• ok, quick question. i had a stent put in LAD
in 1999. i was on plavix for 1 month, then told to switch to a full aspirin.
should i be on plavix at this stage of the game? i'm now 53 and have
had no other problems, thanks!
L.L., New York, USA, June 30, 2007
• I received two stents 6 years ago and have been
on Plavix all of that time. Now the VA won't give it to me says I don't
need it after one year. My Cardiologist says I must take it. My family
Dr. says I don't need it just take a full grain aspirin. What do I do????
Charles Williams, Graysville, Pennsylvania, USA, June 30,
2007
• Dear Forum Editor, thank you for your quick
response. I did, in fact, have an issue with bleeding internally. Colonoscopy
showed "hemorrhoids". Hopefully that is the culprit for the iron deficiency.
Made it through the "iron infusion" yesterday with no side effects. (happy
about that). My question was: will my iron level remain stable after
the next three infusions? Guess I will have to wait that out. If the "bleeding" has
stopped, I'm hoping the iron will increase or at least remain at a good
level. I'm still thinking about the plavix vs. aspirin in October. Hematologist
thinks aspirin would be the better choice to help with "heart" issues
and that Plavix can be safely stopped..Me, I'm not quite sure..For now,
I will stay on both drugs....alternating one every other day....Thank
you again for your quick response. God Bless and stay healthy all my
DES friends.... Rosanne
Rosanne Giuliano, Stoneham, Massachusetts, USA, June 13, 2007
• Rosanne -- have your doctors suggested that
you might be having some bleeding issues? The fact that you have a history
of having bloody noses and a low hematocrit might suggest that. Bleeding
is one of the main complications of clopidogrel (Plavix). As for advice
-- we've often stated, we do not offer specific medical advice and nothing
on this web site should be used as a substitute for medical advice from
a physician. In particular, yours seems to be a somewhat complex situation,
best discussed with physicians who you see in person and who have your
complete medical history. That being siad, our recommendation is to make
sure that any decision to stop Plavix is made jointly by your interventional
cardiologist, hematologist and any other doctor involved in this aspect
of your health care.
Forum Editor, Angioplasty.Org, June 10, 2007
• Dear Forum Editor. I need your advice. It will
be two years since my DES coming up in October. I start "iron infusions" this
Tuesday, as my Iron levels have not responded to 3x a day IRON pills
(orally). Seems the recent "celiac" disease diagnosed in March of this
year is a malabsorption disorder causing the iron not being absorbed
through my GI tract. In any event, hematologist are saying I can stop
my Plavix in October and stay on my 81mg. of aspirin...I hear these stories
of people going OFF plavix and a year later having "heart attacks"...I
now take my plavix every other day since the onset of celiac and my CRIT
going down to 27..I've finally got that up to 36. I'm feeling much better
off wheat and gluten products but my iron level is still making me tired.
HELP...I have time to think about this, but I am not comfortable going
off my plavix. The bloody noses have subsided and basically I'm feeling
GREAT.... Any advice would be of great help.
Rosanne Giuliano, Stoneham, Massachusetts, USA, June 9, 2007
• MM -- was Plavix prescribed for you after a
stent? If so, we DO NOT recommend that you stop taking it or you are
increasing your risk for a blood clot. In any case, if you were prescribed
aspirin as well, definitely continue with that. You need to contact your
cardiologist right away to discuss any adverse reactions -- these specific
reactions you're having exist, but are relatively rare for Plavix and
may be due to something else -- another medication, etc. Let us know
what you find out.
Forum Editor, Angioplasty.Org, June 6, 2007
• Can anyone tell me how long it takes to get
this drug out of the system. It's been 5 day since I stopped taking it
and I have really been sick. Is This because my body is detoxing? I still
am nauseated, suffocating, coughing, and worse having the "D" just out
of the blue. Thank you for your time.
MM, California, USA, June 6, 2007
• I had 3-stents implanted in Nov 03 and all is
fine. Two were the drug eluting type. I am on 75 MG Plavix, 81 MG Aspirin,
5 MG Crestor and 1000 Units of fish oil twice daily. Initially all was
not fine. I had many of the same symptoms others have described, but
my doctor and I discovered my side effects were the result of trying
to tolerate too high a dose of statins, such as 40 MG of Lipitor, Vytorin,
Zocor, etc... to get my LDL to 70. I am now trying a low dose of Crestor
5 MG to see if it will get my LDL to 70, if not we will gradually increase
the dose to from 5 to 10, 15, 20 etc. So far all the muscle soreness,
pain, etc. are gone since switching from a 40 MG dose of Vytorin to the
low 5 MG dose of Crestor. I will take a blood test next week to see how
well the Crestor is working. I recommend staying on your 75 MG of Plavix
as long and you can.
Ed Lipinski, Retired, Woodbridge, Virginia, USA, June 6, 2007
• TO TM UK [March 6,
2007] -- Simvastatin update ! - a short time after starting
my simvastatin I noticed a shortness of breath and aching in my legs
, spoke to cardiologist who stopped simvastatin, reverted back to
previous good condition very quickly. I will not be taking statins
again !! - on reflection these drugs that prevent production of cholesterol
by the liver(at night) are not needed if you don't have a cholesterol
problem. my problem was caused by smoking ! not bad diet ! therefore
having stopped smoking 18 months ago improved my fitness levels & improved
diet even further I don't need the drugs.
David W., England UK, June 4, 2007
• An update from Span in California. It has been
two months since I had 4 DES put on. Everything is going well. I exercise
for 1 hour at least 5 days a week with no pains, mostly cardio stuff.
I have been asked to taken the Slo Niacin to improve my bad cholesterol
numbers. I am able to tolerate the slow niacin very well as opposed to
the regular niacin, which I just couldn't take. My dentist indicated
that if I ever need to have dental surgery she would do it for me with
no hesitation. She said that she needs to be extra careful because of
the platelet therapy. My energy, happiness are all back into my life
and I feel good. My cardiologist is hoping that sooner or later there
will be a test available that will tell us when to get the patients off
of the platelet therapy.
Span, California, USA, May 31, 2007
• Temporary stopping PLAVIX - I had 2 DES fitted
in the r/h artery on the 1st Feb 2007 & was put on plavix for minimum
of six months,however I was due to have an 'op' on my eyes on 9th may
- Plavix was stopped 1 week prior to the 'op' but I continued with the
75mg aspirin only twice per day instead of once, the 'op' was carried
out with great success and I went back on the Plavix next day with no
ill effects, eyes have now cleared of all bruising etc. Generic Plavix
- My son is a Pharmacist and he thinks this was withdrawn due to worldwide
licensing dispute with the drug company that produce the original, the
generic was a copy of their product & they stopped the sale of it (allegedly).
