discharged on Plavix

My mom had a CVA - Right 100% blockage carotid artery.  Initally on heparin drip then on heparin 5000 unit SQ
every 12 hours. 1 month after CVA, while in rehab developed anemia and ASA held but heparin continued.
Was discharged 45 days after her CVA on plavix and ASA.  The morning of discharge she received her heparin 5000 units SQ .  She did not start her plavix or ASA dose before stopping her Heparin.  
MY MOM died 3 days after discharge of a massive PE.   I'm wondering why she wasn't started on coumadin?

Any thoughts?



This discussion is related to Plavix vs Coumadin.

[kenkeith]

There are 3 serious medical conditions (right-side heart failure, uncontrolled bleeding, and clots (pulmonary embolism and thrombosis) that requires consideration when prescribing medication.  Anticoagulants are effective in preventing pulmonary embolism and deep vein thrombosis, but there is a risk for bleeding.  

More than 80 percent of patients with massive PE die within the first two hours after onset, mainly from right-sided heart failure. To decrease the mortality associated with acute PE, the thrombus must be broken down quickly and the obstruction resolved rapidly to preclude right ventricular dysfunction. Furthermore, the rate of recurrence of PE must be reduced.

The rationale behind PE  is that, in conjunction with anticoagulation, it may reduce the rate of clinically important endpoints such as death, recurrent PE and pulmonary hypertension. Its goals, therefore, include the following:

More rapid clot lysis (decline) and quicker reperfusion of lung tissue.
Elimination of the source of the clot, thus decreasing the incidence of recurrent PE.
Prevention of chronic complications of PE by producing more complete clot lysis.
Reduction of morbidity and mortality, especially by reversal of right-sided heart failure.

Your question: "She did not start her plavix or ASA dose before stopping her Heparin (generic for coumadin)".   There is about 2-3 days before the platelet count starts to rise after discontinuing (ant-platelet, anti-clotting) medication.  To start plavix or ASA before stopping Hepirin, could have substantially decreased the platelet count and put your mother at a high risk of a hemorhage.  Its a judgment by your doctor that weighs the risk/ benefit of treatment.  Sorry to hear of your loss and my condolences.