Looking for Sources on Platelet Therapy?

[Apuusa]

Currently I am 38 years old, I have 17 stents implanted in the vessels of my heart. I had my first MI at 25 years old. I have had blockages consistently ever 9-12 months since the first incident. I was a gym rat until my first heart attack and like most atheletes I didn't change my eating habits as my ability to excercise diminished.

I am currently in the process of getting ready for gastric bypass. I had a drug eluting stent implanted in June.  The Gastric Bypass requires me to be off of Plavix for 7-14 days. My cardiologist is opposed to discontinuation of platelet therapy for a short time in order to have a proceddure. I want to know why it is recommended to remain on plavix for a minimum of 12 months after the stent? Does the risk of thormbosis decrease so significantly at 12 months that it is worth the risk of another Major Cardiac Event? Is there any information to support an argument that 6 months is a significant amount of time?

I ask because my cardiologist, whom I trust very much, is suggesting I wait until I am 12 months out. The risk that I fear is that we are in a downward spiral the frequency of the blockages requires immediate action and intervention. By June of 2010 I could have eliminated the majority of my risk factors.

[Flycaster305]

Eighteen months ago a stomach ache was determined to be a double bowel obstruction and I needed immediate surgery.  Because of recent heart stents I was taking Plavix and Aspirin.  Like you, I have multiple stents and was going through a period of aggressive CAD.  The need for the life-saving operation trumped the worry of restinosis of my stents, and the worry of excessive bleeding because of Plavix and Aspirin therapy required extra planning during the surgery.  I did have bleeding issues and spent about ten days in the hospital - it was complicated.  

[ed34]

You drug eluting stent has a chemical attached to the surface which prevents scar tissue forming on it, which in turn will cause restenosis. The last thing you want, which is why your cardiologist is concerned, is atherosclerosis forming in the stent causing another blockage. Plavix has been shown to stop platelets sticking to the stent, due to its rough surface, and this stops a clot forming. However, there is little evidence to show that this is required after 12 months because you form a new smooth lining through the stent of healthy artery tissue. In the UK many patients are prescribed Plavix for 18 mths to be on the safe side. The drawback with Plavix, especially if taken with Aspirin, causes you to bleed for much longer when an artery is damaged, through surgery or an accident. I had a decision last over a year ago when I developed a bad tooth which needed extracting. My GP said that I would have to bear the pain because the heart is far more important than the tooth. Easy to say when you get constant toothache.
7-14 days out of a year doesn't sound long, but to blood chemistry this is an eternity for reactions to take place.

[erijon]

I have to agree with Flycaster, this one is most likely over our heads here, so many variables. I think I would want to get a second opinion with another cardiologist on a face to face basis.

Wish I could help, good luck.

Jon

[Flycaster305]

Your situation seems very complicated, and I suggest you ask your doctor to submit your records to a teaching hospital like the Mayo Clinic or the Cleveland Clinic.   I'm not a  health professional, but I think you need a secondary opinion.  Please, keep us informed.