dawn

i would like to know if anyone can help, my husband had  5 stents fitted over thelast 6 years, after taking colplidogral tablets with asprin and several others for some time, he went in for a minor op on his leg (private) and was refused treatment due to the blood thinning tablets he was on, they said he would bleed to death on the operating table. he was told to go back to local gp in which he did and they took him straight of them,nov 07, my poor husband went out on a sunday morning in january and never came back, i have now been told he died from a blood clot in the artery, age 44, this took just approx 8 weeks ?????????. its like some one just turned the light of on him for no reason. as far as we were concerned he was healthy, until they stopped the tablets.

[kenkeith]

Sorry to hear of your loss.  There is test to determine time for clot formation.  It is my understanding that medciation for blood thinning, anticlotting requires only about a week stoppage prior to a risk of bleeding operation.  Plavix could have been discontinued with very little risk, but to discontinue aspirin for about 2 months is unacceptable and not necessary

[me194]

Thanks for your reply .my husband was taking asprin and he used to take plavix, it was the cloplidogel blood thinning tablets that they stopped,i am sure they should have winned him of them,as 1 every other day and taken blood tests, to make sure the blood was not clotting. is this right ???????????  do you know what this test is called that you mentioned ?

[kenkeith]

For some perspective:
Prothrombin time is a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working. Prothrombin time (PT)...Normal: 10–13 seconds.  It seems reasonable that a test to assure PT does not fall below 10 seconds putting one at a higher risk for blood clot formation.

About 12 blood clotting factors are needed for blood to clot (coagulation). Prothrombin is one of the clotting factors made by the liver. Vitamin K is needed to make prothrombin and other clotting factors. Prothrombin time is an important test because it checks to see if blood clotting factors are present or lack thereof.

Another test, the activated partial thromboplastin time  test, is a better test to find out if the right dose of a blood thinner is being used.
Low or high levels of blood clotting factors.
A change in the activity of any of the clotting factors.
The absence or over production of any of the clotting factors.
Other substances, called inhibitors, that affect the clotting factors.
An increase in the use of the clotting factors.
An abnormal prothrombin time is often caused by liver disease or injury notwithstanding  treatment with blood thinners that increase PT time.

The doctor should have determined PT was not below the 10 second interval after a week or so when the blood clotting time returns the system free of questionable medication.  A blood test every day may be excessive, but no more than 10 days seems reasonable.  The medical community does not endorse a necessity to wean off a blood thinner.  The rationale may be there is a gradual withdrawl (withdrawal) ipsofacto (waiting for the opportunity to use that word :)...but there are exceptions.    

[me194]

Thanks for your return reply,

I understand what you are saying about it take 12 factors are needed to clot the blood, but what i can't understand is that why wasn't my husband's blood tested when they took him of the clopridogrial tablets, i'm sure if it was tested once a week he would still be here,

surely you cannot just take someone off this type of medication (life threatening) and expect all to ok, especially having 2 perivous ops that resulted in having 2 major arterys stented.????????  

[kenkeith]

It is recognized drug eluding stents reduce restenosis compared to metal only stents, but there appears to be an increase in thrombosis (clots).  The following is from FDA dated 2/1/08.  The issue of clots with DES remains unsettled for length of time with clopidogrel regimen, and evaluation should be patient based and doctor's judgement.

However, it is important to recognize that the current recommendation for an extended
duration of clopidogrel use reflects a consensus opinion among experts within cardiovascular professional societies based on limited data, rather than on rigorous randomized clinical trials.

Further, it is not clear that 12 months is the optimal maximum duration of a dual antiplatelet therapy. In fact, the ACC/AHA/SCAI guidelines were recently revised to specify that patients with low bleeding risks should receive clopidogrel for at least 12 months postprocedure. While extending the duration of clopidogrel use may decrease the risk of very late stent thrombosis events, this strategy may also result in an increased risk for major bleeding complications and involves lifestyle modifications, such as deferral of surgical and dental procedures that may affect a patient's health and overall quality of life.

[Finally, it is known that stent thrombosis can occur in some individuals despite the continued use of dual antiplatelet therapy. With these considerations in mind, it is imperative that the risks and benefits of continued clopidogrel use be evaluated to determine with greater precision the optimal duration of dual anti-platelet therapy to ensure that these patients receive the best care possible].

[me194]

I take on board what you are saying about anti platelets, but sure enough when someone has taken life threatening tablets for so long there must be a written rule to test someones blood for clotting, and sure it must be done straight away the same day that the person was taken off the drug and a follow up blood test of  every 1 - 2 weeks, and by doing this test it  would have resulted in finding out how quick and tthe blood was thicking.
Then sure enough the clot would not have happened.