P.S. my cardiologist says that Plavix only needs to be taken until the
stent is covered with new cells and is therefore undetectable and will
not cause the "protective" blood clot that can be so dangerous.
David W., England, UK, May 30, 2007
• P.B. -- This is a b ig problem with DES -- it
is recommended NOT to use a DES if surgery is likely in the next year.
But what happens in an unplanned surgery? Check out our topic on Plavix
and Surgery for more stories about having surgical procedures while
taking Plavix. There is definitely a risk to stopping Plavix and aspirin
prematurely. Does your husband need a hernia repair? If so, you should
have the interventional cardiologist and the surgeon consult with each
other -- so that the cardiologist makes the surgeon aware of the risks.
Maybe a compromise, delay or temporary plan, can be worked out.
Forum Editor, Angioplasty.Org, May 20, 2007
• My husband had a DES put in his RCA in Feb of
2007. What do we do if he needs a hernia repair? He is on Plavix and
Aspirin.
P.B., Florida, May 20, 2007
• Dan -- generic Plavix was briefly marketed in
the U.S. by Apotex, but is the subject of a patent suit by Bristol-Myers
/ Sanofi-Aventis and the judge issued an injunction against Apotex back
in August, stopping the sales. They flooded the market with six months
supply, but that's run out now.
Forum Editor, Angioplasty.Org, May 15, 2007
• I was just informed by my pharmacy that the
generic for plavix is no longer being produced. They said that there
was nothing wrong with the generic but the manufacturer has stopped the
production. Any idea why? Is there an alternative generic drug that can
be used in place of Plavix?
Dan, Indiana, USA, May 13, 2007
• In two months it will be a year since I had
(2) Taxus DES stents placed in my RCA. Whenever I ask my cardiologist
how long I'll need to be on Plavix, she usually says at least a year,
possibly for life. The last visit in December she gave me a little more
information. She said that the most risky period for late stent thrombosis
with my type of stent was from 6 months to a tear after placement. She
said that after 1 year the occurrence drops off dramatically. I don't
mind being on Plavix. I have absolutely no bad reactions to any of my
medication. Sure it's not easy forking over $32/month after insurance
for it, and $35/month for Lipitor, and $25/month for Zetia ... But considering
the alternatives ...my wife will have to pay a lot more than that to
bury me ;)
Kevin, Albuquerque, New Mexico, USA, May 10, 2007
• First, I just want to thank you for this forum
that provides great information and support from those that have 'been
there'. Thank you. In Dec. 05 I had two DES's placed in the right side
of my heart and than a third in Feb. of 06. I was put on Plavix and Aspirin
like everyone else. Now my pharmacy has informed me that they will no
longer provide the generic for Plavix (Clopidogrel). They assured me
there was no problem with the generic but it's manufacturers are quitting
production. If it does the job than why is it going out of production?
My second question is my cardiologist has indicated that during my May
appointment, he will be taking me off the Plavix. I realize that there
still is not enough information or testing that is available to determine
if this is a good course of action. I intend on asking him to let me
remain on Plavix until some test is available that will confirm cell
growth in the DES's. After this amount of time, do you feel that I am
being too cautious by wanting to stay on the Plavix? I trust my Dr. but
maybe not this decision..... Thanks Again !
Dan, Indiana, USA, May 6, 2007
• Pat -- the "Y" is technically known
as a bifurcation lesion -- and they are tricky to stent. Aspirin and
plavix are both antiplatelet drugs. They prevent the blood from clotting
(which can be the cause of a heart attack). They do act differently,
which is why they are often used in combination. Any specific adjustment
to your mother's drug regimen should be done by her cardiologist -- it
sometimes can take a while to get the right combination.
Forum Editor, Angioplasty.Org, May 3, 2007
• My mother is on plavix and aspirin. she has
a blockage but no stent due to the difficulty of placing the stent in
the Y where the blockage is. she is always tired. is this a side effect
of both these meds? can she go off plavix and just keep on the aspirin?
Pat K., California, USA, April 30, 2007
• It's a Rosanne update: After my hospital stay
it was discovered that I now have "Celiac Disease". While I was admitted
in March 07 for "angina" pain, test revealed Celiac. I had all the symptoms
but no one paid attention. My crit is 27.4, my iron level is 7, my head
was so itchy, I had an abscessed tooth causing major infection throughout
my body. My blood pressure would not go down. My cardiologist suggested
I go off my Plavix and Aspirin, but I am so nervous that I decided to
take them every other day. My problem now is that after my endoscopy
I've developed two polyps on my vocal cords and have lost my voice the
past six weeks. My stomach has never felt so good since I've gone wheat
and gluten free. My blood pressure has been NORMAL for the past four
weeks. I feel like a new person with the exception of being weak from
my anemia. I have blood in my stool (they say from the plavix and aspirin),
which brings me to my question: SHOULD I STOP the Plavix and aspirin
for awhile while I await having my "second" colonoscopy.(I had a normal
one last JULY). I'm awaiting my second one to ensure there is nothing
wrong. I went off Plavix and aspirin for one week after being discharged
from New England Medical Center in Boston and tolerated it well. I'm
in another "catch 22" with my life and would really appreciate your opinion.
My life has surely changed since my STENT in Oct. 05. If I didn't loose
my voice and could get my crit UP..I'd be happy to say I'd be on my way
back to the ME I use to BE... Anyone care to give some advise??? I'd
really appreciate it.
Rosanne, Stoneham, Massachusetts, USA, April 26, 2007
• Tom -- you light the way. Your interaction with
your gastroenterologist is precisely the model for physician-patient
teamwork that we discuss so often. As we reported back in January in
our report, "New
Advisory: Will Stent Patients and Their Doctors Get the Message?",
you also have performed an invaluable service for your doctor as well.
Good luck!
Forum Editor, Angioplasty.Org, April 25, 2007
• All of us who have DES stents are concerned
about procedures or surgeries which may be required in the future, due
to our need to stay on plavix & aspirin. Recently on this site (April
18) I reported that my Gastroenterologist would not perform a colonoscopy
while I stayed on plavix & aspirin. However, this was second-hand info
from his nurse. I have now personally discussed the issue with him, and
he has agreed to do it even while I remain on both drugs, and I am scheduled
for early June. It will be a full colonoscopy, not a virtual one. He
seemed reluctant at first, but after I discussed the possible danger
of stopping plavix therapy and mentioned that now many cardiologists
advise plavix therapy indefinitely, he admitted that he had done the
procedure before on patients under such therapy and would do mine. For
anyone in a similar situation, I would suggest getting past nurses or
assistants who schedule procedures and talk to the doctor directly.
