Clot in stent - lovenox

[Husbandndshlp]

I wrote on 4/6  re my wife was diagnosed w/ spasming arteries after a recent cath that showed patent new stents (5 wks) and patent LIMA & SVG grafts post CABG (1 yr 4 mos). You wrote to take my wife to the E.R. after I explained she had a terrible bout with angina a day earlier.   She wasn’t feeling worse and spoke with the Dr (who ignored her symptoms the week before) and as it turns out you were correct!  2 days later, she couldn’t even walk down the steps and we went to the ER and her troponin level was high and the CBK #s elevated but coming down.  She had a heart attack without changing the EKG.  It was a clot in the stent.   Our interventional cardiologist was away and his partners wouldn’t touch it and made her wait for 3 days in the E.R. for his return.  She had i.v. nitro and heperin.  Was that safe?  She is now taking lovenox injections to see if this prevents further clots because 1 platelet count came back slightly elebvated and it should have been zero (it was 288)..  1) Have you ever heard of lovenox injections to prevent further clots in stents and 2) what are the risks from lovenox to her relatively healthy kidneys (after 30+ yrs of diabetes)?  Thank you for your good advice.  You were the only Dr. who said E.R.

[Douglas Bogart, MD]

Lovenox is safe if the kidney function is normal.  If it is abnormal then the Lovenox therapy need to be monitored with blood tests to check factor Xa.  Lovenox can be given to prevent clots in the stents but your wife might need triple antiplatelet therapy with aspirin, Plavix and Pletal (100 mg twice a day).

[sumaro]

Jeeez you need to find another hospital all together...They made her wait on his return for 3 days?