Plavix, Aspirin and Stents

Current Postings on This Page (174):

• Gary -- Plavix allergies can sometimes take a while to show up. We are not certified to recommend any drug for you to take, but certainly consult your cardiologist about this. Do not stop taking Plavix, however, without discussing this with your interventional cardiologist. Read this topic and you'll see you're not alone. It is also possible to "de-sensitize" any Plavix hypersensitivity. An allergy specialist should be able to help you through this.
Forum Editor, Angioplasty.Org, May 8, 2008

• Had a heart attack on April 19th.. stent in the main.. on plavix woke up today may 8 with whelps on lower back that got worse throughout the morning.. like everywhere.. assumed food allergy.. called heart doc.. no response as yet.. nurse on phone indicated allergies to plavix are common.. wasn't certain if it was safe to take Benadryl. still itching incredibly.. any ideas?
Gary, Oklahoma City, Oklahoma, USA, May 8, 2008

• Jennifer -- resistance to clopidogrel (Plavix) is certainly known, but studies of a variety of tests do not yet agree on what the mechanism is -- so it can be difficult to test for. An August 2007 study, published in the Journal of the American College of Cardiology, "Poor Responsiveness to Clopidogrel: Drug-Specific or Class-Effect Mechanism?", discusses this resistance and postulates that switching to ticlopidine (Ticlid) may work in these patients. Ticlid was used in the U.S. prior to Plavix; Ticlid is the only antiplatelet drug used in Japan, where Plavix is not reimbursed. A question for you: if your mother has never experienced symptoms such as angina or high BP, what was the initial event/reason for her being diagnosed with and treated for a coronary blockage?
Forum Editor, Angioplasty.Org, May 8, 2008

• My mother has had five stents put in one artery. Her cardiologist says that she is resistant to Plavix and that is why the clotting occurred after the first stent was applied. She also had clotting within six months of the application of stents 3 and 4. These stents were medicated. She is now on a double dose of Plavix to keep the latest stents from clotting. I am concerned about this dosage and the thinning of her blood. Is this dosage a good idea? My mother is 83 and has never had a single symptom - no shortness of breath, no angina, no high blood pressure. The first stent was applied so she would have better circulation to the heart muscle.
Jennifer, Peoria, Illinois, USA, May 7, 2008

• Debbie -- have your husband's surgeon read our article from over a year ago: "New Advisory: Will Stent Patients and Their Doctors Get the Message?" In January 2007, all the U.S. professional heart organizations, as well as the American College of Surgeons, etc. issued an unprecedented Joint Advisory about Plavix, stents and surgery. Key points that pertain to your question were:

• Patients also should be instructed to contact their interventional cardiologist before stopping antiplatelet therapy, even if stopping is instructed by another healthcare professional;
• Healthcare providers (surgeons, dentists, etc.) need to be made aware of the dangers of asking stent patients to stop antiplatelet therapy and should communicate directly with the patient's prescribing cardiologist;
• Elective surgeries where there is a significant risk of bleeding should be postponed for 12 months after the stent implantation;
• If an unexpected surgery must be done that requires cessation of therapy, aspirin should be continued if possible and full antiplatelet therapy should be resumed as soon as possible after the surgery;

Check out our related topic on "Plavix and Surgery" for other patients' stories about this issue. Compounding all of this Catch-22 situation is a more recent issue concerning a possible Plavix "rebound" effect -- where stopping Plavix may put the patient at double the risk of a heart attack for about 90 days. We're going to be interviewing the lead author of this study later this week for a follow-up.
Forum Editor, Angioplasty.Org, May 6, 2008

• My husband received four stents in January 2008 (one medicated). Upon discharge he was told very clearly that under no circumstances was he to stop Plavix for one year and was provided a wallet card to this effect to show any doctor suggesting this. A surgeon has advised him to stop one week prior to a routine colonoscopy, still insisting even after reviewing the wallet card. Is a one week interruption something to be concerned about?
Debbie MacDonald, Nova Scotia, Canada, May 6, 2008

• Hamid -- we cannot give medical advice and we always recommend to patients that they discuss these issues with their cardiologist. The guidelines state that Plavix should be given for a year after drug-eluting stenting; many cardiologists feel safer prescribing it for life. There are, however, complications that can occur (bleeding) and then there's the cost. As we noted in our April 30 post, we are increasingly concerned over the possibility of a "rebound effect" when stopping Plavix. We're going to be posting an update to our article next week -- stay tuned and good health to you.
Forum Editor, Angioplasty.Org, May 5, 2008

• Can I stop taking Plavix after having a drug-coated stent since 2 & 1/2 years ago? My cardiologist says that as far as I can afford I should take it!
Hamid Rahimzadeh, Tehran, Iran, May 5, 2008

• Frances -- the possibility of a Plavix "rebound" effect (see "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents") is not proven, but is an observational study -- and, if this rebound does exist, a "withdrawal" or tapering off method has not been tested. That being said, the authors of the study suggested that the tapering off methods you describe "might" be prudent. Also, many cardiologists in the U.S. are prescribing Plavix for more than a year. You've been keeping informed (good) and your concern is appropriate. We recommend discussing these issues and making treatment decisions together with your father's interventional cardiologist -- and let the Forum know what you decide.
Forum Editor, Angioplasty.Org, April 30, 2008

• My father is nearing the end of a year-long course of Plavix after implantation of a drug-eluding [eluting] stent. The 3-month danger period after stopping Plavix is a major concern. Does stopping Plavix slowly (e.g. taking every other day, every few days, or halving the dose for a while) help reduce the risk of heart attack? Does increasing aspirin dosage during this period help? Is there anything else one can do during those 3 months to reduce risk?
Frances, Tel Aviv, Israel, April 29, 2008

• Michael -- have you discussed these issues with the interventional cardiologist who did your stenting? Certainly no stent patient should stop taking their antiplatelet medications without consulting their interventional cardiologist. Fatigue has been noted as be a side-effect of Plavix in a small percentage of patients -- are you taking other meds as well? Ticlid used to be prescribed before Plavix was introduced. It tended to produce more side effects, although we have spoken with a number of cardiologists whose patients have done better on Ticlid. (In Japan, Plavix is not prescribed at all, only Ticlid.)
Forum Editor, Angioplasty.Org, April 29, 2008

• I am a healthy 45 year old male who received a DES in December 2007 (No high cholesterol, blood pressure, normal EKG, no history of heart disease, etc). I had previously been on no medication. I was put on Plavix and 325mg aspirin. I have continued to have some chest discomfort, numbness on left extremities and EXTREME debilitating fatigue since starting the Plavix. So much so, that I thought I had another blockage, and did the stress test and heart cath. Clean as a whistle, no blockages. After more tests, I can find nothing wrong, and am starting to suspect my symptoms are side effects of the Plavix. After reading all this information, I am afraid to stop the Plavix. My question is, can I be switched to Ticlid? Am I likely to experience the same side-effect symptoms with Ticlid as Plavix? The fatigue is so severe, I can't imagine suffering from it for the rest of my life.
Michael M., Georgia, USA, April 29, 2008

• Jody -- what type of stents were placed? Drug-eluting or bare metal?
Forum Editor, Angioplasty.Org, April 23, 2008

• I had 2 stents in Nov 06 due to a spontaneous dissection of the LAD. Have been on Plavix and 81 mg aspirin since. I have no coronary artery disease. My cardiologist is reluctant to take me off the Plavix since there are no studies on Plavix and dissections. I, of course, would like to get off it since this seemed to be a very rare event. Do you know of any information on the use of Plavix in the case of a dissection?
Jody A., Colorado, USA, April 22, 2008

• Lots of good info. Looks like I am in the same boat as many others. I had Heart attack and single CYPHER DES placed in left coronary artery in Sept. 2004. Was prescribed Plavix, Lisinopril, Toprol, Zocor, Spironolactone and 325mg Aspirin. Taken off Plavix after 3 months. Sept. 2006 had 95% blockage of CYPHER stent. Cardiologist then placed a TAXUS DES inside the CYPHER stent and put me back on Plavix. My side effects have been bruising and nearly constant fatigue but otherwise OK.
Joe R., Seattle, Washington, USA, April 22, 2008

• Jeff -- the major risk of Plavix is bleeding. The rebound effect at present is a hypothesis, gleaned from observational studies. The other downside is that Plavix is expensive. The study on Plavix suggests that tapering off might be one way to stop taking Plavix, but nothing has been proven at this point. You should discuss the specific issues with your cardiologist. By the way, the TAXUS is a drug-eluting stent, a.k.a. medicated stent
Forum Editor, Angioplasty.Org, April 22, 2008

• I am a 52 yrs.old male & had a Taxus Express2 Paclitaxel-Eluting coronary stent (3.0 x 20mm) implanted 3 1/2 years ago (10/2004) located in the MIO-LAD. Is that the non-medicated stent? I have been prescribed Atenolol 100, Lipitor 20, Plavix 75, Zestril 10, Folic acid 1 & Aspirin 81 for the past 3 1/2 years. On my last appt last week, my Cardiologist has instructed me to discontinue my Plavix since I was now approaching 4 years on the drug & that Aspirin should be sufficient go forward. I am not experiencing any ill effects from any of my medications. I am hesitant on stopping Plavix after reading the rebound effects article above. Should I discontinue Plavix? Am I facing a greater risk of blockage if I stop? What are the risks of continuing plavix long term? Thanks.
Jeff Lim, Walnut, California, USA, April 21, 2008

• According to the manufacturer, Boehringer Ingelheim, "Pradaxa® is approved for the prevention of venous thromboembolic events in adults who have undergone elective total hip or total knee replacement surgery."
Forum Editor, Angioplasty.Org, April 21, 2008

• Just being released today in UK is a `new` drug for anticoagulation........Pradaxa. It suggests it is better than Warfarin as it does not need constant monitoring. I also heard it said that its better than Plavix, or was this out of context?? Anyone have more info?
Tel, United Kingdom, April 20, 2008

• Regarding Plavix and hearing loss and tinnitus. I have a sister who has experienced severe hearing loss and severe tinnitus. I know she is on at least five other drugs. I am in the process of doing some research as I am concerned the medications play a significant role in the problems she is presently having. I was curious when I read the posting and now will keep my eyes out. I also know that every persons body metabolizes drugs differently and as variable as that is, so is the way our body reacts.
Jane R., Ontario, Canada, April 14, 2008

• I recently had two stents placed and have had extreme difficulty adjusting to the medications, etc. Does anyone know of a doctor who has had this procedure done him/herself? It'd be great to receive treatment from a doctor who has first-hand experience!!! Thanks.
Ron J., Louisiana, USA, April 13, 2008

• Gordon -- we'll guess that the 12 year old stent didn't clot, per se, but it closed up. That's called restenosis and it's not a blood clot, but a progression of the disease -- it's called in-stent restenosis and is often treated, as was yours, by placing another stent inside.
Forum Editor, Angioplasty.Org, April 13, 2008