Tom, Arizona, USA, April 25, 2007
• Just to keep you all posted. I'm Paul from New
Hampshire. At the age of 42 I received 7 (seven)...yes...count'em...SEVEN
drug eluting stents. I received them in Sept. of 04 at Mass General Hospital.
I have been on Plavix, Toprol, Lipitor, Cozaar, and Aspirin (ecotrin)
325 since that time. All is fine (knock on wood) I continue to exercise
and hope I can become the poster boy for how long you can avoid a bypass.
I am proud because I did nothing to induce my CAD. I have never smoked,
I don't drink, I have watched my diet and have never had high cholesterol.
I am told it was mainly stress and genetics that were the main culprits.
There is hope. Lets all be appreciative of the medical minds that have
helped us avoid the knife. I love you all.
Paul, New Hampshire, USA, April 25, 2007
• Shirley [April 12, 2006], I'm so sorry! I can't
help you but I'm with you!
Ilona, Maryland, USA, April 24, 2007
• To Span in California, you are right! Most posts
here are from people doing the asking and wondering, and the fantastic
Forum Editor is working tirelessly to answer as much as he can. Here
is my contribution - I am 56, had one DES stent put in at the end of
April 2006 (yeah, one week short of a year!) The same drugs which you
described, seemed tolerable (tolerable .... as long as I ignored the
rash, nose bleeds, bruising, the Lisinopril-induced dry cough and the
nags from the GI doctor) until August. At that time major stomach bleeding.
After few days in a hospital and few blood transfusions, I changed the
prescription from Protonix to Prilosec (over the counter) and then I
changed the cardiologist, because not all are in the top 50%. With the
new doc's guidance, I continue to take Plavix, but no more aspirin. Major
lifestyle change is great! Quit smoking, good diet, lost few pounds,
got into cardio exercises and actually enjoying it. "I can live with
that!" As a result, my BP is down, heart rate is down, LDL is down, all
naturally, and I am gradually eliminating all the "temporary" pills.
The cardiologist is reluctant to let me drop the Plavix. Well, I've got
one week's worth of it left to decide and I just might keep getting refills
until I read some good news on angioplasty.org. After a year, it is becoming
tolerable. Now, the worst part is figuring out how to deal with the GI,
who is bigger pain in the @$$ than what he is curing.
Tom, San Diego, California, USA, April 24, 2007
• Basavaraj -- great question -- the one that
everyone is asking. Some doctors say at least a year, others say two
years, others, like your cardiologist say "for life" or until
better data come out that can be a guide. We're not trying to skirt the
issue and avoid answering. There is real debate on this issue -- sometimes
within oneself. My favorite story is this
exchange from the December 2006 FDA panel.
Forum Editor, Angioplasty.Org, April 23, 2007
• I am 56 year old male underwent PTCA to distal
RCA & implanted TAXUS Drug Eluting Stent 3x32 mm. I am keeping fine without
any problems. I am on Clopidogrel and Aspirin medication for one year.
Now my cardiologist advised me to continue these drugs for life. What
is latest finding on exact duration of this medication after implanting
DES. How long I should be on this medication?
Basavaraj M, Bangalore, karnataka, India, April 23, 2007
• Thanks Tom for your post. As regards Michael
C's posting I agree that all aspirins are meant to be the same and they
are not! I have tried the following safety coated aspirins: Ecotrin,
St. Joseph's and Bayer. The one that doesn't really screw up my stomach
and cause itching was St. Joseph's. I couldn't tolerate Ecotrin at all
and Bayer was in between the two. I am glad I listened to my wife, before
trying it out I thought all aspirins are the same. My advice is try different
brands to figure out what suits you. My observations were all for baby
aspirin. Also interestingly I did not find any difference between plavix
and the generic clopidogrel, except of course the whopping price increase.
Once I again pls try both to figure out which suits you best.
Span, California, USA, April 19, 2007
• Interesting posts re allergies. After receiving
a stent in the RCA, my wife purchased a large bottle of 325 Mg Aspirin
to take home, along with Plavix and Altace. A month later, my legs began
to itch intolerably, especially in the shower. We tried changing from
generic plavix to brand name, and from generic altace to brand name,
with no effect. My cardiologist and my allergist were baffled. Which
left the aspirin - we changed from the generic stuff to Ecotrin, and
bingo - no more itching. I think it must have been the binder(s) or dye
in the generic aspirin that caused the problem. I hope this helps someone.
Michael C., Los Angeles, California, USA, April 19, 2007
• Rick -- this was discussed by the FDA panel
we attended in December -- the consensus was that if the patient had
gone off for any length of time and hadn't thrombosed, that the healing
had probably happened and they wouldn't recommend going back on. Of course,
Plavix has other indications and might be useful for other reasons. It
also has downsides -- surgery, for example.
Forum Editor, Angioplasty.Org, April 18, 2007
• Just curious, if say one year after stenting
one goes off of Plavix and then because of all of this news regarding
Plavix a year after stopping, can it do any good to restart the plavix
or does the one year off nullify the benefits of restarting?
Rick, New York, New York, USA, April 18, 2007
• Tom -- there's been talk on these Forums, both
in this topic and the one on "Plavix
and Surgery", about the problems of getting, say, a colonoscopy
while you are still taking Plavix. (To find a word on a text-heavy web
page, do a "Control-F" and then type in, for example, "colonoscopy").
No great solutions were presented, other than finding a doc who does
the "virtual" colonsocopy -- which some feel isn't quite as
thorough. If you find a doc who will do the standard procedure while
you're still on Plavix, let the Forum know this option exists. Thanks
for the post.
Forum Editor, Angioplasty.Org, April 18, 2007
• Span from California wants to hear from others
who have had no problem with drug therapy after drug eluting stent placement.
I had 2 DES and 1 BMS placed in February of 2006. I have been on 75 mgs
of Plavix, 325 mgs of Aspirin, Lisinopril, Metotoprol, Lovistatin, and
Zetia ever since (14 months). Fortunately, I have had no meaningful side
effects. I just bleed a little more than normal, if I receive a small
cut or scratch. My Cardiologist wants me to stay Plavix indefinitely.
He believes that at some point a test may become available to determine
who might be relatively unlikely to develop in-stent thrombosis when
stopping Plavix therapy. My Internist, I am sure to make the point of
staying with the therapy, jokingly said I can go off it "post-mortem".
My only concern, is that I am overdue to have a colonoscopy. and the
doctor who did the last one for me wants me to go off Plavix for it.
