Danger of stopping Plavix for procedure

[Suzie2127]

I am a 76-year-old female with AFib for the past three years.  The last of Jan. I was hospitalized for AFib with a high heart rate that wouldn't stabilize. Feb. 13th I had a major heart attack and SCD. Was sent to the heart hospital where two stents, one bare metal and one drug eluting, were implanted in the LAD. Five days later a pacemaker/defibrillator was implanted. The next week I was hospitalized for a blood clot near the area of the implant, then back into hospital for AFib, after which I had an infected right arm from the IV. Three months ago I had a very infected left breast, also many cysts-- which is not unusual for me. One small one has debris, and a needle biopsy was recommended. The problem is the radiologist wants me to go off Plavix and aspirin to do this. I am confused because the surgeon who saw me for the breast infection said he could aspirate the large, infected cyst in his office that day even though, at that time, I was on both Coumadin and Plavix. The cardiologist said I shouldn't have the biopsy until the middle of August. Several weeks ago, the cardiologist took me off of Coumadin and added two 81-mg, aspirin and recommended that I stay on the Plavix for the biopsy. The radiologist's office contacted the cardiologist and they agreed I could go off Plavix for seven days prior to the biopsy. At this point, I am more concerned about a blood clot in my stents than breast cancer. Is it safe for me to discontinue Plavix? Which is the greater risk, bleeding from a needle biopsy or a possible blood clot as a result of stopping the Plavix? Thank you for any advice you can give me.

[Suzie2127]

Thanks so much for your thoughtful answer. I'm aware of the INR problems, however I am no longer on warfarin. My biggest concern is that my eluting stent is barely six months old and I fear going off of Plavix and aspirin for 7 days prior to the biopsy. I am to consult with an EP soon. Hopefully I'll get a more clearcut answer. I know it's not a simple problem to solve and there are many views on the subject. Thanks again.

[kenkeith]

You are correct there needs to be an assessment of the risk and benefits and that would be the doctor' responsibility. But it seems the appropriate treatment before any decision would be to test your clotting time (INR). The following is generalized and is not intended as specific medical advice as each indiviual has their own response to medication.

In healthy people, the INR is about 1.0.
For patients on anticoagulants, the INR typically should be between 2.0 and 3.0 for patients with atrial fibrillation, or between 3.0 and 4.0 for patients with mechanical heart valves. However, the ideal INR must be individualized for each patient.

An INR can be too high; a number greater than 4.0 may indicate that blood is clotting too slowly, creating a risk of uncontrolled bleeding. An INR less than 2.0 may not provide
adequate protection from clotting. It is important to have follow up blood tests as scheduled by your doctor and to know your Warfarin (Coumadin) dosage and INR.

Hope this helps give you a perspective and good luck.  Take care and thanks for sharing.