• I received a bare metal stent last November following a heart attack after a stent I received 12 years ago clotted. My cardiologist prescribed 75 mg/day Plavix and 325 mg/day aspirin. I did what Mike suggested in his posting (January 7, 2008) and asked my doctor to test me for Plavix and aspirin resistance. I had a TEG test for Plavix and the AspirinWorks test for aspirin and both drugs are working like they are supposed too. I have heard that it is possible to develop resistance to aspirin or Plavix over time. Does anyone have a recommendation how frequently you should be tested to see if the dose is still effective? Thanks.
Gordon E., Wichita, Kansas, USA, April 13, 2008

• am a stent patients Oct 2005 and i just went thru hell while on plavix i had almost every side effect from plavix. How i know? It started 3 weeks after i had the stent put in and was on plavix then in nov 2007 they took me off plavix am a lot better now and for the 90 days you folks are talking about all so true i kepts a bottle of nitro and aspirin with me all times due to the ill effects am having since i've been off plavix.
Frederick, Brockton, Massachusetts, USA, April 7, 2008

• Catherine -- read over these posts. Patient DO have allergic reactions to Plavix and there are desensitization techniques available. Some cardiologists also try Ticlid instead. Allergic reactions, however, can be difficult to pin down. By the way, are you consulting an interventional cardiologist for your second opinion? The current recommendations from AHA/ACC/SCAI are for 4-6 weeks of Plavix after a bare-metal stent.
Forum Editor, Angioplasty.Org, April 7, 2008

• The interventional cardiologist who did the angiogram, angioplasty, and placed the bare metal stent seems to be the least concerned of all my docs. Everyone else is VERRRRRRRRRRRRy worried about me. Under NOOOOOOOOOO circumstances can I take aspirin and am now on my second round of prednisone for the rash and other symptoms including the worst stomach ache I've ever had in my life. I've reacted to simvastatin and potentially, platel, as well as Lipitor. I'm still on the Plavix 75mg. B.I.D. and dipyridamole I've tried the aspirin desensitization and just couldn't tolerate even the baby aspirin dosage. Am still trying to get in for a 2nd opinion with another cardiologist. Meanwhile I am getting sicker. Current interventional cardiologist said I would be on plavix for life at reduced dose eventually. GREAT! What if that is the the drug making me so miserable!!!!!!!!!! I cannot tell you how much pain I am in. This reaction to whatever has now hit my bones. It hurts just to be touched to the point where I am in tears every time I have to take a bath and apply the creams on my skin for the rash and I am not a person who cries even when a central line is inserted with NO pre-anesthesia such as versed. I can stay perfectly still during an art stick so I am not a wimp when it comes to pain. My Family doc ran a bunch of blood tests Friday and the only thing that came back weird was the potassium level (way low). I am still having angina AND on Friday had bloody stools. Bruises still 'appear' for no reason and hurt like hell but cardiologist isn't concerned. Every other specialist you can name IS worried. I don't want to eat and drinking is becoming a real challenge. Still trying to get into see a 2nd cardiologist but this all leaves me in the 'land of scared.' The headaches are monstrous but the family doc can't give me most of the drugs which relieve the pain because of the dipyridamole My mother was VERRRRRRRRY allergic to aspirin and I had an anaphylactic reaction to it several years back. No one in our family has been able to drink orange juice since we were kids. I feel like I have been on downward slide ever since the Darvon reaction in July and no one has an answer as to what is happening to me. I can't stay on prednisone the rest of my life. The stuff makes me jittery but right now it is the only thing relieving the allergic reaction. Is there any chance I could be reacting to the bare metal stent???????? This whole mess is making me neurotic and I have never been neurotic in my life! Is there any alternative to plavix which is the drug my allergist suspects I am reacting to now.
Catherine, Ann Arbor, Michigan, USA, April 7, 2008

• Thanks for your summary of the current position. I'll have to see what the GP says in July, and perhaps then ask for a specialist's opinion too. I haven't had a blood count (except for cholesterol, due this week), but I'm seeing the GP about the nose-bleeds tomorrow - expecting a repeat of the cauterisation treatment I had about 30 years ago. Out of interest, most of the nose-bleeds happen in the shower after I get up - perhaps brought on by the heat. [It's also when I suffered three out of four of my ACS incidents.]
John Edwards, United Kingdom, April 7, 2008

• John -- getting a consensus around this topic is not an easy task. The US guidelines call for a one year minimum for Plavix (lifetime for aspirin) and longer, if there is no bleeding risk. But the guidelines also state that drug-eluting stent patients should discuss stopping Plavix specifically with their interventional cardiologist. Very recently, a study from the VA in Colorado described what might be a rebound effect from Plavix cessation for the first 90 days (see our article, "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents".) While it sounds like you might be experiencing some bleeding, we would suggest that, since you are a stent patient, you consult an interventional cardiologist as well as to your best therapy. He/she may well concur with your GP. Curious, have you had your blood count done recently?
Forum Editor, Angioplasty.Org, April 2, 2008

• I had a single DES implanted in July 2006 (following ACS), with Plavix prescribed 'for at least 2 years' and small aspirin (for life), together with Lipitor 40mg. I've had no cardiac problems whatever in the past 20 months and I'm conscious that I'm approaching the 2-year anniversary. My GP has noted to stop prescribing Plavix at that point (he was reluctant to go beyond 1 year - and would also like to switch me to simvastatin!) and I'm wondering whether I should push to continue with Plavix, in the light of all the latest developments reported here. My only concern over Plavix (as we're lucky not to have to pay for it here) is the greater susceptibility to bleeding - especially nose bleeds (which I've always suffered from); they seem to be more difficult to stop now, and twice recently I've woken up with a bloody pillow. [I have also suffered from greater daytime tiredness since the angioplasty - but I can't be sure that's the Plavix.] As I no longer see my cardiologist, what's the consensus view?
John Edwards, United Kingdom, March 30, 2008

• Catherine -- let us know what the second opinion shows. The COURAGE trial, presented a year ago, was much touted in that medical therapy showed equivalence with stenting in the set of stable patients in the study -- but a little reported result was that 25% (that's 1-in-4) patients still reported some angina after 5 years, whether they had medical therapy OR stenting. It is known that women react differently than men as well. There are other therapies: anti-anginal drugs like ranolazine, EECP therapy, etc.
Forum Editor, Angioplasty.Org, March 30, 2008

• I am a complicated patient. After a colonoscopy/endoscopy done in July, had many complications. One of which was being given Darvon, known allergy for me. I was to have been discharged the following morning but instead was rushed to CCU because suddenly in addition to the usual allergic response my heart wasn't filling and emptying right. I have had every test you can name and only 3 weeks ago during an angiogram did the cardiologist find a 70% blockage of the LAD. Angioplasty performed and bare metal stent placed. Sent home on 4 new drugs (highly allergic to aspirin) Plavix, simvastatin, dipyridamole, and pletal plus long acting nitro AND nitroKwik. Great! thought 'frightmare of 2007' was just about over. WRONG! rushed back to hospital because I was experiencing an allergic reaction. Taken OFF simvastatin and pletal and the rash was treated topically with prednisone cream and pletal. Discharged after 2 and 1/2 days sicker than when admitted. Went to private allergist who started a course of oral prednisone with taper. Was feeling better only to have rash come back . Allergist, neurologist, and family docs very worried and cardiologist is blowing it all off IMHO. Plavix dose is 75mg bid and Dipyridamole is 50 mgs. t.i.d. I had both leukemia and polio as a young child. PLUS developed seizures & migraines from closed head injury; lifetime asthma; diagnosed P.A.T. since age 23; chronic renal problems; diagnosed hypothyroidism; rheumatoid arthritis; fibromyalgia; and Raynaud's Syndrome. The docs now think I also along with a heart attack had a stroke after the allergic reaction to Darvon. I am allergic to half the PDR and feel like I am taking the other half. I am scared, exhausted, and angry and feel like the cardio team thinks everything is hunky dory since they put in the stent but still can't explain the ongoing chest pain and angina and are simply treating it with Imdur and nitro quik. Am getting a second opinion fro a doc who specializes in women's cardiology. Any insights would be helpful.
Catherine, Michigan, USA, March 30, 2008

• Regarding Plavix, I barely tolerated it for 30 days after having a drug eluding [eluting] stent placed in an 50 percent blocked artery in July 2004. I was taking Protonix, but I still had a severe stomach ache and possible stomach bleeding. A month ago, my internist and I decided to put me on Protonix, 40mg, twice a day for 30 days. On the 31st day I continued with the Protonix twice a day, and I started taking an approximate 1/4 of a typical Plavix pill once a day for one week. No problems. Now I am taking 1/2 of a typical Plavix pill once a day and still on Protonix twice a day. I had a minor headache for 3 days, and I took extra-strength Tylenol. That got rid of the headache. I am still taking 1/2 of a Plavix pill, but without the headache and no extra strength Tylenol. On Sunday, March 30, I will increase the dosage to 3/4 of Plavix pill once a day and continue with Protonix twice a day. The goal is to be able to take a typical full Plavix pill once a day in preparation for an angiogram, IVUS, and possibly more stents in arteries. If I have stent placed in an artery, I want to be prepared to take Plavix for one year without any problems.
James J., A Non-Textbook 47 Year-Old Patient, California, USA, March 28, 2008

• Sue and Michael -- Yes. Patients have reported rashes after starting Plavix. And sometimes the hypersensitivity reaction to a drug (Plavix included) may not show up for a while. However, do not stop taking the drug without discussing this with your interventional cardiologist, because it is important to prevent stent thrombosis. Also read our posting below from November 30 about densitization protocols that have been developed at Scripps Clinic in La Jolla.
Forum Editor, Angioplasty.Org, March 25, 2008

• Are there reported cases of hives associated with Plavix? I had two stents placed on a Monday and starting with itching of the genitals two days later. I now have hives on the front of my thighs and radiating outward, slowly each day. I have ruled out environmental changes at home (laundry detergent, body soap) and other than the Plavix, my medication regime stayed the same with the exception of an increase in medication levels for Zocor and gliptizide.
Michael, Pennsylvania, USA, March 25, 2008

• My husband had a medicated stent abut 45 days ago. He had no reaction with the first 30 day supply. When he started on the second prescription, he has had many reactions-- severe debilitating joint pain, muscle pain, bruising, and itching. Could he have gotten a bad batch, or does it take several weeks to build up a sensitivity?
Sue, New York, USA, March 25, 2008

• Don G. -- We posted a feature in February, titled "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents", discussing the possibility of a rebound effect with Plavix. We had spoken directly with Dr. Rumsfeld, lead author on the study, but we haven't seen much coverage since. Interesting that your well-informed cardiologist was aware of this and is "weaning" you off. Such a strategy hasn't been proven to be of benefit in a randomized study, but such a study could take several years to complete, so if there's no downside, why not? And Sharon -- have you informed your doctor of the adverse reactions?
Forum Editor, Angioplasty.Org, March 24, 2008

• I was put on Plavix and 81 mg aspirin because of possible TIA's. MRI showed that no TIA's, but my dr. still said I should stay on Plavix. It's really affecting my stomach and esophagus. I want to taper off, but he says not for 6 months. Anyone out there taking Plavix who did not have a stent? Has anyone tapered off the drug? Please help!
Sharon, Pennsylvania, USA, March 24, 2008

