Use of Plavix ASA in lieu of Coumadin

I am a family physician involved in care of a patient with recent titanium valve replacement.  He is +++++ sensitive to Coumadin and his INR bounces up and down such that I believe the risk outweighs the benefit.  Will Plavix + ASA give "reasonable" anticoagulation ? If so please supply a reference if available.  

Many thanks.

[CCF-M.D.-KE]

Dear sgoldmd,

You are describing a patient with a mechanical heart valve who is experiencing fluctuations in his or her INR. Plavix and aspirin will not give this patient the degree of anticoagulation required for a mechanical heart valve. I would recommend sending this patient to a hematologist or a coumadin clinic where specialists in the area of anticoagulation can review genetic and/or dietary factors which may be affecting his response to coumadin.

Thanks for your question,


CCF-MD-KE