My Cardiologist suggests that I find a doctor who will do the colonoscopy
while continuing Plavix. He says there are ones that will. I haven't
starting searching yet.
Tom, Phoenix, Arizona, USA, April 18, 2007
• Shirley -- your husband's experience highlights
one of the problems of stents, and drug-eluting stents in particular
-- the need for long-term Plavix. If a patient is at high risk for bleeding
complications, a DES should probably not be used, because of the greater
tendency towards blood clots. The problem is how does the cardiologist
determine "high risk for bleeding"? Of course, even bare metal
stents have a thrombosis risk in the first few months. We would suggest
consulting an interventional cardiologist at a major center since he/she
would be the most familiar with the risk/benefit situation. And Span
from California -- we also would like to hear from patients who have
had no problems with the required regimen -- and you ARE in the majority.
Forum Editor, Angioplasty.Org, April 17, 2007
• I had 5 des put on March 16, 07, 3 cordis and
2 driver stents. I have been taking clopidogrel, plavix, vytorin, baby
aspirin, metoprolol and lisinopril. I have been doing fine, ever since.
It looks like my stomach is able to tolerate the super aspirin strategy.
For how long is the question. Studies have clearly shown that des causes
late stage thrombosis. It is at a different time for different people.
People who suddenly stop plavix seem to show a faster rate of thrombosis.
If you can tolerate it then continue with it. If you cannot speak with
your IC before stopping it. I do have slight itching, like an earlier
poster has pointed out, only in the areas where clothes touch the body.
Mostly in my lower back. It is so mild I can easily tolerate it. I am
soon going to try plavix instead of the generic to see if the itching
goes away. I'll feedback to this forum. It would be good to hear from
people who are doing well with plavix and baby aspirin, that would be
a good feedback to the rest of us. I keep hearing only from people who
have unfortunately run into one problem of the other. I am a 53 year
old Male living in California.
Span, California, USA, April 13, 2007
• My husband had a CYPHER drug-coated stent on
Jan 7, 2007 because of a 70% blockage and was put on Plavix and 81 mg
aspirin.Soon after he began to feel weak and very tired.His family doctor
ran blood tests and found his blood count 8.5 which meant he was bleeding
somewhere. A few days later he began bleeding from his colon badly. We
were out of town and after arriving at the emergency room of the nearest
hospital, they took him off of all his blood thinners to try to stop
the bleeding. After missing three doses, he had a blood clot to block
the stent and he had a heart attack. They immediately put him back on
Plavix and aspirin. The bleeding stopped for awhile, but is now recurring
again. He has just been released from the hospital and now four days
later he is bleeding again. He needs to know if anyone out there knows
where he can go for HELP as his doctors are at a loss of how to help
him. He is 66 years old and very active. I am afraid I am going to lose
him if we do not find help soon. Please advise.
Shirley, South Carolina, USA, April 12, 2007
• My husband and I moved to Az from Pa in January
of 2005.I had a cholesterol problem for 3 years which I continually tried
to address. It seemed everything I tried I had reactions to. I went on
Red Rice Yeast pills and one aspirin a day. After moving to Az, I started
walking like I used to in pA. I started getting a burning sensation which
would last about 5-10 minutes during and after I walked. Finally I went
to a family doctor for an exam and told him about it. He sent me to a
Cardiologist whom told me I had Angina. The next day, I had a stress
test. Two days later, I was in for angioplasty and received three stents.
That was Jan 13, 2006. I went in for four more stents April 5, 2006.
During that procedure, the Cardiologist discovered that I had an Aneurysm
on the very first stent he inserted. He told me later, he thought it
was caused from an infection. He had tried to put the line for the stent
in my arm and could not get it to insert past my elbow. I got an infection
in it and ended up back in the hospital for two days. May 31, 2006, My
Cardiologist did another angioplasty to see if the aneurysm had grown
and it had not. Of course I will always have it and I will have to be
on Plavix the rest of my life. I hate it. I have a memory problem which
I think is from the Plavix. I get stomach pains also. Needless to say,
I am full of bruises continually. I also get chest pains if I try to
work out too much. Is there anyone who has experienced the same occurrence
as me? I would love to talk to you.
Linda, Arizona, USA, March 27, 2007
• Editor -- Many thanks for the rapid response
to the question. Is the supposed issue then limited to the polymer coating
on the Cypher stent and not any retained drugs? To a layman, with a mechanical
background, it would appear that the arterial tissue would be more acceptant
to a polymer than stainless steel. Is there any concern over the porosity
of the polymer used? To a degree, it would appear that the systematic
continuation of the Plavix & Aspirin is more a function that, if it does
not harm the patient, there is no solid reason to discontinue. For example,
if it does not harm and could potentially help, there is no solid reason
to discontinue the drug. Limited experience with the medical profession,
but have been seeing this trend.
Steve E., Florida, USA, March 31, 2007
• Steve -- Supposedly the Cypher stent has a "nominal
elution period" of 90 days, although most of the drug is eluted in the
first 30. The Taxus also elutes a controlled dose in the first 30, although,
depending on the version used (slow or moderate release) 70-90% of the
paclitaxel drug stays in the polymer (is never eluted). But the drug
is eluted from a polymer (plastic) coating on the stent, and for the
Taxus and Cypher, the polymers are permanent -- they do not degrade.
Some second and third generation stents, not yet on the market, have
biodegradable polymers (like the Conor, now part of Cordis / J&J)
which will turn into a bare metal stent after about 6 months.
Forum Editor, Angioplasty.Org, March 31, 2007
• Greetings. Rather new to this game, installation
of a Cypher in the RCA October, 2006. Might be a rather basic question
on my part, but just how long do the DES stents continue eluding their
coating? At that point, does it effectively turn into a bare metal stent?
Thanks.
Steve E., Florida, USA, March 31, 2007
• Randy -- scroll down to January 29, 2007 where
a couple Forum posters had a discussion about this. And Pbenge in Florida
-- talk to your GI doc as well -- there is a non-invasive diagnostic
test called a "virtual colonoscopy", but it's very new.
Forum Editor, Angioplasty.Org, March 31, 2007
• After my 5th DES I am back on Plavix, this time
for an undetermined time. I also have an AVR and am on Coumadin for life.
My doctor increased my aspirin to 350 mg per day. My question is how
common is it to be on Coumadin, plavix, and aspirin, possibly for life?
What are the long term risk? My age is 52 male.
Randy, Alabama, USA, March 30, 2007
• My husband had a heart attack in Feb-2006. A
DES was put in his RCA. He has been having GI problems and was scheduled
to have a colonoscopy to diagnose the problem. The cardiologist says
we need to wait on any invasive procedures. Are there other diagnostic
tests that can be done that would be safe while still on Plavix and aspirin?
