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Heart Attack
I am on Plavix for my Heart Attack and my husband is on Coumadin for a blood clot he had 3 years ago 1 month after he had broken his ankle and had to have surgery. I say he should be off the Coumadin already. He went back to work full time after the broken ankle and also lost 60 lbs. He says the Plavix is just as bad. What are your thoughts
Additional information that is more recent and specific regarding Plavix and restenosis subsequent to DES implants, and I began to question whether or not more recent published studies may have changed the outcome conclusions.
"More recently, similar studies of larger groups of patients who were followed for an extended period of time have been published (1, 2) that validate the benefit of DES. Findings and recommendations from these recent studies are summarized below:
1. Although DES are associated with a small, finite risk of increase in late stent thrombosis (<1%), the long-term mortality and non-fatal myocardial infarction rates are similar or even lower for DES when compared with BMS.
2. Compared with BMS, the risk of restenosis and the subsequent need for repeat cardiac interventions are substantially reduced by DES. Therefore, DES should be employed in high-risk patients for restenosis, e.g. diabetics, patients with long arterial narrowing, and those with small (narrow) arteries. BMS are recommended for low-risk restenosis patients, those in need for surgery in the near future who cannot take clopidogrel for an extended period of time, incompliant patients, and those at high risk for thrombotic complication.
3. The combination of (clopidogrel) Plavix and aspirin is very effective in preventing stent thrombosis and should be continued for at least one year after DES, though the proper duration (indefinitely?) is still to be determined by more and longer experience."
Citations: 1. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. The Lancet 2007; 370:937-948
http://www.thelancet.com/journals/lancet/article/PIIS0140673607614445/abstract
2. Effectiveness and Safety of Drug-Eluting Stents in Ontario. N Engl J Med 2007; 357: 1393-1402, http://content.nejm.org/cgi/content/short/357/14/1393
In Practice
Date Posted: 16 April 2008
"More recently, similar studies of larger groups of patients who were followed for an extended period of time have been published (1, 2) that validate the benefit of DES. Findings and recommendations from these recent studies are summarized below:
1. Although DES are associated with a small, finite risk of increase in late stent thrombosis (<1%), the long-term mortality and non-fatal myocardial infarction rates are similar or even lower for DES when compared with BMS.
2. Compared with BMS, the risk of restenosis and the subsequent need for repeat cardiac interventions are substantially reduced by DES. Therefore, DES should be employed in high-risk patients for restenosis, e.g. diabetics, patients with long arterial narrowing, and those with small (narrow) arteries. BMS are recommended for low-risk restenosis patients, those in need for surgery in the near future who cannot take clopidogrel for an extended period of time, incompliant patients, and those at high risk for thrombotic complication.
3. The combination of (clopidogrel) Plavix and aspirin is very effective in preventing stent thrombosis and should be continued for at least one year after DES, though the proper duration (indefinitely?) is still to be determined by more and longer experience."
Citations: 1. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. The Lancet 2007; 370:937-948
http://www.thelancet.com/journals/lancet/article/PIIS0140673607614445/abstract
2. Effectiveness and Safety of Drug-Eluting Stents in Ontario. N Engl J Med 2007; 357: 1393-1402, http://content.nejm.org/cgi/content/short/357/14/1393
In Practice
Date Posted: 16 April 2008
QUOTE: "Dang, you were kept on Plavix for an entire year after stent implantation? I've never heard of anyone, before you, being on it that long after stents. Did your doctor say why you were on it that long?"
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My stent implant (DES) was little more than 5 years ago. At that time there was said to be evidence that Plavix and aspirin helped prevent restenosis with DES....many cardiologists stopped using DES and went back to bare metal...sales dropped for DES!
In an extraordinary hearing of the FDA in late 2006, the recommendation was to continue Plavix therapy for at least 12 months after DES. But recognizing that there was little data on which to base this recommendation, a strong plea was made to conduct a randomized clinical trial as rapidly as possible to answer the Plavix question once and for all.