• My BMS was placed in late February 08. The interventional cardiologist prescribed Plavix & Aspirin for a month, followed by 81 mg aspirin indefinitely. Last week, my local cardiologist cited the rebound affect and prescribed Plavix every other day for a month to wean me off the drug. The drug may be expensive but thanks to Canadian medicare, the government supplies it to me without charge. Regards.
Don G., British Columbia, Canada, March 23, 2008

• Plavix is a drug that is supposed to prevent, not cause, blood clots. We have heard of aspirin overdose being associated with Tinnitus, but not Plavix. Anyone else out there experience this?
Forum Editor, Angioplasty.Org, March 22, 2008

• I had a Plavix stent put in in Feb. of 2007. I had some hearing loss before but in May after Plavix I lost the rest of my hearing and have terrible Tinnitus along with it. They think that the Plavix caused a clot in my "good" ear and caused this problem. I was wondering if anyone also had had a similar experience.??
Jo-ann G., California, USA, March 22, 2008

• Dear D. Lynch -- you should follow your interventional cardiologist's recommendations. Plavix and aspirin both help prevent thrombosis, or clot formation. They each work in different ways, which is why dual antiplatelet therapy (Plavix AND aspirin) is recommended for at least 12 months after a drug-eluting stent (which the Cypher is). Your regular doctor should be made aware of two of the Guidelines released by all the major heart organizations in January 2007:

• Patients also should be instructed to contact their interventional cardiologist before stopping antiplatelet therapy, even if stopping is instructed by another healthcare professional;
• Healthcare providers (surgeons, dentists, etc.) need to be made aware of the dangers of asking stent patients to stop antiplatelet therapy and should communicate directly with the patient's prescribing cardiologist

Forum Editor, Angioplasty.Org, March 21, 2008

• I had a medicated stent placed last Sept 25, 2007. It is a cypher RX cxs13350 3.50mm x 13 mm lot 13263677. The doctor never talked to me about what kind he was putting in and whether I had a choice or not. I took plavix and 325 mg aspirin until Jan 21, 2008 when I was bleeding in the right groin two small dots oozing blood. I wiped it and no more noticed until the same time next night and I was bleeding half as much as the night before or 1 ounce of blood, about. I then went to the emergency room and the doctor there couldn't find anything. I went to my regular doctor and he said take just the 81mg aspirin. and I didn't have any problem with it after that until I went to see the cardiologist and he said I needed to keep the plavix and aspirin going and if I bleed again call him and meet him at the emergency room. I would like to know if I need to really keep taking the plavix and aspirin or continue the 81mg aspirin only. I am currently back on the plavix and 81mg aspirin at present.
D. Lynch, Florida, USA, March 20, 2008

• Jeff -- you're welcome. We invite readers to comment on your ITP and platelet/Plavix situation, as well. As for the stent sizes, a 3.0mm diameter artery is a pretty average size. Just as an example, Abbott recently received European approval for their 2.25mm XIENCE DES -- that's considered small. The XIENCE is also available in 2.5, 2.75, 3.0, 3.5 and 4.0mm diameters, so you can see the typical range of stent sizes, and 3.0 is smack in the middle. 32mm in length IS somewhat long, so that may be why the DES was used. The lesions (blockages) may also have been anatomically complex or eccentric, making them more prone to restenosis. For more information on some of the issues with Plavix and stents that were addressed over a year ago, read our feature, "New Advisory: Will Stent Patients and Their Doctors Get the Message?"
Forum Editor, Angioplasty.Org, March 16, 2008

• Re: ITP and DES placement. Thank you for your comments on my post. Believe me, I told everyone who came in contact with my case that I had ITP X 2 years including the range of platelet levels. Stent sizes are 3 X 24mm and 3 X 32mm which I assume are quite small and would necessitate inability to use bare metal. I would love to hear from someone - anyone with similar experience. I can tolerate down to 50(000) without issues, perhaps 30, but below that it becomes problematic. Also ITP tends to produce very large platelets. Is there any data on how much Plavix drops the platelet level on average? Found my first bruise this a.m.
Jeff, New York, USA, March 16, 2008

• Andy -- Don't be too ticked -- the article you found (there's no citation) but it was probably from sometime in 2003, when a German study came out that called the statin-clopidogrel interaction into question. Several studies were subsequently done and found no inhibition of clopidogrel's antiplatelet effects with any of the statins. Which is a good thing since virtually every heart patient is most likely on both. The most recent, and most robust, study was a secondary analysis done by the very prestigious investigators for the CHARISMA trial, initially presented in 2006. Titled "Lack of Evidence of a Clopidogrel-Statin Interaction in the CHARISMA Trial", published in the Journal of the American College of Cardiology in July 2007, it found no effects.
Forum Editor, Angioplasty.Org, March 15, 2008

• I'm getting a little ticked at my doctor. Have two stents... BMS in 10/99 in LAD; Taxus Exp2 9/06 in Circumflex. Also take Toprol XL, 81mg aspirin. Was on Lipitor since 99 but became intolerant in 06. Stopped taking it and tried Crestor & others... same reaction. For giggles I typed in Lipitor Plavix interaction and came up with the following. If I read this right, the Lipitor 20mg was basically rendering the Plavix ineffective or at best 25% effective. I tried to discuss with my doctor.. but he's stuck on a one size fits all medication regimen. I'm beginning to wonder if he just doesn't know or what is going on. I'm also wondering if BMS is funding the studies. Wouldn't it be nice to have a product that adds thousands of customers a year with no end in sight. atorvastatin and clopidogrel (Moderate Drug-Drug) MONITOR: The concomitant administration of atorvastatin may reduce the metabolic activation of the prodrug clopidogrel and its antiplatelet effects. The proposed mechanism is competitive inhibition of CYP450 3A4 enzymatic activity, which is responsible for the conversion of clopidogrel to its active metabolite. However, data have been conflicting. In a trial with coronary stent implant patients receiving clopidogrel 75 mg/day (n=44), the percent platelet aggregation was 34% with no atorvastatin, 58% with atorvastatin 10 mg, 74% with 20 mg, and 89% with 40 mg. Results from an in vitro study suggest that equimolar concentrations of atorvastatin inhibit clopidogrel metabolism by more than 90%.
Andy, Cleveland, Ohio, USA, March 15, 2008

• Glenys, Hi, I too was in the same boat as you. My health insurance ran out and was not able to afford Plavix. However, the good news is you can get it free of charge from Bristol Myers Squibb!! Call their toll free number, in turn they will send you paper work to complete and a portion to be completed by your Dr. Just be sure to follow up that your Dr. has in fact mailed in the forms. Within a couple weeks I had a 3 month supply of Plavix at NO charge to me!! The toll free number is 1-800-332-2056. The lady I spoke with was very helpful and I had the forms within days. I did the same for Vytorin which I also take. You can get their form online at their website. Every little bit helps a lot. In addition there is another site I would suggest everyone visit. They will mail you a complete packet of information on stents and your care as well as reminders, cards to carry in your wallet etc. I urge everyone with a stent to visit this web site and sign up for the free packet of information. God Bless... Shelly
Shelly, Florida, USA, March 14, 2008

• Jeff -- you've got a complex and relatively rare situation, but our question is: was the interventional cardiologist who placed your stents aware of your ITP condition? Low platelet count is an adverse effect of clopidogrel (Plavix) to begin with. We're not going to second-guess any medical doctor, not only because we're not M.D.'s, but because every patient is unique, and the best way to treat a patient is to have all the clinical info at hand. Current guidelines state that drug-eluting stents should be followed by a minimum of 12 months of aspirin and clopidogrel, and many cardiologists prescribe it for life. Bare metals stents are 4-6 weeks of clopidogrel. You should ask your interventional cardiologist why DES were used, especially given your blood disease. He/she may have had a good reason. In any case, you should regularly have your blood monitored while you're on these drugs, which you should NOT stop taking without discussing it with your interventional cardiologist. Let the Forum know what you find out.
Forum Editor, Angioplasty.Org, March 14, 2008

• Entered a major "heart hospital" in the NY area for angio, was told 70% occlusion of the circumflex artery - no stent. Week later; cardiac event, two DE stents, ramus and lad arteries. Because of history of ITP [Idiopathic thrombocytopenic purpura] wanted bypass or bare metal. Got DES probably because of narrow artery locations - no one explained. ITP is a immune disorder that reduces platelet levels. Taking Plavix, 81 mg asa, zocor for life. Beyond petrified. Last platelet level 89 (000). Any experiences with ITP and Plavix/coronary artery disease ?
Jeff, New York, USA, March 13, 2008

• Glenys -- check out our related topic on "Financial Assistance for Plavix". You might find some suggestions there. Good luck and please keep us updated.
Forum Editor, Angioplasty.Org, March 12, 2008

• Plavix is a very expensive drug. I will not be able to continue with my medication when my Medicare drug plan runs out. Tough I guess. When is this drug going to be a reasonable price? I have four stents and have been advised to take plavix forever.
Glenys L., Florida, USA, March 12, 2008

• J.H. -- did you inform your cardiologist prior to stent placement that you had a history of not tolerating Plavix (clopidogrel)? Most guidelines caution against using DES in patients who will not be able to remain compliant with dual antiplatelet therapy.
Forum Editor, Angioplasty.Org, March 5, 2008

• I had a des 3 weeks ago, i have 8 plain stents. When twice on plavix before had to come off after a few weeks due to side effects. I am now suffering stomach and bowel problems i.e. pain and cramps finding it hard to eat. My cardiologist says i must take plavix for at least a year this does not seem practical to feel so unwell. Is there anything i can do or take to help? I also have had problems with ticlopidine in the past.
J.H., England, March 5, 2008

• S.S. in Georgia -- we cannot give medical advice and we always urge patients to ask their cardiologists these questions -- did you explain to him/her that you did not do well on Plavix? This issue, as you can tell from this topic (over 500 postings) is a big one -- and cardiologists and patients are caught in the middle between the up and down sides of Plavix. Current guidelines from AHA/ACC/SCAI recommend a minimum of one year of Plavix after DES. Many cardiologists prescribe it for life.

