how long to stay on prasugrel (effient)

Question

In 2007, at age 54, I had a heart attack and received 6 drug-eluding stents in one artery. Prior to that I had virtually no symptoms, and no risk factors except for stress, and the cause of the heart attack was a mystery to everyone. I stayed on plavix for 6 months (along with low-dose aspirin which I continue to take) and couldn't stand the side effect of severe bruising. My recovery was slow in that I continued to experience lots of chest pain with stress, and was eventually diagnosed with GERD, which I believe was caused either by the stents or the plavix. In 2010, at age 57, after continually being told that there was no cardiac reason for my chest pain, I had a coronary thrombosis at one of the stents during an exercise class, which led to another heart attack. I was very lucky. At this point, I am on prasugrel and it's been 1 1/2 years. I hate the bruising - the dose is way too high for me (10 mg) but we don't have the 5 mg dosage in Canada, which is the preferred dosage for lightweights like me. So I  take my pill every 36 hours instead of every 24, which helps tremendously with the bruising and the GERD. It seems to me that those stents must be healed by now and I no longer experience any chest discomfort whatsoever. But my cardiologist seems content to keep me on this forever. Is my story familiar to anyone out there, and how long did you stay on platelet inhibitors?

ed34 · Accepted Answer

I really think the problem is "nobody knows". It was decided from research that nobody benefited being on plavix for more than a year, but sometimes a patient would develop clots in stents after stopping the medication. There are no obvious reasons why this occurs with some people, and not others. This makes Doctors very cautious about stopping the medication. I stopped mine after a year and suffered no clots, but I was one of the lucky ones. You on the other hand were not so lucky and this is why the Doctor wants you to continue to take the medication. You are correct that your stents will now have a new artery lining grown through the mesh, but this seems to mean nothing in relation to the stent forming clots. Some patients were taken off plavix after 2 years and suddenly formed clots. I can certainly understand your frustration, but do you risk the same thing again. If I was in your situation and wanted to come off the medication, then I would feel much happier being in the hospital or pretty damn close to it.

Ger57 · Answer

The normal procedure is to take Prasugrel for one year. In that year a biolayer is formed over the stentmaterial and the need for strong anticoagulation medication is no longer necessary. (Aspirin medication continues).

I can concur about the bruising.
In stead of taking the pills 1x/36 hours, I would rather cut a piece of it and take the pill 1x/24 hours. This is imo preferable because of 
- a more constant dose in the blood
- less chance of forgetting a dose (same time every day)

Ask your cardiologist about his reasons for continuing the Prasugrel. I have heard it before but I wonder what the rationale behind it is.
The risk of Prasugrel causing very severe bleeding is not negligible (especially at weight75 years).
The benefit he sees should outweigh the risks.

JamesBMac · Answer

Late response I know, but...just discontinued Effient after 2 1/2 years after a ST elevated MI and 3 scents into the LAD coronary artery. My cardiologist said as long as I was a low bleeding risk to continue the Effient, but 2 1/2 years was as far as he felt it was safe to be on such a powerful anti-platelet. 5mg dosage. I'm pretty sure it's not recommended to be on anti-platelet for much longer than a couple of years. Studies seem to show no rebound from stopping them either. I found Effient to be a great drug; no side effects other than the drugs intent...bleeding and bruising, but hey...I'm alive and well!

Confuscio · Answer

Had three stents in June 2014. Still on Effient 10mg daily. Don't plan on getting off it anytime soon. Have minimal bruising if any. Only recently have had some pain in the esaphogeal and throat area after physical exertion. Think it is GERD as I take meds for that as well, but going to Cardiologist to verify and be sure. Have had no problems that I can identify other than that.

queenofcups · Answer

Thanks for your input. I guess my thing is that if we cannot get the 5mg dose of prasugrel here, I would prefer to try something else that isn't too much for me, rather than deal with the side effects. I am pretty much consigned to having to take blood thinners forever.