The CHARISMA study, for example, suggested that long-term dual antiplatelet therapy in patients with vascular disease reduces death, MI, and stroke, but that benefit may not be specific to DES....The issue of restenosis with DES is the reference in the post, and there is evidence dual therapy helps reduce restenosis with DES...mechanism is not known, but the mechanism of action, etiology, differs between the two anti-platelet medications.
"Conclusions In this trial regarding CHARMISMA study, there was a suggestion of benefit with clopidogrel treatment in patients with symptomatic atherothrombosis and a suggestion of harm in patients with multiple risk factors. Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing the rate of myocardial infarction, stroke, or death from cardiovascular causes." (ClinicalTrials.gov number, NCT00050817)
_________________________________________-
My stent implant (DES) was little more than 5 years ago. At that time there was said to be evidence that Plavix and aspirin helped prevent restenosis with DES....many cardiologists stopped using DES and went back to bare metal...sales dropped for DES!
In an extraordinary hearing of the FDA in late 2006, the recommendation was to continue Plavix therapy for at least 12 months after DES. But recognizing that there was little data on which to base this recommendation, a strong plea was made to conduct a randomized clinical trial as rapidly as possible to answer the Plavix question once and for all.
The CHARISMA study, for example, suggested that long-term dual antiplatelet therapy in patients with vascular disease reduces death, MI, and stroke, but that benefit may not be specific to DES....The issue of restenosis with DES is the reference in the post, and there is evidence dual therapy helps reduce restenosis with DES...mechanism is not known, but the mechanism of action, etiology, differs between the two anti-platelet medications.
"Conclusions In this trial regarding CHARMISMA study, there was a suggestion of benefit with clopidogrel treatment in patients with symptomatic atherothrombosis and a suggestion of harm in patients with multiple risk factors. Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing the rate of myocardial infarction, stroke, or death from cardiovascular causes." (ClinicalTrials.gov number, NCT00050817)
Some people are on Plavix for the rest of their life after stents. I know a lot of doctors that are now recommending that their patients stay on Plavix. Plavix works more like aspirin. Coumadin works more on the deep thrombus blood clots. Is your husband getting his blood drawn every month while on the Coumadin? Doctor's usually watch their patients closely and ordered a blood draw every three weeks to a month when on Coumadin. I know from our family history that it is better to be taking these medications than go up against a blood clot that can cause heart attack and strokes. If a persons blood is thick, it is best to take the medication or if the person has an irregular heart beat which increases the risk of heart attack and strokes by causes blood clots. Make sure not to take Vitamin K when on blood thinners. Vitamin K acts as a blood thinner and is found in some calcium chewables with the Vitamin D.
Dang, you were kept on Plavix for an entire year after stent implantation? I've never heard of anyone, before you, being on it that long after stents. Did your doctor say why you were on it that long?
There is consensus with medical community to continue anti-platelet medication after a heart attack, implantation of stents and CABG.
The good doctor from expert forum states Plavix is unnecessary and aspirin is sufficient. After a stent implant my cardiologist put me on Plavix and aspirin for a year...then dropped Plavix and continued with aspirin. There is some evidence that Plavix helps prevent restenosis with a drug eluding stent up to about a year.
There is a risk of excessive bleeding and that should be serious consideration when on anti-platelet medication, and the benefit, if any, don't outweigh the risk.
The good doctor from expert forum states Plavix is unnecessary and aspirin is sufficient. After a stent implant my cardiologist put me on Plavix and aspirin for a year...then dropped Plavix and continued with aspirin. There is some evidence that Plavix helps prevent restenosis with a drug eluding stent up to about a year.
There is a risk of excessive bleeding and that should be serious consideration when on anti-platelet medication, and the benefit, if any, don't outweigh the risk.
I understand you being on Plavix for your heart, and you should remain on it. But I am very surprised to hear that your husband is still on Coumadin for a clot 3 years ago. Is this clot the only reason he takes it? My daughter had a blood clot due to a very serious car accident, but once her injuries healed, she no longer had to take anything. He needs to address this with his doctor, and ask why he still has to take it.
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