Thank you
Pbenge, Florida, USA, March 24, 2007
• My brother in India had 2 drug coated stents
implanted on March 5, 2007. The doctor forgot to prescribe aspirin and
Plavix and after 2 weeks put him on those drugs. Would the anti coagulants
still be effective and prevent blood clot formation?
Rajani C., Maryland, USA, March 20, 2007
• To both Rosanne and David from England -- when
is it safe to stop Plavix? That's the big question. First of all, this
is something which needs to be answered for each patient by their interventional
cardiologist. This was the topic of discussion at the FDA panel in December
and will be next week at the American College of Cardiology meeting.
The most oft-repeated general recommendations we've heard for DES patients
are aspirin for life, Plavix for at least a year -- both assuming that
the patient is not at risk for bleeding complications. (Rosanne -- it
sounds like you have been having such complications.) In patients who
are not having problems with Plavix, many cardiologists are now recommending
Plavix for longer than a year -- but each patient is different and has
different clinical situations. It is highly recommended that the decision
about Plavix and aspirin be made by your interventional cardiologist.
This is the specialist who knows the most about whether you need to continue
dual antiplatelet therapy -- and can best weigh the risks of stent thrombosis
against the risks from bleeding or other blood problems, which can be
very serious.
Forum Editor, Angioplasty.Org, March 17, 2007
• Dear Editor. I am in need of some major advice.
I was admitted to a Boston hospital last Saturday. This is Rosanne from
Stoneham. 55 year old non smoking female who had DES procedure October
2005, LAD. I have ITP (platelet dysfunction) and have been on 81mg baby
aspirin and Plavix Blood counts were down to 114,000 (plts), 28.0 hematcrit.
I have been extremely fatigued and blood was found in my stool. Had stress
test done on Monday (normal), Had Endoscopy done on Tuesday (two biopsies
were taken. they are thinking "Celiac Disease). Sent home with advice
to stop my aspirin and Plavix until I see cardiologist, April 10, 2007.
Now comes the "abscessed tooth" that needs to be pulled asap. HOW LONG
CAN I SAFELY BE OFF BOTH ASPIRIN AND PLAVIX? I ASKED TO BE PUT ON PLAVIX
IN JANUARY AND HAVE BEEN TAKING ONE OTHER DAY..I WISH I THOUGHT OF TAKING
ASPIRIN THE SAME WAY. IT IS VERY FRUSTRATING TO HAVE TO THINK EVERY WAKING
MOMENT IF WHAT I'M DOING IS GOING TO AVOID A HEART ATTACK..why did I
have to suggest this to my doctor when he knows my history. I brought
him an entire copy of some of your Forum studies and he was not interested
at all...I was very sad as I wanted to share with him all the knowledge
I've learned.....ANY THOUGHTS that might help me sleep better..? As always,
so appreciated for any advice you may have... FYI...my "roommate" was
a 68 year old women who had DES 2 years ago..Doctors took her off Plavix
after one year and there she was ...back at hospital with heart attack...I'm
scared.... God Bless and Thanks
Rosanne, Massachusetts, USA, March 15, 2007
• I am 63 years old, over-weight but otherwise
quite fit, generally healthy and very active. I haven't ever smoked and
I rarely drink alcohol. I had a bare metal stent fitted four years ago
in England and a drug-eluting stent (DES) fitted two years ago in Florida.
After the first I was put on aspirin and simvastatin, after the DES on
Plavix, aspirin and Carvedilol (my cholesterol was then at an all time
low, so no simvastatin was required). When testing me prior to the second
stent, my first stent was found to be fully open. I started having heart
fibrillations (rapid heartbeats and excessively strong pulses) about
2 months after having the second stent fitted. They occurred infrequently
but were very worrying although they lasted only about a minute every
time. I guessed that the medication cocktail was to blame but my US doctor's
simple solution proved correct, I had to stop drinking coffee (I was
then drinking about 6 to 8 cups a day). Perhaps I have been lucky but
in spite of switching between originals and generics many times, after
two years medication, I can't report any side-effects at all from the
Plavix and aspirin combination :-) Unfortunately(?) my new National Health
Service doctor has just decided that I don't need the (free of cost to
me) Plavix any longer, citing a "normal" 12 months term for this medication
and the high cost to the NHS! I am very concerned but after reading this
forum I intend to ask my doctor to give me Plavix and a referral to visit
a cardiologist with a view to having a nuclear stress test to establish
my current condition and recommendations on future medication. Am I doing
the right thing?
David Kerry, Blackpool, Lancashire, England, March 14, 2007
• Dr. Dixon -- the study reported in NEJM that
you refer to is the CHARISMA study. You can read our "Patient
Alert", issued the morning after the results were announced
at the ACC meeting last year and which were then mis-reported by the
popular press (not the NEJM). The patient population for whom there was
no significant benefit were those who had no evidence of coronary
artery disease. The CHARISMA study was undertaken to see if there
was a preventative effect from the combination -- and, as you note, there
wasn't an additional benefit over aspirin alone. However, the results
DO NOT apply to patients with drug-eluting stents -- quite the opposite.
All DES patients should continue their Plavix and aspirin until their
cardiologist recommends stopping. Doctors have reported to us that unfortunately
some patients read the popular press headlines back in March 2006 and
stopped taking Plavix on their own, some with unfortunate results: heart
attacks from stent thrombosis.
Forum Editor, Angioplasty.Org, March 14, 2007
• The New England Journal of Medicine of March
12, 2006 reported a large study on the plavix/aspirin controversy. Their
conclusion was that there was no significant benefit in taking plavix
over aspirin alone. Not only was my cardiologist unaware of this (and
disbelieving), but he had prescribed 500mg of aspirin with the expensive
Plavix. For those who cannot tolerate low dosage aspirin, there are some
very benign alternatives, such as Vitamin E and also nattokinease. Unfortunately
your doctor will likely not be aware of these either. Some promising
answers to the plaque problem include anti-inflammatories as preventative
and ellagic acid or citrus pectin for removal.
Dr Jack Dixon, Ft Lauderdale, Florida, USA, March 14, 2007
• Well I knew it wouldn't last forever. Walgreens
stopped offering generic clopidogrel, stating that the court injunction
against Apotex required them to clear their shelves. So it's back to
the ultra-expensive name-brand Plavix for me. I suppose I shouldn't complain
- I was able to use the generic from 8/06 until a few days ago. So I
saved some money at least. My share of the cost after insurance was $12/30
pills for generic. Now it's $37/30 pills for Plavix brand.