A recent study (see our feature: "Stopping Plavix Doubles Risk of Heart Attack or Death for 90 Days, With or Without Stents") highlighted possible dangers of stopping Plavix, but that's just in the immediate three months following. Your cardiologist may have other reasons for wanting you on the drug -- it's definitely not just a drug taken after stenting. Ask your cardiologist and let us know the answer. Also we'd be interested in which studies were being referenced.
Forum Editor, Angioplasty.Org, March 1, 2008

• I am a 50 year old female who had a Cypher DES implanted in Dec 2003. In July of 2004 I had another blockage and additional implant of Cypher DES. In July of 2005, I was back in the hospital and my Doctor implanted an overlapping TAXUS Express2 (thought I may have an allergic reaction to Cypher). It's been over 2 1/2 years and I have not had any other episodes. My problem now is with Plavix which I took for 2 1/2 years and stopped in July of 2006 at my Cardiologist's advice. I just had an annual checkup and was advised by my Cardiologist that he was recommending that I go back on Plavix indefinitely. When I inquired as to the reason for this, I was told that there are some new studies coming out in 2 years and he was recommending that all his patients remain on Plavix. I did not do very well on Plavix, with terrible bruising and swelling. I am very concerned about going this route again. I do take 81mg Aspirin daily, Metoprolol and Zocor. I am very active physically and feel fine. Any suggestion would be greatly appreciated.
S.S., Georgia, USA, February 28, 2008

• My boyfriend had a DES placed in Dec. 2005 and put on plavix. Tried to stop the plavix twice as his quality of life goes to about a 2 on a scale of 1-10. First time he quit was March 2007 and had a stroke in May 2007. Second time he quit was Nov. 2007 (on a physician's advice) and has had at least 2 TIAs. So back on plavix since Feb. 4, 2008. Stress test shows DES is clogged but can't risk surgery until they find out what is causing TIAs. What hope is there??
Joyce, McAlester, Oklahoma, USA, February 24, 2008

• Noni -- the Vision stent is a bare metal stent. The reaction you are having MAY be related to Plavix, but it may be something else. You should consult with your cardiologist about this. Perhaps you can be put on Ticlid, but we cannot recommend that you change your medical regimen without consulting your cardiologist. Let us know what you find out..
Forum Editor, Angioplasty.Org, February 23, 2008

• i had a Multi-Link Mini Vision stent placed on January 3, 2008. Since then I have been taking 75 mg Plavix and 325 mg ASA. Recently (after taking Plavix 75mg for 50 days) I developed swelling of leg and feet and itching. My questions are (1) Is this BMS or DES? (2) Can I stop taking Plavix and continue on 325mg ASA alone? Many thanks for your suggestion.
Noni B., New Jersey, USA, February 22, 2008

• Mamie -- thanks for the compliment. The study showed that the rebound effect, if it in fact exists, is there whether or not you have a stent. So having a DES wouldn't put you more at risk for this "rebound" effect. Are you experiencing side effects from the Plavix? Because it has several beneficial effects for heart patients, regardless of stent or no-stent. However, at three years you are quite far out, and we recommend that you discuss stopping Plavix (if that's what you want) with your cardiologist -- he/she will give you the risk/benefits of doing this and together you can make an informed decision. Let us know how your fare.
Forum Editor, Angioplasty.Org, February 21, 2008

• Very interesting article on Stopping Plavix and rebound effect. Most people on long term Plavix use are harboring stents...mainly drug eluting stents. I am going on 3 years of this miserable med and want desperately to wean off in another year. I have 5 DES. Now, my sister and cousin both have bare metal stents. They received these in 2001. Sister has 2 stents, cousin has one. They were on Plavix for 2 years and each got off cold turkey due to low blood counts and internal bleeding. Neither one of them have had any re-bound effects from getting off Plavix. No heart attacks...bare metal stents are doing their job. I do not think we should discount the use of bare metal stents. I wish I knew back in 2004 what I know now. I would never agree to drug eluting stents as with these DES..Plavix forever or else. I had too eager of an interventionalist. I wish they could be removed. )-:
Mamie, Houston, Texas, USA, February 20, 2008

• Ron -- the word here is "revascularization". It means opening up the coronary artery and eliminating the blocked area. It can be done with angioplasty: a balloon, and maybe a stent. It can also be done by bypassing the blocked area. There's really no difference. However, and I'm sure you've heard this before, continuing to smoke is without question the worst thing you can do. Smoking has been proven to cause ulcerations in the lining of the arteries, which leads to blockages. Ask your doctor to help you with smoking cessation. It's not easy, but stopping smoking (we did) is the best medical procedure you can do. Better than bypass! And don't go off your meds. Neither bypass or angioplasty "cures" coronary artery disease. These are merely mechanical solutions to a biolocial problem. The disease will progress -- and it will progress much more quickly as long as you're smoking.
Forum Editor, Angioplasty.Org, February 20, 2008

• I had 3 drug coated stents put in, in November and have had pain and discomfort all along. I'm 47 years old and a smoker still. Was told at the time I would need by-pass, but new cardiologist says stents are fine. Now bad news -- I quit taking all meds including plavix 1 month after heart attack hoping he would have to do by-pass to get it over with. Deadly yes but I want by-pass done.
Ron Garrard, Canada, February 19, 2008

• Sherry -- Guidelines for post-DES patients are a minimum of one year of Plavix (or Ticlid) and aspirin for life, but many cardiologists prescribe Plavix for longer. These are antiplatelet drugs which keep blood clots from forming in the arteries, which can cause a heart attack. Toprol is a blood pressure med and Lipitor a statin to keep your cholesterol down. Both are long-term meds. None of these should be stopped without consulting your cardiologist because they are beneficial to preventing the progress of coronary artery disease. Are you having problems with the meds? Bad reactions?
Forum Editor, Angioplasty.Org, February 18, 2008

• I had a stent put in May 15 2007. I take a plavix, toprol, lipitor, 325mg aspirin and an Ambien CR each day. When can I STOP and is this mix hurting me?
Sherry, Ohio, USA, February 17, 2008

• To John K. from the U.K. -- Thanks for the post. There's a bit of controversy over whether or not the internet helps patients or hinders them. Your story shows that informed patients are often an excellent source of Continuing Medical Education for healthcare professionals who may not be up on the latest research! It's a big problem, one that we've discussed before -- and while specialists like cardiologists are acutely aware of the need for continued antiplatelet therapy (like yours AND your regular GP) sometimes the non-specialized healthcare workers are not. Thanks again for sharing your story and cheers!
Forum Editor, Angioplasty.Org, February 16, 2008

• I was placed on Coumadin as I "threw" a clot to my lungs. I suffered with Coumadin bleeding. I was off of Coumadin and told to go on Plavix. Almost immediately I got two-three nosebleeds daily. One day awoke with a bloody pillow. My PCP agreed for me to go off the Plavix and stay on my 81 mg ASA. Bleeding stopped. He wanted 1 Plavix every three days. I had been on the Plavix for less than two weeks. Am loath to restart. I take 9 meds daily.
Robert F., Crystal Lake, Illinois, USA, February 15, 2008

• Hi, About 18 months ago I posted here after having 2 DES inserted. I felt well, I was pleased with the effect and was looking forward to life. My cardiologist put me on Plavix and small aspirin with, at that time, no indication of how long I would remain on Plavix, but at least a year. In the last few weeks I have developed a rash and I continually feel tired and unwell. I went to my GP but saw a stand-in GP who immediately said. 'I'm stopping your Plavix, not because of your symptoms but because of cost to the Health service, maybe your symptoms will clear up as well'. You can imagine that we had a heated discussion and the upshot was I demanded to see my own doctor. His reaction: 'I will never take you off them unless your cardiologist recommends it, keep taking them.' I also spoke to my cardiologist and he of course said that for him there was no question..Plavix for life and I see him about the symptoms in 2 weeks. Bottom line...Don't give in, it is your life they are playing with. I suppose they work on the basis that dead we are no cost and no problem.
John K., United Kingdom, February 14, 2008

• Karen -- we assume you're referring to the study we reported on last week. Going off Plavix has presented the problems noted, and there are no tested solutions right now, althugh suggestions have been made to taper off the dose as a possibility. Your mother is being prudent in postponing surgery until she can talk with her cardiologist. That's what all the recommendations suggest. Let us know how things go.
Forum Editor, Angioplasty.Org, February 14, 2008

• Hello My Mom had drug eluting stents put in in June of 2006 and has been on a regime of Plavix and aspirin ever since and doing OK. She had "an episode" this past Oct. She had another Cath. done and it showed that the stents were open and all her other tests were good. No change or damage to her heart etc. She had a successful hip replacement in Nov. 2005 even with the undiagnosed heart disease, thankfully. She needs the other hip done and we went for her pre-op testing yesterday. The ortho's cardio. said he would clear her for surgery and that she should take the Plavix up to a week before the surgery and the aspirin the day before ....But we should be aware of the risks and mentioned the new study. Mom has decided to postpone the surgery pending a visit to her own cardio. But he has really scared us...What are the odds of her having a problem?
Karen B., Pennsylvania, USA, February 13, 2008

• Jack -- we'll preface this with our standard statement that nothing written here should take the place of medical advice given by your doctor. That being said, ALL guidelines state that stent patients should be placed on dual antiplatelet therapy -- which would be either Plavix (clopidogrel) or Ticlid (ticlopidine) -- AND aspirin. The idea is to keep the blood from clotting. Aspirin and Plavix work differently, which is why both are prescribed. However, your cardiologist may not have prescribed aspirin for a good reason (perhaps concerned with bleeding complications, etc.). But you should definitely call him/her with this question. If aspirin is in fact recommended, ask what dosage of aspirin you should be taking. (And let your cardiologist know that aspirin was NOT mentioned.) Let us know what you find out.
Forum Editor, Angioplasty.Org, February 12, 2008

• I just had 2 stents put in 1 month ago and was only told to take Plavix - for life. No one mentioned aspirin and the more I read, the more it seems I should be on that too. Is not being on aspirin dangerous?
Jack L., New Jersey, USA, February 8, 2008

• To All Patients On Plavix: take note of a very important new study published in today's Journal of the American Medical Association. The finding are basically that there may be a "rebound effect" when you stop taking Plavix -- so for a period of around 3 months immediately after you stop, the risk of your blood clotting and having heart attack, is DOUBLE what it is later on. And this effect was seen no matter how long the patients were on Plavix: 3 months, 6 months, a year and more. And the authors studied over 3,000 patients.

This does NOT mean you should not take Plavix. The benefits of the drug, especially for stent patients, are well-documented. It means that there needs to be more research as to what this effect is and possible strategies for going off Plavix -- for example, slowly reducing the dose, or increasing aspirin during this period, etc. The advice to patients that the co-author of the study gave to us at Angioplasty.Org is that if a patient has finished their prescribed dose of Plavix, they should discuss with their cardiologists whether they should continue or not, especially in light of this study.

