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warfarin vs aspirin+Pelvix therapy

After six years post MI and ef varying between 25-35%, my cardiologist now feels that I should shift from aspirin(150)+clopidogrel (75) to warfarin. Two years back he did tell me that he is double minded on whether to put me on warfarin. But this time he appears to be very sure and has insisted me to go for warfarin.

His justification is "that is what literature says".

I have no AF or valve problem. In fact there is no other problem except big patch of damaged heart muscles and low ef. Warfarin has its own set of problems and some serious risk factors. On net I find literature both in favour and against warfarin, with some tilt towards warfarin.

I am not able to understand:
-  why a clot should form in my heart when the muscles were damaged six years back and considering that I am on aspirin+clopidogrel which too have anti clotting function.
-  warfarin may be slightly better as compared to aspirin+ clopidogrel, but in my case with no AF, does it makes sense getting into this risky business of conatantly monitoring of INR and fear of bleeding.
-  I have seen on net some other drugs in market which are equally good as warfarin with lower risk of bleeding. Any feedback on them.

Sorry for asking so many questions. I am really worried about warfarin.
Do you think I have any strong reason to continue with aspirin+clopidogrel and/or resist warfarin?

Thanks in advance
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976897 tn?1379167602
found this, perhaps it may give some hints

Coagulative necrosis is characterized by the formation of a gelatinous (gel-like) substance in dead tissues in which the architecture of the tissue is maintained,and can be observed by light microscopy. Coagulation occurs as a result of protein denaturation, causing the albumin in protein to form a firm and opaque state.This pattern of necrosis is typically seen in hypoxic (low-oxygen) environments, such as infarction. Coagulative necrosis occurs primarily in tissues such the kidney, heart and adrenal glands.Severe ischemia most commonly causes necrosis of this form.
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Avatar universal
I fail to understand why my Doctor relates choice of anticoagulant to EF. When my EF was 30-35% post MI in 2007 my Doctor thought aspirin +copidogrel was OK. Now some of my recent ECHO show EF of 25-30%   and he feels I need to go for warfarin because there are chances of clot formation in the damaged heart muscles. Does not sound very convincing to me.

A blood clot is a blood clot irrespective of its location. What puzzles me is why a blood clot in arteries can be treated with aspirin/clopidogrel combine and the one in heart muscles will require warfarin? And why a blood clot should form on heart muscles which are dead for last six years?

I agree with you that even high dose of aspirin can cause bleeding. But over time I have got used to 150 mg of aspirin daily and psychologically my comfort level is higher.

Thankyou so much for sharing your thoughts.

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976897 tn?1379167602
Well before any decision is made for something like Warfarin, you should have your INR (clotting factor) tested. An INR of 1 is how long normal blood takes to clot. An INR of 2 means it take twice as long and so it goes on. Aspirin and Clopidogrel (plavix) I believe attack the clotting mechanisms in different ways. Personally I don't think they know the long term outcomes. I in no way say you should do the same, but two years ago I went against my Doctor and Cardiologist and came off anti coagulants. I was fed up bleeding for a long time if I cut myself, and wondered what would happen if I had a small bleed in the brain or somewhere. I concluded that taking anticoagulants was too risky and stopped them. In the last two years I've not had any problems and my cuts heal very quickly. If you have known blockages then these meds can be beneficial. If plaque breaks loose, then lodges further down the vessel, it will restrict blood flow, likely anything up to 99%. The real killer is the area where the plaque broke loose, where a clot will form and create a blockage of 100% usually. If you have no blockages and have no AF then I am at a loss. Even with blockages, I'm pretty sure that clopidogrel and Aspirin are beneficial enough. There are also the statistics of combined therapy, i.e. aspirin WITH plavix. The UK decided that combined therapy was only beneficial for about 1-2 years, then the effect seemed to reduce.
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