Kevin, Albuquerque, New Mexico, USA, March 12, 2007
• Paul -- the recommendation for uncoated stent,
also known as bare metal stents, is antiplatelet therapy (Plavix and
aspirin) for 4-6 weeks. This differs from the drug-eluting or drug-coated
stents. So your aunt is pretty much at the stopping point. That being
said, we always suggest that the surgeons and interventional cardiologist
consult about stopping antiplatelet therapy. We would recommend consulting
the interventional cardiologist who implanted the stents regarding when
or even if she should resume Plavix. Each patient is an individual case,
and some patients are at higher risk for bleeding than others.
Forum Editor, Angioplasty.Org, March 11, 2007
• My 80 year old Aunt had three cardiac uncoated
stents implanted about 5 weeks ago. She is scheduled for vascular surgery,
in one week, to clear blockages (with stents) in her leg. She was told
to stop taking, aspirin and Plavix, 5 days before the currently scheduled
vascular procedure. Does the risk of excessive bleeding during the vascular
procedure outweigh the risk of blood clots forming in the cardiac stents
due to the stoppage of aspirin & Plavix?
Paul D., Syracuse, New York, USA, March 7, 2007
• To:
Dave W , England Yes I too am in the UK, and was started on Simvastatin
after my first Stent back in Dec 2005. Although I never thought my
chol was particularly high. I`m still on it at 20mg day, last Tot chol
was 155 with LDL at 99, which although not ideal is i feel as low as
i can get it, without upping statin dose which I don`t want to do.
TM, UK, March 6, 2007
• D.M. -- a quick reaction is that numbness on
the right side after an angioplasty/stent procedure would seem more likely
a result of the femoral puncture (if the catheters were inserted through
the right groin area). Reactions to Plavix tend to be more of a rash
or bleeding. See our Forum Topic on "Femoral
nerve damage or other complications from angiogram or angioplasty" for
more info. This may be due to a nerve trauma and should pass, but definitely
report this to the cardiologist who did the procedure.
Forum Editor, Angioplasty.Org, March 5, 2007
• After placement of one drug-eluting stent, I
am experiencing numbness on my right side (only) from mid-chest down
to my toes. The right foot is very tingly. The fingertips on my right
hand are slightly tingly. If the numbness is related to the Plavix, is
this a side effect that may go away in time or is it likely to persist
as long as I am on the Plavix? I am on the following drugs: Plavix (75
mg), aspirin (325 mg), Lisinopril (5 mg), Isosorbide ( mg), Lipitor (
mg).
D.M., Ohio, USA, March 5, 2007
• To
Corrine B (Malta) on the eye bleeding. After my DES in Oct. 2005,
I had a nose bleed for 24 hours resulting in going to the E.R. and
having my nose packed. The next morning I woke up with a blood clot
in my left eye...Seems my left side was affected by my angina attack.
The clot covered my entire eye and lasted six weeks. CT scans were
done to be safe brain was not bleeding. I just want to stress the need
to "check out anything" that you are not comfortable with, with you
Dad..Plavix can cause bleeding and bruising. I've recently (after my
first year anniversary of DES) now take my Plavix every other day and
the nose bleeds are less frequent..Good Luck and God Bless...
Rosanne G, Stoneham, Massachusetts, USA, March 2, 2007
• P.B. -- bruising is another name for hematoma
-- which means bleeding beneath the skin surface. It is a known side-effect
of Plavix. It may not be serious, but you should contact your prescribing
physician and let him/her know what's happening. An alternative antiplatelet
drug is Ticlid (ticlopidine) which may have similar effects, but let
your doctor know -- and let us know what they say.
Forum Editor, Angioplasty.Org, March 2, 2007
• My 41 yr old husband has had a mild MI a few
weeks ago. He has a DES in Right Coronary Artery. He was ok'd to return
to construction work which is physically demanding. He is getting fairly
large bruises on abdomen (size of tennis ball), arms, etc. Should I be
alarmed? Plavix mentions bruising as a side effect. When should I be
concerned? I feel like I need to call them everyday. Thanks for any advice.
P.B., Florida, USA, February 28, 2007
• "Educated" -- quite right you are.
Angioplasty.Org posted a "Patient
Alert" the morning after the CHARISMA study results were presented
last March -- and the news media did a horrible job of mis-reporting
(we mean they did a great job of MIS-reporting!) and headlines like "Plavix
and Aspirin: A Deadly Combo" went flying around the country. Wrong!
And we've been told by more than one cardiologist that a patient of theirs,
reading the headlines, decided to stop taking Plavix, and proceeded to
have a heart attack. By the way, it took the American College of Cardiology
and the American Heart Association four more days to issue their own "Alerts" and
another day or two for the press to acknowledge the error.
Forum Editor, Angioplasty.Org, February 27, 2007
• Harold - The media that you might be referring
to could be results from the CHARISMA study that was released a year
ago. The study looked at two different groups of patients. The first
group were patients that have had a stroke, MI or PAD (Peripheral Arterial
Disease) and the second group were patients that had the risk factors,
but haven't had an actual event or PAD. Plavix did not fair well with
the second group and is not recommended for that group. Which Plavix
is not indicated for the second group of patients to begin with.
Educated in this area, Saginaw, Michigan, USA, February 27, 2007
• To
John from New Hampshire...your story sure sounds like my life in
Oct. of 2005. Same situation..I live in Stoneham MA..Just want to say
thank you for sharing your thoughts as I can only share my concerns
with other DES patients. Family members really do not "get it".....Stay
well and stay educated on the effects of our meds....My prayers for
all of us to remain well.....
Rosanne G., Stoneham, Massachusetts, USA, February 26, 2007
• Harold, I am also on Plavix for DES Stents,
and have been on it for a year. It looks like I may stay on it indefinitely.
If I were you I would consult immediately with my cardiologist about
stopping it! I certainly wouldn't stop anything based on ads from attorneys
who have a big financial interest in suing! You may be seriously risking
sudden heart attack or worse without plavix.
Tom T., Arizona, USA, February 26, 2007
• My aunt died from a massive GI bleed just two
weeks after being put on plavix and aspirin. She was scheduled for her
angioplasty at the end of this month. Her blockage was very small according
to the cardiologist. We are still in shock. Anyone heard anything like
this happening before?
Dee T., USA, February 26, 2007
• The media articles I was referring to that instigated
my choice to stop taking Plavix were the TV ads by attorney's stating
that it has been known to cause strokes, heart attacks and death. Than
some of the newer ads are stating that its Plavix and drug eluding (?)
stents. Which was what I had installed in Feb. '06. If I remember correctly
the first newspaper article I read was out of the Chicago area regarding
the Plavix problem. I searched for more info but wasn't able to find
much. Afterwards I began to see those TV ads from attorney's. I usually
measure my emotional response to new medications by what I perceive physically.