By the way, the authors of this study started it precisely because of an incident that occured to one of their relatives. They've also read this Forum and commented that what they saw on Angioplasty.Org was exactly what they'd observed in many patients. Dr. Rumsfeld in particular made some interesting comments to us about the importance of what patients say about their own experience, and that the medical profession needs to listen to patients more carefully. Read the article.
Forum Editor, Angioplasty.Org, February 6, 2008

• Hello Shelly and all others in need of free plavix, my boyfriend is 49 and just had two heart attacks within a week of each other and is on plavix with no income and can't go back to work right now, in the hospital he was given an application from Bristol-Myers Squibb who make plavix, we filled it out wrote a short letter of explanation, and sent it off through the cardiologist, and we just heard back that he was approved, and that a 90 day supply will be waiting for him at his cardiologist office this will also cover 3 refills so basically he is covered for a year and after that he can reapply, all within 3 weeks and his cardiologist office gave him samples to get him through till this came through, I don't know what would of happened without their help, obviously it would have been not too good!!! please check this out, hope this helps someone. This is called The Bristol-Myers Squibb Patient assistance Foundation, Inc. P.O.Box 1058 Somerville, NJ 08876 Phone (800) 736-0003 If anyone has any comments or questions, [please post to this topic].
Pamela Eiseman, Gainesville, Florida, USA, February 4, 2008

• A bit off topic, but I wonder if NICE in the UK will be making more financial constraints regarding Prescriptions for Plavix use, as they appear to be about to do regarding types of stents to be used in UK.... `The draft guidance also states that drug eluting stents should only be used if the price difference between it and a bare metal stent is no more than £300` I suspect that the difference in price is considerably more than £300 ( 600USD), unless manufacturers `knock up a special Value Stent` for the UK!!!!!!!
Tel, United Kingdom, February 4, 2008

• I have been advised to take Plavix and not to stop taking it for any reason. Further it has been suggested that I continue it for life. This is advice from my Primary care physician and my cardiologist. I have had two trips to the ER since. I was administered 4@ 75 mg Plavix in the ER each time. My DES were placed Sept. 2007 and restenosis occurred Dec.2007. Two additional DES were added at that time. I will be waiting to read if administering Plavix for life will become the standard.
R. G., Wisconsin, USA, February 2, 2008

• Hilda -- you are not alone -- read our posting below from November 30 about densitization protocols that have been developed at Scripps Clinic in La Jolla.
Forum Editor, Angioplasty.Org, February 2, 2008

• I have been on plavix for 3.5 months, and I am itching like a dog with fleas. Are there any remedies besides benedryl?
Hilda H., Alabama, USA, February 2, 2008

• Tel -- you've brought up an extremely interesting point. While there's been much written about the optimal length of Plavix therapy (medical guidelines now recommend one year of clopidogrel or ticlopidine post-DES) little has been written about what happens after that year of Plavix is stopped. A number of DES patients or family members have posted to this Forum Topic about having stopped taking Plavix after a year, and then having a heart attack within weeks. One such story was posted just three days ago. It's a disturbing thought and, although these are just anecdotal events, we believe this area urgently requires further study. Your idea of "weaning" off of Plavix is also an interesting one. We'll run it by some cardiologists and report on their thoughts. Thanks so much for contributing this post!!
Forum Editor, Angioplasty.Org, January 31, 2008

• With all of the issues regarding the stopping of Plavix after 12 months following DES, with no none really knowing when to stop, is it not possible to have a halfway house and reduce the Plavix to every other day for say 6 months after the first 12 months. Is that an option???, at least for some sort of peace of mind if nothing else. I have 2 stents one BMS and one DES, the former fitted to a bifurcation in 2006 and the latter in Jan 2007. It was noted at the time of the implanting of the DES that there was restenosis of the BMS, but it was felt that the RCA was in greater need of a stent. As a consequence I am aware that the BMS must still be partially blocked, but because the DES is now 12 months old it has been decided to stop the Plavix. Any comments please.
Tel, United Kingdom, January 31, 2008

• P. in Jersey -- your cardiologist prescribed Plavix and aspirin no doubt to keep clots from re-forming in the narrowed artery. How long you stay on this drug should be a question you discuss with your cardiologist who knows your clinical situation best. Bleeding complications are the most common serious side effects of this therapy, but if you're not at risk, this medical therapy can be very beneficial in terms of prevention.
Forum Editor, Angioplasty.Org, January 31, 2008

• I had a MI, small one they tell me, two weeks ago, and was put on Plavix 75 mg and Aspirin, 325 mg afterwards. I did not get a stent inserted. Apparently, the artery with the clot was too small. I wonder how long I will be on plavix? I weigh 110lbs and am also concerned with the aspirin dose.
P., New Jersey, USA, January 31, 2008

• Ralph -- have you discussed these results with your cardiologist or even primary care physician? 10,000 is a very low count -- you should be talking to him/her ASAP. Bleeding complications are a known adverse effect of Plavix.
Forum Editor, Angioplasty.Org, January 31, 2008

• Does Plavix lower your platelet count? My platelet count is 10,000. It should be about 250,000.
Ralph D., New Jersey, USA, January 30, 2008

• Joe -- read our posting below from November 30 about densitization protocols that have been developed at Scripps Clinic in La Jolla. Your cardiologist has probably seen these reactions (rash, etc.) before. Switching to Ticlid might work (that's all they use in Japan) but you might have an allergy to that as well. La Jolla is not far from you. Check it out.
Forum Editor, Angioplasty.Org, January 29, 2008

• I am a 61 year old male, in previous good health without any meds until 3 weeks ago when I developed exertional angina. @ 2 -3 weeks ago, I had 2 DES(Cypher)stents placed( one stent was difficult to place). I did fine with Plavix, Aspirin, Lipitor and Metoprolol and Prilosec until yesterday when I developed a very itchy rash and swelling on hands, and hive like rashes on my elbows, scalp and inter-gluteal area. I just started low dose prednisone (steroids) and Benadryl and this seems to help. The cardiologist felt that most likely this was due to Plavix. Have others had similiar problems and were they able to continue Plavix or was a change to Ticlid necessary? Thanks!
Joseph S., California, USA, January 29, 2008

• James -- the issues you raise are THE issues with drug-eluting stents and Plavix. As you can read in the many, many posts to this Forum Topic, there is still much debate about the optimum length of antiplatelet therapy required after DES. The medical reason for taking a patient off Plavix is to reduce the risk of bleeding. The financial reason is something else again. All the major medical societies have recommended one year as the minimum for dual antiplatelet therapy, assuming there are no bleeding problems. But many cardiologists prescribe it for longer and, while it's not possible for us to say that your grandfather-in-law's heart attack was caused by stopping Plavix, your story is striking and unfortunately not unique. Plavix is stopped -- stents acutely close off -- heart attack. The cardiologists who treated your grandfather-in-law might be able to determine from the cath films whether the stents were blocked off by clots (or thrombi) or whether they had restenosed (something which is not an acute event, but takes place over time, and represents a progression of coronary artery disease). The two look different on the cath film. If it's determined that it was an acute clot formation, by all means discuss this with the cardiologist. It may help change his (and the VA's) practice of stopping Plavix after a year.
Forum Editor, Angioplasty.Org, January 29, 2008

• I spent yesterday in the hospital with my wife and her 82 year old grandfather who had a massive heart attack. While reviewing the grandfather's medications, the grandmother revealed that her grandfather's Dr. had taken her grandfather off of his plavix over the phone about 2 weeks ago because he said he only needed it for a year and the VA would no longer pay for it. And 2 weeks later his 2 stents had total blockage and he had a massive heart attack. I am a pharmacy student on this website researching the effects that taking him off the plavix had on his heart attack. Everyone should know that being taken off a medication such as plavix should be the decision of yourself and your Dr. If you have a fear of being taken off of this medication after a year make your concerns known to your Dr. I am getting the feeling after the more research I do that the decision to take patients off of plavix after a year is more of a monetary rather than a medical decision. There is currently a debate on whether plavix and aspirin should be lifelong or temporary therapy.
James F., Virginia, USA, January 28, 2008

• P. Benge -- current guidelines are for one year of antiplatelet therapy following drug-eluting stenting. Beyond that it is up to the cardiologist and patient. There are bleeding risks involved with any drug like Plavix -- but many cardiologists prescribe Plavix for their DES patients for longer periods. On the other hand, some studies have shown no benefit for Plavix after 6 months. It's a complicated area, and to emphasize that, we always like to quote an exchange that took place during the FDA Stent Safety Panel last December. Panel member Dr. Chris White of New Orleans (Dr. White is one of the top interventional cardiologists in the country) said he didn't see any reason for changing the FDA labeling for drug-eluting stents to require Plavix for longer periods than 3-6 months. He said there has been no evidence presented that would mandate such a change. But when Dr. White was asked by the Panel chairman, if he himself had a DES and was at low risk for bleeding, how long would he take Plavix, Dr. White answered, without hesistation, "indefinitely". There was laughter in the hearing room, mainly because the exchange precisely hit upon the conundrum of "how long for Plavix". We would not begin to get in-between your and your cardiologist on this or any matter of medical advice. He/she knows your husband's clinical situation best. Read over other entries and also our "Patient Advisory" and then talk to your husband's cardiologist about your concerns.
Forum Editor, Angioplasty.Org, January 27, 2008

• My husband had a DES put in RCA last February. His cardiologist is considering taking him off of Plavix next month. Is there a greater danger period immediately after discontinuing the Plavix? What should we watch for? We aren't fond of this medication but we are a little nervous to do without it. Thank you
P. Benge, Florida, USA, January 20, 2008

• Ask your doc to test for Plavix and Aspirin Resistance . 20-30 people tested are, Why take more of something if it doesnt work. even worse why Die not Knowing about other options or drugs that might. Your doc can't know if your not tested. I wouldn't let mine continue to roll the dice and just suffered from another clot while on plavix . If you dont ask then they won't tell.
Mike, Stent Clotter x3 on plavix/aspirin, Florida, January 7, 2008

• I had a DES in Sept.07, went home next day doing o.k., 3 da. later had the artery to start leakage in left leg, it was black and quite swollen. More surgery to stop bleed, came home with Plavix & ASA. One week later started having severe pains in both arms, called the NP in Dr. office she said probably unrelated, got worse called again and she made me an appt. the next day. He did an echo and said it was not my heart but an inflammation. Since I have a lot of arthritis, namely RA and Dermatomyositis which had been in remission for several years. Referred to Rheumatologist, on mega doses of Prednisone, have cut back now but still have some pain. I am sure it was a reaction to Plavix or the DES, talked to the research group in Texas, they say they are seeing a lot of inflammatory reactions. I have ins. that covers 1/2 of Plavix but its still bad when you are on a fixed income. However, it does look like a drug company that made 60 billion on Plavix alone last year 06, could afford to help people that have no ins. It's no wonder the drug companies push it. Research I did quoted that figure, of course they would fight a generic. By the way it costs $25,000 for a DES in the hospital I went to in Missouri, they say it is more for a DES. I wish I had had a choice, if I knew what I knew now it would have been a bare metal stent.
Martha, Missouri, USA, January 5, 2008

• Michelle -- our sympathies to your family. Plavix allergies usually involves rashes, etc. As for blood clots, that is exactly what Plavix is used to help prevent -- it is an anti-clotting drug. 600mg of Plavix done as a "loading dose" is currently recommended by many and is thought to reduce complications from the stenting. All the major medical societies recommend Plavix for at least a month or two after bare metal stenting. There is a known condition called "Plavix resistance", and more currently is being learned about this -- basically it's when a patient does not respond to Plavix -- rendering the Plavix (and possibly other antiplatelet medications) ineffective at preventing clots. We don't know of any studies correlating patients with a Plavix allergy to resistance. We'll try to research this.
Forum Editor, Angioplasty.Org, January 3, 2008

• Hello- My father passed away on 11/15/07 at the age of 62. He was placed on Plavix following a bare metal stent placement. My father had a history of a Plavix allergy but the doctor who did the multiple stent placements put him on it anyway. Before each stent placement he gave him 600mg of Plavix. My dad had some symptoms listed as adverse reactions to a Plavix allergy. I really need somebody's help or opinion as to whether Plavix can cause a blood clot to a person who has a Plavix allergy?? We need help....
Michelle, Lancaster, Pennsylvania, USA, January 1, 2008

