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315318 tn?1353251800

plavix

Well, plavix is coming off patent next year so the cost should come down substantially.
In my case though, I got a DES placed in my LAD in December 2009. My cardio said, I am not responsive to Plavix, but not to worry. Start taking this new related medication called Effient.
Effient, however, comes with greater chance of bleeding and it is expensive. If like Plavix, I have to take Effient for life then I guess, unlike Plavix, I will be paying a lot of out of pocket expense for a long time to come !


This discussion is related to Plavix dosing following drug eluting stents.
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367994 tn?1304953593
The medical literature  I have read (keeps changing!) a couple of months ago, the preferred treatment with individuals that have DES is dual therapy of aspirin and plavix up to a year, then just aspirin.  The risk of restenosis due to a blood clot is minimum after about about a year,  and the risk/benefit ratio favors discontinuing plavix and its probability to cause excessive bleeding.  Did you have a test that indicates your are hypercoagulable (excessive blood clotting characteristics)?  A  PT-INR test that times the clotting time? If you didn't have the tests, or if you did and it is unremarkable, you may want to get  second opinion

Helpful - 0
976897 tn?1379167602
I have had a total of 6 stents now and my first stent required 1 year on plavix. Then as Kenkeith stated, the guidelines seemed to change and my new 5 stents will require plavix for 18 months to 2 years. I am on Aspirin for life.
Helpful - 0
315318 tn?1353251800
My PT and INR results in February 2010, two months after starting Effient (prasugrel).and an increased dose of Aspirin.
INR 1.0 Sec ( ref  0.8 Sec ) ,
Prothrombin  11.3  Sec ( Ref 8.7 Sec)
aPTT 31 Sec ( Ref 24 Sec)

As I said in the earlier post, Plavix, according to tests done at a New York Hospital, does not do any platelet inhibition for me. Hence Effient. Incidently, Plavix and Effient come from the same chemical family and the mode of action is identical.
Now whether they keep me  on Effient (10 mg) +Aspirin (320 mg)  therapy for 1-2 years or for life remains to be seen. Prior to stenting back in December, I was only taking 80 mg of Aspirin.
I would be interested to know whether the results I have presented offer any clue as to whether they can wean me off Effient in a year's time.
Helpful - 0
367994 tn?1304953593
Parameters for INR: The INR is the ratio PT (time to clot) test divided by PT normal. A high INR level such as INR=5 indicates that there is a high chance of bleeding, whereas if the INR=0.5 then there is a high chance of having a clot. Normal range for a healthy person is 0.9–1.3, and for people on anti-platelet therapy, 2.0–3.0, although the target INR may be higher in particular situations.

Apparently, you have a genetic abnormality that could prevent the drug from reducing the risk of blood clots by interfering with the liver’s ability to process Plavix in the bloodstream. If your system has a high sensitivity for clotting, it is difficult to analyze a future dispostion for the medication. It comes down to risk of bleeding vs. risk of clots, and that would require a professional opinion by your doctor based on apropriate testing, etc. From the information provided your INR is not in the anti-platelet range.  
Helpful - 0
315318 tn?1353251800
The doctors have established that PLAVIX is not for me and I only took it for a few weeks eight years ago. After my recent procedure, I was prescribed Effient and an increased dose of Aspirin. The INR number I quoted in the earlier message came from a blood sample 7 weeks after I started Effient. I thought INR number 1 should be within the range.
Besides that, I still have not come across that me people on this forum who were prescibed Effient. I am really anxious to read their experience of this new drug which comes with warning on the bottle about increased bleeding.
Thanks.
Helpful - 0
367994 tn?1304953593
I haven't heard about the drug Effient either.  In fact, I was never checked out for Plavix efectiveness!?.

" Healthy person is 0.9–1.3, and for people on anti-platelet therapy, 2.0–3.0, although the target INR may be higher in particular situations". I read the therapy should put someone in the 2.0 to 3.0 range.  A healthy person's range (no medication) is 0.9-1.3...that indicates to me the medication is not prolonging the clotting process into the recommended time range for you.  There could be a testing error, but you may want to get some confirmation.  Your clotting time should be longer.  I just take a baby  aspirin, and my clotting time is if anything too long!! A small cut doesn't clot/heal  very quickly and a dental experience I didn/t stop bleeding for hours.
Helpful - 0
315318 tn?1353251800
I will talk to my cardiologist about the point you make about my INR number. On the other hand, two months ago, I had to spend four days in a hospital after a nose-bleed event. The bleeding kept going , on and off, for more than 12 hours and made the doctors suspect gastrointestinal bleeding. In the hospital they discontinued both aspirin and effient for 2-4 days. I guess, I must be lucky because the discontinuance did not lead to any thrombosis.
I did not know about Plavix efficacy tests until I had one done after a stenting procedure three months ago.The  test was developed by a well known interventional cardiology group at a  major New York hospital. I did not have the test eight years ago when I was prescribed Plavix after my first stenting procedure. That makes me suspect that it may be a very recently developed test.  I have asked questions on this and other forums about the test but have not received satisfactory responses. The FDA has put a warning about lack of efficacy of Plavix  for patients who are "poor metabolizers of Plavix". Here is the link:http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm203888.htm
Thanks.
Helpful - 0
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