Even though they may not be accurate.
Harold, Joshua Tree, California, USA, February 24, 2007
• Just had 4th angio. Like prior 3 I was put
on Plavix despite my protest. Like the other times I developed rosacea
in my eyelids within hours of taking Plavix. I have purple circles around
my eyes and my vision is blurred. I have to take this stuff for 7 days.
I am on a rosacea drug Orecea which was working but is now being defeated
by Plavix. I was told I have acne in my eyelids from Plavix.
Tom Pettit, Wilton, Connecticut, USA, February 23, 2007
• Hi i am from Uk i had stent angioplasty in 2000
after a heart attack. I have have been on plavix since and been told
i will be on plavix for the rest of my life,i was also on aspirin but
after 4 years my stomach couldn't take it anymore the Doctor said it
was a risk either way but he thought it would be a bigger risk if i carried
on taking asprin.is there anyone on here who knows how much risk i am
running by not taking aspirin. God Bless
Sylvia, UK, February 21, 2007
• Harold -- what media articles motivated you
to STOP Plavix. Most of the news has been how you need to stay on it
longer than originally thought -- assuming you are not at risk for bleeding,
many cardiologists are prescribing it for life. If you are experiencing
angina, now a year since you were stented, you should contact your cardiologist.
He/she can also look through all your med (including over-the-counter)
and assess whether you're having any drug reaction.
Forum Editor, Angioplasty.Org, February 20, 2007
• Had angioplasty performed Feb. 20, 2006. Doctor
prescribed Plavix 75 mg an Aspirin 81 mg. afterwards. Except he stated
instead of being on Plavix for only two months (which was average) he
stated that he wanted me on it for at least nine (9) months. Well it's
been a year today and I'm still taking Plavix. However, I have stopped
taking it at least twice for two weeks up to a month on my own volition
because of articles I read in the media. Am currently taking Isosorbide
to also help with any angina I have. Along with CAD I have COPD or emphysema
and the medications that go with that problem. At times I'm not sure
if medication(s) for one problem isn't causing problems for the other
one. I have experienced strange flutterings or sensations in my chest
or breathing almost every morning. Lately, more minimal angina the last
week. Causing me to use Nitro tabs to be safe.
Harold, Joshua Tree, California, USA, February 20, 2007
• Had DES x2 fitted
02.02.07 in closed R/H coronary artery (dominant)prescribed Plavix 75mg
+ 75mg aspirin (dispersible) + 40 mg Simvastatin (anti cholesterol) all
seems to be well apart from slight cold/flu symptoms, had quick look
through post's is anyone else on SIMVASTATIN ? everyone on the ward was
put on this after 'op', I was told I will take this for rest of 'Life'
David W., England, UK, February 20, 2007
• did anyone have
any side effects on the eye like bleeding while on Plavix? I am concerned
about my father who says that he is seeing certain shadows. DOn't know
what symptoms one can expect with bleeding of the eye.
Corrine B., Malta, February 20, 2007
• Hi all...Just caught up on everyone's concern.
It sure is scary thinking about our DES and meds taken daily. I am still
experiencing high blood pressure numbers..bottom number is always 90+.
Saw some info on Caduet and will ask cardiologist if maybe taking this
drug along with my diltiazem aka Tiazac will be helpful. I have been
in bed and not feeling well at all for the past two weeks. Blood test
show low crit, very low iron level due to nose bleeds from Plavix.(remember
I have platelet dysfunction (ITP) and am in "catch 22"...I would like
to know if the weird sensation I've been experiencing on my left side
(I had 99% blockage and DES in Oct. 05) could be blockage from 60% that
they did not stent? Stress test of a few months ago was normal. NO ONE
(except my fellow stent patients here) know exactly what I'm saying when
I say, MY LIFE HAS CHANGED SO MUCH since Angina came into my life. I
am now taking Plavix, 81 mg baby aspirin, lipitor, 2 protonix (and yes,
thank goodness for them), two iron pills, vitamin C, Tiazac for HBP,
and I just started a multi vitamin (one a day for women) as I would like
to have some energy to play with my grandchildren...I can't express my
thanks enough to this Forum for all the information received as "doctors" do
honestly "forget to tell us" all the side effects of the meds they put
us on. MY doctor says I am so "side effect sensitive", it's difficult
for me to try new drug. I am interested in Caduet...any comments????
any reaction if I should take two blood pressure meds to control my high
blood pressure..AS ALWAYS, GOD BLESS... Rosanne
Rosanne G., Stoneham, Massachusetts, USA, February 19, 2007
• In July 2007 I was scheduled for a stent. Going
on Plavix 30 days before that. The day before going into the hospital,
I had a severe reaction to Plavix, i.e. swelling in my hands, itching
and red whelps all over. Similar to allergic reaction to penicillin.
After the stent, the Dr. put me on Ticlid to be taken for 3 months. Then
on aspirin (baby). I have been highly allergic to aspirin all my life.
I have been on the baby aspirin for one month and just lived a week of
living hell from headaches, throwing up and extreme pain in my upper
back. I am not taking anything now to thin my blood and I am concerned
but I had rather die than live with the results of aspirin. I will be
calling my Dr. on Monday 2/19/07 to let him know I had to stop the aspirin.
What are my risks?
Rosalyn Roberts, Lakeland, Florida, USA, February 17, 2007
• If you get a rash after angioplasty, how do
you know if it's from plavix allergy or contrast (iodine) allergy?
Patrick, Quebec, Canada, February 11, 2007
• I am a 47 year old male. I've just had my second
angioplasty where I was given stent(s). The first was in January, 2004,
when a 100% blockage was found in my Left Anterior Descending Artery,
and I had a mild heart attack (MCI). I actually drove myself to the hospital,
not seriously believing that I had a heart attack. Maybe some Angina,
I thought. Two drug eluting stents were installed, must've been the Cypher
because FDA hadn't approved the Taxus just yet. I was put on Plavix and
I continued on Aspirin, which I had already been taking. I had to fight
with the insurance company to stay on Plavix after my cardiologist recommended
it. I needed a special letter to say "yeah, we weren't kidding with that
prescription there, it's necessary." Other than those days when my prescription
expired and three minor (knee and dental) surgeries where I stopped for
three days each, I always took my Plavix and my aspirin. Over a year
ago, I asked the Cardiologist, whom I had been seeing and paying out
of pocket because he's "out of network", how do I keep an eye on another
artery, the Right Coronary, where I had 60 per cent blockage at the time
of my Angiogram, but not enough to warrant a stent. He said "next time
we'll do a nuclear stress test". In December, I got a referral to an "in
network" Cardiologist to do this test. He called me back and said there's
blockage, better schedule another Angiogram. My old stents in the LAD
were 100per cent blocked again, and the RCA was now 90 per cent. The
new cardiologist told me point blank that if this got to 100 per cent
also, "you would die". He said there is nothing that can be done about
the blockage where the old stents are. 'It's like concrete" he said.