• Dear Angioplasty.org, One year ago tomorrow I underwent my second angioplasty and DES stenting in 10 days-no MI, just accelerating anginal symptoms. NO co-morbidity prior to or after (was a fat kid so I am thinking Juvenile Metabolic syndrome as the culprit). OK, here are the 2 questions: (1) today is the 365th day since my second stent. Do I stop Plavix after today? I want to start ice skating, possibly return to playing hockey, and other activities with possibility of blows to the head. As an emergency physician who takes care of the rare Plavix disasters, my one fear is a closed head injury or intracranial vascular accident while on Plavix. I also am tired of the bruise with minor (or major!)bumps to soft tissues. So I want to stop the Plavix in the worst way. But I am a good patient so I have continued for the full year. I have the OK from my cardiologist> What does everyone else think? 2) What is the antiplatelet effectiveness of the Plavix? In other words, how long should I be off the Plavix before there are no antiplatelet effects? I know I should be able to get this from websites/pharmacists but I trust the input here more and have kept my stents quiet for fear of employment discrimination. Thank you all for being my distant reassurance and support through this. Sincerely, PA doc
Dr. R., Pennsylvania, USA, December 26, 2007

• For some of people that don't have drug coverage, you should go to your family DR, and your cardiologist and ask them for samples the drug reps leave at their offices for people when they start on plavix. A lot of time they would rather write a scrip than give samples to people who are not covered by insurance. I have seen out of date samples trashed when they could have give them to their patients. You just have to ask and ask again.
Ronnie B., Kentucky, USA, December 20, 2007

• Hi all..It's been awhile since I've written and sad news about my mom suddenly passing away Oct. 7th. A lot of stress going on here..To recap I had a DES in place Oct. 18, 2005. Although my doctor suggested I can now go off my Plavix (75mg) and continue my 81 mg of baby aspirin, I've decided to take my plavix every other day...Overall I've been feeling much better..Today, here's my concern: I have been extremely fatigued the past 3 days. Last nite for the first time in along time, I had to take a nitro as I was having arm and jaw pain like I did the night I had my angina attack...We had snow up here in Boston and although I didn't "shovel" any snow, I did clean off my car using my arms for a while...I'm wondering if I am so tire because of this exertion??? I was anemic 3 months ago and required 5 infusions of IRON...I'm not sure if it's my blood counts going down or is it my heart? Does anyone experience this fatigue on exertion? Thank You...Rosanne
Rosanne Giuliano, Stoneham, Massachusetts, USA, December 17, 2007

• T.M. -- did your husband get a drug-eluting stent (DES)? All the major cardiology associations (ACC, AHA, SCAI) have recommended that DES patients stay on Plavix and aspirin for at least one year, assuming there are no complications. The US FDA has now seconded that and will soon be issuing a formal recommendation. You might want to check out and post to the Forum Topic on "Financial Assistance".
Forum Editor, Angioplasty.Org, December 14, 2008

• Is there anymore information about the VA refusing to continue issuing Plavix? They informed my husband that they will no longer dispense Plavix, even though his cardiologist says that he needs to remain on it.
T.M., Texas, USA, December 14, 2007

• Why on plavix and aspirin does one feel cold?
Dana, RC hospital, Russell Springs, Kentucky, USA, December 4, 2007

• Roger -- we love it when patients and readers scoop our news! We actually just conducted an interview with Dr. von Tiehl and Angioplasty.Org will be posting an article soon about this subject. For those interested, here's the link to the abstract (free) for Dr. von Tiehl's journal article in the Journal of the American College of Cardiology (JACC). The article is titled "Clopidogrel Desensitization After Drug-Eluting Stent Placement". And, as we've said, and Dr. von Thiel strongly agrees, "don't try this at home!"
Forum Editor, Angioplasty.Org, November 30, 2007

• Last August I placed a post noting my experience with a simple desensitization procedure, performed at the Scripps Clinic, to overcome allergic reactions to Plavix. As a follow up for those who may be interested, I note that the Scripps Clinic staff, Dr. K von Tiehl et al, has recently published a paper on this topic in the Journal of the American College of Cardiology. The article is available on line at the journal's website.
Roger l., California, USA, November 30, 2007

• After receiving two DES stents in early 2007 in the US I was placed on one 75M Plavix and a 325M Aspirin daily. After moving to Germany I continued to have chest pain. I consulted German doctors and after various tests to include treadmills and nuclear medicine it was decided that my heart was OK. Following some blood tests my German doctors changed my daily dose to a 100M Aspirin and two (2) 75M plavix pills daily. Is anyone aware of a someone being prescribed to take two 75m plavix daily along with Aspirin?
Doug, Germany, November 30, 2007

• Re: Bruce's post below -- please see our disclaimer at the bottom of the page and our note from November 16.
Forum Editor, Angioplasty.Org, November 22, 2007

• Shelly, I buy my plavix & lipitor in Tijuana, There are hundreds of farmacias at the border competing for the trade of many americans in our predicament. The plvx. & lip. are brand name in sealed 30 pill packs. Prices are haggled according to volume so shop prices. These are "over the counter" and do not require a Rx, I do take my empty american bottles though. Customs only once checked my bag and the drugs must be for your personal use. Prices are a little more than you can get from Canada via internet where they advertise 90 Lipitor generics 80mg. which can be split for about $3ea. I take the San Diego trolly to the border and meet people that fly in and out the same day. Maybe a trip to Texas is in your future. Customs rule I think is 60 days supply, but I've heard that six months worth is not a problem as they tend to look the other way and not enforce this.
Bruce Chandler, retired, La Mesa, California, USA, November 21, 2007

• In your response of 11/18 to Salman, you mention that CT can show a lot, but with stents the only good way to check on them is with angiography. Recently my cardiologist did a CT 64 Slice Scan and showed me the results, in which he said (and it looked to my untrained eye that he was right) that their was no-restenosis in my three stents. Is there a difference of opinion on the results shown from the CT?
Tom T., Arizona, USA, November 19, 2007

• To the Forum Editor: Thank you for the detailed reply. I do not believe I was given DES but the plain metal ones. I wonder if the Surgeon decides which ones to use or maybe because the government pays for health care in Canada, they use the cheaper ones. Not quite sure. Are periodic routine exercise stress tests a good enough indicator of how a patient is doing? I was also told that as a South Asian my risks were greater of CAD. Is that borne out by statistics? Because the sub-continent has people of all races, starting with the Aryan invasion 3 millennium ago. I don't have a family history either. Mom's fine at 89 and Dad got a stroke in his 70's at a time when medical science was not as advanced as now. Besides I was told that the text book definition of "family history" was one of the parents having heart disease under the age of 55. Is it the same in the U.S.?
Salman, Toronto, Canada, November 18, 2007

• Salman -- you're right -- there is a debate going on. We just attended the TCT meeting in October where studies were presented, showing that stent thrombosis is not decreased by clopidorgel (Plavix) after 1 year, and others that were less clear. The debate will no doubt continue, but in the U.S. right now, the guidelines recommend a minimum of one year of dual antiplatelet therapy (clopidogrel or ticlid and aspirin) post-DES. As for a continuing benefit, that's something between you and your cardiologist. Plavix has benefit beyond helping to prevent stent thrombosis, but it also raises the risk for bleeding complications. Like the ads says, "Ask Your Doctor...". Stents are permanent implants, but they can close up, or restenose. Drug-eluting stents restenose less than bare metal stents, which have a restenosis rate of 15-20%. Remember, that means 4 out of 5 stents never restenose. With DES, it's more like 9 out of 10 never do. CT Angiography can show a lot, but when there are stents implanted, the only good way, right now, to image the arteries is through invasive angiography in the cath lab.
Forum Editor, Angioplasty.Org, November 18, 2007

• I had angioplasty in Mar 2004 at age 60. Two stents (a 90% blockage and a 75% blockage) and a ballooning without stent in the 3rd, cause I was told it was too narrow. I took Plavix (75mg once a day) for a year. I believe there's a debate going on, on whether to take it for a lifetime or up to a year. If it is a blood thinner, it could only be good for someone with CAD; so I wonder why do they stop it? Does anyone know, how long do the stents last? Is there any imaging technology available to see the arteries with the stents and the flow of blood?
Salman, Toronto, Canada, November 18, 2007

• Thanks Betty & Pete, I will check out both the sites you mentioned. I am not giving up! When I find one that works ya'll will hear from me!! I'll yell it from the rooftops!! lol And, no worries, my meds will be legal... I have enough problems without adding any new ones. ;) Thank all of you again, this is a great bunch of people!!
Shelly, Florida, November 16, 2007

• By "stent site", the doctors are talking about the site of the actual stent - the midportion of the distal vessel (I think) in the right coronary artery. Still unsure of exact origin of bleed.
Susan, Texas, USA, November 16, 2007

• Shelly, I don't know if this will help or not but I found this site. It seems to offer some help in finding a program that can assist you in getting your prescriptions. I have not signed up but it looked interesting. This is the website: http://www.rxassist.org -- Good luck and let us know if that helped at all and anything else we can do for you. And hang in there, you'll get this figured out.
Pete, New Jersey, USA, November 16, 2007

• Just a note to all -- we welcome opinions and information from our readers, but any opinion expressed by posters are their own and do not necessarily reflect those of Angioplasty.Org or its editors. We also do not endorse obtaining prescription medicines or pharmaceuticals from any source that may conflict with the laws or regulations of any country.
Forum Editor, Angioplasty.Org, November 16, 2007

• i keep reading about the cost of drugs like plavix in US and Europe and difficulty in people not financially sound to continue on treatment. I am from india where lot of angioplasty procedures are performed daily and though i do not have data to support but am sure restenosis and or Late thrombosis rates would be similar to the world. The patients are given same prescriptions like Clopidogrel, aspirin,statins,ace inhibitors. These are dirt cheap here and i must add they are generic versions but i am sure equally effective. let me tell people are taking these even if they are rich enough to import and afford 200-300 dollars a month but still doctors (let me again say Indian doctors are as good as anyone in the world and they know that quite a few of the patients can easily AFFORD imported medications but they say indian medicines are equally good. Now lot of indian company medications are marketed in US and EU. So my suggestions to people who cannot afford drugs in US like plavix etc is to consider getting it from india just for reference - clopidogrel 75+ aspirin 150 combo tablet for 30 days dose costs only 3(three)dollars in india.please dont think they are not effective ,they are as good. indian medicine compares to the best in the world today. even procedures like stenting ,bypass etc on the same machines. are much cheaper . a angiaoplassty with one cypher des costs 3000 -3500 dollars at the best hospital which let me say are comparable to world standards. bypass costs 1ian medicine 10000-12000 usd. i myself went thru angioplasty im mar 06.so people rather than not taking plavixe for one year as recommended should explore indian medicine options. it is false propoganda of big cos that generics is not effective. my emailid is tarunsud@hotmail.com
Tarun Sud, New Delhi, INDIA, November 15, 2007

• Shelly--Have you checked out www.scbn.org? I'm sure there is paperwork, but it might be worth a shot if you haven't already tried it. It stands for Select Care Benefits Network, a patient advocacy organization. Good luck to you. YOU GO GIRL!!!!
Betty S., Arkansas, USA, November 15, 2007

