then one from a stent problem. Some look at the glass as half empty, some as half full. I generally try to tell my patients we've done everything to lower your cardiovascular risk as low as possible --- live it up.

7) What should you do if you need surgery?

No definite answer and depends on where the stent is located. If its far from implantation and not located in a proximal major vessel, usually I will stop the plavix. For some patients, some have suggested brdging with heparin.

8) Can aerobic or weight bearing exercise reduce risk of clotting problems--so should more be done after stopping Plavix?

Cardiovascular fitness will decrease your overall risk -- period.
It is a vital component of anyones therapy with CAD.

good luck
13 Comments
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129317_tn?1189759421
Looking forward to the doctor's response, because I have had the same question regarding Plavix.  My military doctors told me that they were going to take me off Plavix after 6 months, but my new cardios have said that I'll be on Plavix for life.  Thanks for the post!
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61536_tn?1340701763
My dad is on Plavix also, as well as an aspirin regimen, following his three stent procedure two years ago.  We're under the impression this will be a life-long thing.  To my knowledge, he is on the same dose as he was from the start.  He did have a CABG (three) in 1997 also, so this may be part of the consideration to continue the Plavix indefinitely.
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Avatar_n_tn
Interesting enough, I work in a cath lab.  We have seen patients come in with thrombosed drug coated stents that are a year or more old.  They had recently been taken off of Plavix for dental work or various other reasons. The best cardiologist that I work with said that it looks like there is a possibility that people with the drug coated stents may have to take Plavix the rest of their lives.  If anyone on Plavix has a doctor other than their cardiologist that tries to take them off Plavix, refuse and contact your cardiologist first.
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Avatar_f_tn
My husband had a heart attack a year ago in June had two stents, was on Plavix for a year, the cardio took him off the drug and in one month he had a another heart attack due to the stent blocking up and had to have by-pass.He is not on plavix after this attack.

He is changing cardio's, has his 1st appointment on Monday I am anxious to see if this Dr. puts him back on plavix. He is on coumadin and aspirin plus a lot of other meds.
I know people who are on plavix for life and others only 6 months to a year. I am also anxious to see the answer to this question.

We just saw our G/P she went over reports with us, the report from the surgeon says my husband still has a 60 and 70% blockage, he told us after the surgery and durning the office visit that he had a 40%. we do not know what to think about this, but I would think while they were operating they would have done something about these other blockages if they are there.

Linda


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Avatar_n_tn
Read this with interest.  I have five DES. Now, cardio mentioned different strokes for different folks.  I do not understand some of his lingo...I have stents in the RCA and LAD.  LAX is clear all the way.  None of my DDS asked me to get offr Plavix forsental procedures this year.  I have had 4 Implants, 3 root canals and two teeth extracted. I did well but I had great DDS!~!  My Cardio doctor said I need to be on Plavix for life....I do know that I cannot have knee surgery ever...ever...as Orthopedic surgeon says I must be off Plavix for 7 days and on Lovenox for 10 days.  Cardio says no Knee surgery. I cannot walk due to this knee problem yet will have to suffer like this until I am told that research has discovered that one can get off Plavix safely in 3? 4? 5?years.   I have been on Plavix now for over 2 years for 2 stents and close to 2 years for the other stents.  Doctors should warn their p[ateints now about these DES and may want to consider Bare Metal Stents. You do not have to be on Plavix forever with these.
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Avatar_n_tn
In a bare metal stent, a layer of tissue eventually grows over the struts of the inside of the stent, making a smooth highway for blood to flow through.  In drug eluting stents (DES) it is now being found that the tissue may never fully grow over the struts.  This causes rough areas within the stent that blood bumps into and forms clots.  People with bare metal stents take Plavix for up to one year.  As many people have posted, DES patients may never get off of Plavix.  This poses many problems-inability to do surgery, etc.  Give the pharmaceutical companies time...........they'll jump on this and develop another drug to help this matter.  And that drug will have side effects and they'll develop another drug to treat that. And on and on.  Forgive my negativity.  I feel for all of you and for your family members.  If I ever need a stent, I think I'll ask for bare metal. MinnieM, I'm with you.  The doctors need to give this info to their patients as well as ask them if they can afford Plavix.  It's very expensive and we have seen patients come in with clotted stents because they stopped taking their Plavix due to cost.  Al, thanks for the website.  Do you know of any other good cardiology sites?
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Avatar_n_tn
Medicare D pateints have to pay 58.00 co-pay for their Plavix...Many of them are on limited income so some are taking Plavix every other day to conserve....My sister has two bare metal stents.  I was soo worried about her in 2000 with these stents as I heard about the possiblilty of DES stents coming out and wished she had these...Well, now she is worried about me. She was on Plavix 18 months and has been off plavix now for over 3 years and is going GREAT!. I told my Cath doctor if I need  another stent I want it to be bare metal or no stent at all.  I am so *&%^$%&& that this "new toy, DES" cannot be re-called and taken out safely from patients.  Do you really think doctors are going to tell a patient about the latest findings on DES and Plavix?  Guess again.....It is patients like us that will tell them how the cow ate the cabbage.
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129317_tn?1189759421
This is a really great post with lots of good information.  Wish it would have come out a little earlier, because I would have asked some different questions of my cardiologist before receiving a new drug eluding stent two weeks ago.  Not sure there is a good solution.  Bare metal stents have such a high rate of restenosis in some, not sure that they are a better solution than the DESs.  I would be reluctant to ask for a bare metal stent due to my personal experience with having to have two additional angioplasties over a very short time period to open up blockages that occurred in my bare metal stents (I have two, and 3 DESs all in LAD).  In my last procedure, the doc put a long DES under my two bare metal stents to hopefully prevent another restenosis.  Hopefully, if I have any other health problems, I'll be able to continue taking the Plavix, or they'll have something new out that will help.  But again, thanks for the discussion all - I'll talk this through with my cardiologist at my one month follow-up!
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Avatar_n_tn
The coating in these DES stents is suppose to be toxic. It certainly does act differently than that of a bare metal stent.

