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Heart Disease (Expert Forum)
Plavix dosing following drug eluting stents
Answered by
Cleveland - OH
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Plavix dosing following drug eluting stents
by morningglory2006, Sep 29, 2006 12:00AM
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!
Doctor's Answer
by Cleveland Clinic, Sep 29, 2006 12:00AM
, Sep 29, 2006 12:00AM
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
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
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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
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 &%&*!~!
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.