• I still do not have my Plavix but it is nice to see the support here. I am not giving up, I feel there has to be a way for me to get this much needed med I need. It gets very frustrating, but I am very persistent and I vow to follow every lead I can find. Again, I urge any of you if you know of other companies, web sites, etc. that assist people in obtaining Rx medications they need to please post here. I see I am not the only one in this position, and I am sure there are lots more that aren't aware of this site. I did get in touch with my Cardiologist (his nurse) and they do not have any samples of Plavix, but I was told if they did get any I would be called. I'm keeping my fingers crossed & praying.. it scares me every night I go to sleep... I need a miracle as I'm sure others do. It's ridiculous knowing drug companies make the huge amounts of money they do and people as myself and others have to live in fear of death not being able to afford their meds. The amount of red tape these companies put you thru only to be turned down is frustrating. I have filled out no less than 30 pages to qualify for free/reduced meds only to be turned down since they have a quota they can't go over. Hard to think a quota has move value than a human life... (sigh) I haven't offered much information to anyone here, but it helps me to vent. Who knows, maybe someone reading this will know of another place I can try for assistance. At my local drug store I checked the price of Plavix today, $136.00 for a 30 day supply. The U.S. needs better health policies for those like us. I doubt I will ever see that day in view of my current dilemma, but I can fight for future generations. I do plan to fight this; it may take a while, but if it means possibly saving one life it is MORE than worth it! Please, if you have any information on this subject please take a minute and post it for all of us out here in this situation. Thank you & God Bless.
Shelly, Florida, USA, November 15, 2007

• Susan -- when you say "stent site", do you mean the access site (probably in the groin or femoral artery)? We assume you don't mean the actual place in the coronary artery where there stent is. Bleeding complications at the femoral access site are approximately 3-4% (we think higher) but we haven't heard of such a complication occurring 5-6 months out. Possibly it was, as you said, a slow bleed from the beginning. These complications are one reason we have initiated a section on "Radial Access".
Forum Editor, Angioplasty.Org, November 15, 2007

• My husband had surgery to close a PFO in 1999, bare metal stent in 2000, bypass surgery in 2006, drug-eluting stent in 5/07. Ascending aortic aneurysm diagnosed in 5/06 at 4.2 cm. On 75 mg plavix and 325 mg aspirin daily. 10/31 he experienced severe bleeding in the chest cavity. Prior to diagnosis of bleeding, cath showed all previous repairs were open. Chest tube evacuated about 3000 ml of blood and fluid. Transferred to TX Heart Inst. because of two previous surgeries and possibility of aneurysm bleed. Latest diagnosis is that he had a slow bleed from the 5/07 stent site, which pooled and caused extensive chest pain. Lovomax [Lovenox??] given in ER and aspirin/Plavix therapy exacerbated bleeding. Do you know incidence of bleeding from stent site after 5-6 months?
Susan, Texas, USA, November 15, 2007

• Shelly -- you have sure been persistent. We've found out a bit more about Boston Scientific's program. It's called "StentPLUS" and the person in charge of it told me the same thing they told you -- they are looking to launch it right after the first of the year. Even so, it's not going to give direct financial relief to patients -- only to help them find ways to lower their costs through various government, etc. programs. Bristol-Myers and Sanofi-Aventis are the companies that are making Plavix which IS the largest selling drug in the world ($6 billion worldwide sales last year) so keep after them.
Forum Editor, Angioplasty.Org, November 14, 2007

• Well, unfortunately the [Boston Scientific] program I wrote about in the prior post (Oct 16) will not go into effect until 2008. In the meantime they referred me to PPA which I did apply for online. I got my response. Due to the number of people requiring medications I am presently taking there is no assistance available at this time. They did tell me to re-apply January 2008. That means at least 4 months with NO Plavix, Lipitor, or any other expensive medicine my Dr has Rx for me. I do have a call into my Cardiologist hoping for some miracle... All I can do at this point in time is pray. If anyone else has this issue, if you are able to speak with your Dr. prior to surgery that may require you to take these meds please talk with him/her about it so you don't end up in the same position I am. Good Luck to everyone..
Shelly, Florida, November 13, 2007

• Very interesting website! Glad to have found it. In Jan. '06, I had a blockage in the left leg. Went into hospital and 3 stents were placed in the inner thigh area. I was already on a Plavix/aspirin regimen and this was continued at discharge. Absolutely no beneficial results from the stents. Doing a little research of my own, I learned of the Silverhawk Plaque Removal procedure. My cardiologist had never heard of it, contacted a representative of the company. That person came to meet with me, explained all about it, risks, etc. I had the procedure in June '06. The results were amazing to me. I could walk with no pain whatsoever for the first time in a long time. But the surgeon who performed the procedure didn't seem too happy with me for wanting that method. When he discharged me from the hospital, his comment was, "Well, stents are better". In Sept. '06, I had a routine visit with my cardiologist. He had a Physician's Assistant I had never met. This person took me off daily Plavix and told me to take it every three days. Within 3 weeks, I had a blood clot in the left leg. The same doctor who did the Silverhawk procedure also removed this clot. At the same time, he also implanted 3 Cordis stents. I had no idea he intended doing that. From the time I left the hospital my leg hurt terribly in the calf, back of knee and back of thigh areas. I kept being told it was just soreness and would work itself out. In Jan. '07, my cardiologist performed an atherectomy on the leg to try and determine the cause of the pain. Could find no reason for it. In Sept. '07, I had another blood clot in the same leg, even on Plavix/aspirin. I have never missed a day taking the meds. Well, lo and behold, the same surgeon who implanted the stents also removed this clot. Afterwards, he demanded to know who had put those stents in. He said they are the wrong size and are too big and the clot had formed at the stent. I told him he did, but he denies doing it! He told me that when my cardiologist did the atherectomy, he must have done it! Well, I have the card showing when, where, what and who signed it. He did. I am very upset that he is now saying that not only did he NOT do it, but that they are the wrong ones.
Betty S., Arkansas, USA, November 13, 2007

• I have been on plavix and few more other expensive medications for more than 4 years. I had 3 stents put in over 4 years ago and i ended up with an open heart less than 6 months ago (quad). I am not insured and every thing i get i have to pay for. As i said earlier i am taking few other expensive medications beside plavix, such as lipitor 80 mg,zetia 10 mg , hi blood pressure medication, nitro glycerin patched .04 mg and because they are so expensive i am afraid that i might not be able to continue taking them. My question is ,is there any way of getting some help ? If yes , where and how? By the way i am american citizen. Thank you.
Murshed, Ohio, USA, November 12, 2007

• Glenn -- it's always a comfort to get a second opinion (some insurance plans cover patients for this) but it's reasonable for your doctor to be concerned if you are at high risk for bleeding. Only your doctors can make this assessment, but it is one of the big problems with drug-eluting stents and the need for antiplatelet therapy. However, we've recently seen several studies that show no increased benefit of Plavix after a year, that is in regards to prevention of stent thrombosis.
Forum Editor, Angioplasty.Org, November 11, 2007

• April 2005 I had a heart attack. I had a cath, angioplasty, and drug emitting stent. My cardiologist put me on Plavix for one year then took me off. When I questioned being taken off, he said the concern is for bleeding problems. Should I consider an additional opinion? I am not taking plavix now and do take 325 mg aspirin, though he suggested going to low dose
Glenn B., Michigan, USA, November 10, 2007

• Otis -- thanks for the info. We've mentioned Ticlid often -- but bee stings!!?? That's a new one on us. Which stent did you get and where did you find out that the med in the stent is the same as a bee sting??
Forum Editor, Angioplasty.Org, November 10, 2007

• I have a medicated stent placed in 2005. I was put on PLAVIX and aspirin. I had bad reactions to the PLAVIX and the MEDICATED stent! My cardiologist put me on TICLID. No more problems. Hope this helps others. The problem with the medicated stent is that I am allergic to BEE STINGS. The meds in the stent are the same as getting a bee sting, that is why I got HIVES from the med stent.
Otis Holtsclaw, www.santacash.ws, Hopkinsville Kentucky, USA, November 8, 2007

• Shelly, I have a friend who ran out of insurance and plavix is the one he's having trouble finding an alternative for. There is no longer a generic. Try needymeds.com and you can get an application to Bristol-Myers among many other companies for drug assistance. He does complain of itching, but thought it was from dry skin. I'll share your story with him. You are not alone. Your local retail/pharmacy, big chain stores also may offer assistance with their prescription drug plans for as little as $4 per month if you can get a generic. Good luck!
Deb, Andover, Minnesota, USA, November 7, 2007

• Clifford -- if your husband is coughing up blood, it's a possible sign of a bleeding complication. You should not hesitate to see your interventional cardiologist -- right away!! Don't make medication decisions without consulting him/her -- and don't go off Plavix without discussing this with the cardiologist who prescribed it.
Forum Editor, Angioplasty.Org, November 7, 2007

• my husband has been on plavix for 2 months, he has been coughing up blood . since he has been on it . he had one stent put in.what do you suggest about it. we are getting concerned.
Clifford, Missouri, USA, November 6, 2007

• What is the current medical wisdom or findings concerning medicated stents and stopping plavix. I have two taxus 2 stints (for 1 year)in my LAD And i am seeking 2nd and 3rd. opinions before I stop taking Plavix.
George G., California, USA, November 6, 2007

• In January 2007 I had two Taxus DES stents placed in my heart by an American Dr. The Dr. prescribed a Plavix (75) one each day and a 325M aspirin. I have since moved to Germany and, due to persistent pain in my chest, made an appoint with a German Cardio Dr. He changed my medication to a 100m aspirin and two 75M plavix pills each day. I was wondering if anyone else has ever been prescribed to take two 75M plavix daily. I would think I would be getting less medicine since it has been over six month since the placement of the DES stents, however, the prescription is for more Plavix.
Doug, Germany, October 26, 2007

• D.C. -- see other posts about allergic reactions. The rash is something that's definitely been seen with Plavix, but it's hard to sat with all the various meds. There is an alternative called Ticlid -- it used to be prescribed before Plavix was available. Many docs switched to Plavix because Ticlid seemed to cause more reactions, but some docs actually find Ticlid has less allergic reactions in some patients. It's the only drug they use in Japan. Maybe your doc could try that. But you should discuss this with your interventional cardiologist -- and do not go off Plavix without his/her knowledge.
Forum Editor, Angioplasty.Org, October 24, 2007

• My husband just had three stents placed in three arteries Oct 19,07. They sent him home taking these meds: Plavix 75mg, Lipitor 20mg, Atenolol 25mg, Nexium 40mg, Aspirin 325mg & Zoloft 100mg. Now my question is which one of these med's is causing him to have an allergic reaction with hives all over his body? I noticed third day home he had broke out under is arm's and down his side, called the doctor no response, woke up today all over. Called general doctor they said to start taking benadryl. He has taken six tablets in eight hours no relief. What do we do now?
D.C., Indiana, USA, October 24, 2007

• Steve - thanks for writing in. We do not know of any studies about Cipla -- and any Google ads on this site are automatically placed there -- we do not in any way endorse any of them (we're just trying to raise some funds to help keep the Forum online). Again we would urge you to discuss this with your physician. But it is interesting that you're not having reactions to it. We hope it is actually doing what it's supposed to.
Forum Editor, Angioplasty.Org, October 24, 2007

• First let me say that I have adequate insurance and can otherwise pay for brand name Plavix as needed. However, I have experienced unpleasant side affects from the brand name drug.