I do not think the maker of these stents did all of their homework.  Now, what do they do to help the thousands that are harboring these stents.  I would jump thru hoops to get these DES stents out of me and exchange them for Bare Metal. Some surgeons now feel the best way to go is by-pass so stents are not needed.  But, what if one chooses by-pass as their only next option and they stil have these &*%^%*&* toxic coated stents in them! I am madder than &%&*!~!
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Avatar_n_tn
Interesting thread-I am a 57 year old male, extensive familial history of male MI, CAD, and sudden cardio-related deaths. I had 3 "Cypher" DES "installed" in 3 procedures in 2005.  I have been on Plavix continuously since then.  Last cath was in April, 2006-no blockages. I read the Barcelona stuff, brought it up with my congenial cardiologist, who responded by saying:  "the FDA is aware of the problem, and is working on it".  I am also a mathematics professor, and have an intimate knowledge of what I call "intuitive statistics".  The fact that they are still installing these things in MANY people actually gives me comfort.  Risk management is the name of the game-since there is a measurable risk associated with everything we do.  What helps me is what I remind my students of every time I can-the riskiest behavior we all participate in is driving our damn cars. I am glad I was able to go through the whole sex thing when I did-without need of worry about HIV-AIDS, STD's, etc.  I do remember all the stress associated with the "are you pregnant?/did you get your period yet?" stuff when younger.  Since I also have some severe anxiety issues, I either have another glass of wine, or pop another xanax.  Funny-these usually do the trick for me.  I also have a wonderful clinical psychologist who I have a great professional/personal relationship with.  Just talking to her once a month helps immensely.  I am pretty sure the cardio guys are seeing so many patients now that we are all just numbers to most of them, and as a result, they develop what I refer to as "programmed responses" to our pleadings for help/information.  Remember-these guys are pretty young as a group-and they have plenty of experiences to draw from when they see/respond to us.  Sorry for the rambling-just some thoughts to share.
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Avatar_n_tn
I had two drug eluding stents put in back in July this year (06). A couple of weeks ago, my back surgeon told me to stop taking Plavix so he could operate on my back for bone spur and ruptured disk. Three days later I had a heart attack and had to have two more stents put in. My heart doctor never discussed with me or my wife about the drug eluding stents or possible ramification of such. I am glad to have found this website. Thanks to all that have posted comments and questions.
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Avatar_n_tn
On Plavix for 3 years for 3 DES for heart.  Came off a couple of times  at 2+ years for medical procedures with no problems.
Plavix for life is a little scary because of surgeries, car accidents, falls and etc.
The solution has got to be some sort of inspection of the stent to see if it is covered.
I have had a good life these past three years and am much better off with the DES and Plavix but would like a better solution.
Have reduced aspirin which has helped the tininitis.
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315318_tn?1353255400
A related discussion, plavix was started.
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Avatar_m_tn
A related discussion, Off of Plavix was started.
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