For over a year I bought generic plavix from medco, my provider, and had no problems with the generic equivalent. After the Federal judge ruling, medco could no longer manufacture generic plavix and I am back to taking the brand name drug. I am now experiencing the unpleasant side affects, such as sores in mouth and nose, anxiety, muscle spasms, irritability, among others likely precipitated by some of the previous ones.

This situation resulted in my purchasing generic Clopidogrel from discount drugs from Canada online. I received the drugs, but they arrived wrapped in a brown paper bag with a return address from a residence in India. This worried more than a little and I have not taken any of the drugs but have continued taking the brand name plavix. Today, I notice your site includes an advertisement for Plavix from discountdrugsfromcanada.com. The drugs I received are from the manufacturer Cipla as indicated on the link from your site, come packaged individually in aluminum 5 pill strips, and then enclosed in a quality plastic case with two latches. It is very professional looking and expensive packaging. Are these drugs equivalent to plavix? I read all I could find about Cipla and they apparently reverse engineer the drugs they manufacture. Is that standard practice by drug companies outside the U.S.?

I received the Endeavor stent as part of the Endeavor IV clinical trial in May 2006 during an MI, and have maintained my dual anti-platelet regimen since. The brand name Plavix is wearing on me. I am walking 3 miles in 45 min 5 times a week. I have reduced my cholesterol to 140, lost 20 lbs and 4 inches in the waist since the heart attack, but my doc wants me to continue plavix, and continues to try to improve LDL to <70 and HDL > 50 by upping Vytorin to now 10/40mg. I am otherwise doing great until I had to go back to the brand name Plavix for the past couple of months. I'm not sure how much longer I can tolerate Plavix and will likely take the generic i received from Cipla at some point. I sure would like to hear that others are taking this drug without adverse effect. Thank you for all you do
Steve S., Georgia, USA, October 24, 2007

• To all who write in asking for advice about medications and doses -- in our disclaimer we state nothing on this site should take the place of advice from an MD and we urge all patients to ask these questions of their cardiologists. Generally speaking, most interventional cardiologists will prescribe Plavix and aspirin for a year after the placement of one or more drug-eluting stents. Most recommend staying on aspirin for life; some prescribe Plavix for longer, assuming the patient is tolerating it well. For bare metal stents, most prescribe Plavix for 3-6 months and aspirin for life. But Plavix is indicated for conditions other than stenting and you should ask you cardiologist these questions. And certainly if you are not tolerating the drug or having an adverse reaction, call your cardiologist ASAP -- there are a couple alternatives, one if Ticlid (ticlopidine) which is what is used exclusively in Japan.
Forum Editor, Angioplasty.Org, October 23, 2007

• Received two (2) non-drug eluting stents in 2002 -- one in March during an ACS(STEMI) and one in August -- at the ripe old age of thirty-seven (37). Have been on the following medications CONTINUALLY since: Toprol XL 200mg qd, Altace 2.5mg qd, PLAVIX 75mg qd, ASA 325mg qd, Tricor 145mg qhs, Vytorin 10/20mg qd, Nexium 40mg qd. Should I still be taking the Plavix and Aspirin combination at this point five and a half (5.5) years later? Should the ASA level be 325mg? Please advise -- seems unusual from reading other posts in this forum.
Joe Y., South Carolina, USA, October 21, 2007

• Dear Editor and All: My father, 86 years old, had 3 stents put in two years ago. He has been on Plavix, Aspirin, and Lipitor for two years. Does he need to have Plavix for the rest of his life? Plavix is expensive. I am looking forward to your advice. Thanks a lot.
Mark L., North Carolina, USA, October 20, 2007

• Shelley, can't understand why Plavix is so expensive in USA. I am in Portugal at the moment and here its list price on the box is 51euros, you only pay that if you are not in the state health scheme.
Tel, United Kingdom, October 18, 2007

• Shelly, Sorry to hear about your problem with Plavix, but I have been through the same situation. I have not worked in over 2 1/2 years and I am broke. I understand how It feels not to have Plavix and know you need it. I have recently been in that situation. I have also already had a stent thrombosis. You cannot afford one. Call you sponsor, I hope you have one at your Cardiologist office, EVERY DAY. CALL Bristol-Meyers everyday. Explain your situation and tell them you are out. Do this often. You will be heard. But most of all, get all the paper work they request to them immediately. Good Luck. P.S. If you are thinking about SSD file it now, don't wait. You can't speed up the Government!!!
Bob Puckett, Snellville, Georgia, USA, October 17, 2007

• Last night you posted a reply regarding Boston Scientific and a program they recently launched. Today I contacted them via email. They initially responded to me that the stent I have was made by Johnson & Johnson, not Taxus and they would not assist me. I copied the article you sent the link to and emailed them again. I received an immediate reply from them apologizing. They stated I was the first person to make the type of request I had, and that they are forwarding my information to the correct department. It makes me wonder how many may be missing out on this. Even someone at Boston Scientific isn't fully aware of their program. It shows persistence does pay off and I hope others will contact them if they have a need. Thank you again for the information. I will let you know if I am able to get assistance from them and that too may help others. Kudos to you!!
Shelly, Florida, October 16, 2007

• Thanks again, and I do fully understand that you can not give medical advice. You can probably see I am grasping at straws trying to get my Rx for Plavix. I did see my Cardiologist last week right prior to my insurance running out, and not being able to afford Cobra. I advised him of my situation, and he said I NEED to take it somehow! I do understand that. Hard to do when one only has 50.00 to their name. I will call Bristol Myers Squibb tomorrow and maybe with a bit of luck I can speed up that process. Hopefully something will break soon. We live in the great & wonderful USA, and I am sure I am not the only person with this dilemma. it's truly sad that our health care system fails so many, not just me. I will update this forum if there are any significant changes. Thank you again so much for assistance. You do a great service to many!
Shelly, Florida, October 15, 2007

• Shelly -- not to panic you, and we do not and cannot give "medical advice", but most cardiologists agree that Plavix should not be stopped, especially in the first 6 months after drug-eluting stenting. If you have any way of getting some, you should do so ASAP. Call your cardiologist and explain the situation.
Forum Editor, Angioplasty.Org, October 15, 2007

• Thank you so much for such a timely response! You misunderstood one thing; I did have insurance which did cover the Plavix, but not the Lipitor. My insurance has run out and I am no longer employed. It may be a while before I am covered by group insurance if I am able to find employment at age 58 with my medical issues. Not just the heart attack I had but my back surgery prevents me from doing a lot of things. But, back to the issue at hand. I am presently out of Plavix. Do you have any idea how long one may safely go without it? I was wondering if Plavix is stored in the system for a few days while I try to figure out a way to get my Rx for it. My mind of course is playing tricks on me right now... anxiety from not having the drug I am sure. I have contacted Bristol Myers Squibb some 3 weeks ago when I learned I would no longer be insured and to date no response. I have also registered with the program Montel Williams endorses >> Partnership for Prescription Assistance at the same time. (3 weeks ago) and have not heard from them either. I guess all this takes time. But, I have to wonder how much time I have before my stent may be affected by not having the Plavix. I did receive a Cordis Cypher Stent.. Sirolimus-eluting if that is of any help. Thanks again in advance for your thoughts on the subject. I come to this site several times a week and it's great the support I see for each other. I wish everyone the very best in their recoveries.
Shelly, Florida, October 15, 2007

• Shelly -- your cardiologist is right -- Plavix and aspirin are both important drugs to take post-stenting. If you got a drug-eluting stent, you need to take them for 6 months-1 year at least (aspirin for life -- but unlike Plavix, aspirin is cheap). This is a big problem for this field -- in fact a number of cardiologists ask patients if they'll be able to afford a year or two of Plavix before they put in a stent. If patients can't afford that much, then they may use a bare metal stent which only require 6 weeks of Plavix -- however, with bare metal stents, the blockage does have a higher chance of reclosing. In your case, which was an emergency, an extensive interview wasn't possible, so he made the decision based on his experience. Just an aside -- your story highlights one of the great successes of angioplasty. 20 years ago you would have gone to the hospital where they would have given you pain killers while they watched your heart attack play itself out. Assuming you survived, you would have ended up with a damaged heart muscle and a significantly lower quality of life and increased risk of death. So that's something to be thankful for. Now, back to the present.... It is outrageous that insurance doesn't cover a drug that is needed this critically. Try to contact Bristol-Myers or Sanofi-Aventis again -- they make Plavix. Also try the stent manufacturers. We know that Boston Scientific (makers of the Taxus stent) announced a $40 million program back in March to increase compliance, part of which was "a patient assistance program designed to facilitate access to financial support for anti-platelet therapy for patients who qualify". This is regardless of which brand stent you received. Contact them and please let the Forum know the outcome. Good luck.
Forum Editor, Angioplasty.Org, October 15, 2007

• In June while watching a DVD with my daughter I began to have excruciating pain in the back of my shoulders. 911 was called & I was told I was mid heart attack. I have never had any heart related issues. Upon arrival to the hospital, I was prepped and taken immediately to the Cardiac Cath Lab; a Cypher Stent was inserted thru my groin. Other than the anxiety from it all, I felt pretty good other than my back. I had major back surgery a year ago and lying in one position for almost 24 hours was unpleasant to say the least. I was sent home with Rx's for Plavix, Lipitor, Coreg, Potassium, and aspirin. Since then my insurance has run out! Plavix where I reside is $145.00 a month! YIKES!! I have signed up for assistance with drug companies but have yet to hear a thing from anyone. This month I can not afford the Plavix and I am scared to death what may happen without it. There must be others out there in similar situations that can not afford all your medications and I am wondering what people do in these instances. My Cardiologist did give me all the samples he had in his office, but I have used all of it now. He states I NEED the Plavix... what to do.. what to do? Anyone have any ideas?
Shelly, Florida, USA, October 15, 2007

• R. from Buffalo -- itching has been reported here as an allergic reaction, possibly to Plavix. Your mom's cardiologist is correct -- that she should not stop taking Plavix. But possibly he/she could try Ticlid to see if the allergic symptoms go away. Ticlid works similarly to Plavix, but is not used as much in the U.S. because it seemed to have more side-effects. However, some physicians (and all of Japan) find Ticlid works when Plavix doesn't. Remember, this is not medical advice. You must discuss this with your mother's interventional cardiologist!
Forum Editor, Angioplasty.Org, October 14, 2007

• My mom had 4 stents put in on September 1st and another 5 two weeks later. She has been on plavix, aspirin, protonix for her stomach, blood pressure and cholesterol medicine. Up until two weeks ago, she has been fine and getting better every day. However, two weeks ago, she began itching. I called her cardiologist and her primary Dr. and both said that it shouldn't have anything to do with the medication she is on and perhaps she is using another laundry detergent....(she's not). Has anyone else experienced itching from Plavix?...also is there an alternative? Her cardiologist is adamant that she doesn NOT stop taking Plavix. Also, is it possible that the medicated stents put in may be causing this?
R., Buffalo, New York, USA, October 14, 2007

• To all: any adverse reactions, especially bleeding, hematomas or bruising, or abdominal pain, etc. should be reported to your interventional cardiologist. Some patients have allergic reactions to drugs. And bleeding complications and bruising, are an adverse effect of Plavix. Weighing the use of antiplatelet meds against the risk of stent thrombosis is something you should discuss with your cardio. Certainly do not go off your meds without consu