So I'm relying on some collateral arteries to deliver blood to the left
side, front of my heart, as the LAD is blocked, and if this new stent
blocks up like the last one, I'll be dead in three years. He did say
to get a nuclear stress test every year, but this is driving me crazy.
Anyone else experience anything like this?
Patrick, California, February 10, 2007
• J.J
in New York........I have been on plavix and aspirin 325 mg since
February of last year (One full year in one week.) In October of last
year I was admitted with some GI symptoms and was advised to undergo
a colonoscopy along with other GI procedures. Based on what I have
read, since this was not an emergency and my symptoms resolved, I elected
not to undergo the colonoscopy at that time because it required stopping
the plavix and aspirin for five days before and after the procedure.
It is obvious now that we are dealing with a relatively new problem
(late stent thrombosis) and until that problem is more understood and
resolved, drug-coated stent patients should play it safe and follow
recommendations of at least one year on anticoagulants and always check
with your cardiologist before stopping those meds for any kind of medical
or dental procedure.
Jason B., California, USA, February 5, 2007
• I just had a medicated stent put in on January
24, 2007, where I had an 80% blockage. Presently i'm taking plavix (75mg),
aspirin (325 mg), metoprolol, crestor, and lisinopril. My body is accepting
all of the medications, except for the plavix. Within 2 hrs of taking
I have a severe headache where the spine goes into the skull, weakness,
slight heaviness in the chest, and can't think very clearly. Does anyone
else have these symptoms when you take the plavix?
Bruce D., Utah, USA, February 4, 2007
• J.J. -- please read about the latest "Science
Advisory" from all the major physician organizations regarding
drug-eluting stents, Plavix and surgery.
Forum Editor, Angioplasty.Org, February 3, 2007
• My hubby has had 2 open
heart surgeries and 5 stents-- now he may need a prostate biopsy- he
would need to discontinue his plavix- and aspirin - i am so concerned--
he's really borderline for the biopsy- but it's been repeated a couple
of times and it's always a little above what its supposed to be and he's
64
J.J., New York, USA, February 2, 2007
• I spoke to my father and received answers to
the questions in your email:
Guess the Advisory has not found its way to your dentist.
We certainly suggest, as does the "Advisory", to go back on
your Plavix immediately. You should also call your dentist and educate
him/her. Someone has to.
Forum Editor, Angioplasty.Org, January 23, 2007
• I am curious-I have been on Plavix/Aspirin since
MI in 12/2004. Several stents later, my original DES started to close
in 10/06. Another DES was inserted to re-open. Now I have been off Plavix
for 5 days for dental work. Someone pointed out that it had not been
6 months since last stent. Is this increasing my danger for thrombosis?
My dr. says one more time and it is open heart for me. I have a total
of 7 stents-5 DES and 2 BMS. Any answer would be appreciated.
Lynn J., South Carolina, USA, January 16, 2007
• Reply
to Sally in England - Went back into my cardiologist today with
the similar issue - itching, rash from Plavix. It's interesting that
my itching and rash only affects me where clothing touches the body.
No rash on face, forearms, etc. He told me that Plavix can cause an
increased sensitivity in the skin than can trigger to a rash with clothing
washed in certain types of detergents and fabric softener, with the
product Bounce being a common culprit. Came back today - rewashed the
clothing in plain water, I'll let you know how it goes. You also might
want to try something like Claritin or Benadryl for the itch. Good
Luck
John A Gowing, Melbourne, Florida, USA, January 15, 2007
• S.M. in NY -- Ticlid (ticlopidine) and Plavix
(clopidogrel) are related, but allergic reactions are not necessarily
the same. Most cardiologists we've talked to will try Ticlid if the patient
cannot tolerate Plavix. One reason Plavix became widely used is that
Ticlid did tend to have more adverse reactions. But In Japan, Ticlid
is the antiplatelet therapy of choice. One cardiologist recently told
us that he was surprised at how well a number of his patients tolerated
Ticlid. Have your wife's doctors ruled it out? As for IVUS (intravascular
ultrasound) being "dangerous" inside a stent...that would be
news to highly-regarded angioplasty pioneer Dr. Antonio Colombo of Milan,
who recently stated he will now use IVUS on every stent case he does.
Cardiologists who use IVUS specifically use it to inspect stent placement
-- in other words the whole point of IVUS in these cases is to look inside
the stent. What your wife's doctor may have meant was that using IVUS
is done during an angiogram, and in your wife's case, there was no reason
to do that because no new information that would help your wife would
be gained. (Question: does her cardiologist have an IVUS system? -- only
12% of cath labs currently have this capability). See if a different
drug relieves some symptoms. But if she is still having adverse reactions,
you might want to look at our topic on Allergic
Reactions to Drug-Eluting Stents.
Forum Editor, Angioplasty.Org, January 15, 2007
• Update
on wife. She had three taxus stents in July. She developed severe
reaction (burning muscle pain insomnia, upset stomach, feeling close
to death) to plavix after about one month in. Has been off now for
two months. She feels fine now except for residual burning pain and
general weakness. One doc says she has just a 1% chance of a clot another
says she has little protection with just aspirin. Also one doc says
using the IVUS can be dangerous to use especially inside stented areas.
Also she did have another angiogram and doc said they couldn't check
collateral values because of no blockages. What alternative options
are there for a patient with taxus drug stents who can't tolerate antiplatelet
drugs except aspirin? I hear if you are allergic to one you are to
all because of ticlid molecule.
S.M., New York, USA, January 15, 2007
• I've had a problem with my RCA now for 10 years.
Balloon angioplasty in 96 and 98, two stents in 02, two more cobalt stents
plus brachytherapy in 03, and most recently 3 DES Jan 11 07. In 03 I
was given Plavix for a year with no negative effects. I was put back
on Plavix after the DES, and now look like a well done Maine Lobster
from neck to knees. Heading for the doc tomorrow for desensitization
discussions. My cousin is an internal medicine guy, and says that it
is not unusual to take a drug with no ill effects and then develop a
problem later on. In all my other cath lab encounters I felt much better
immediately following the procedure, after this one much worse. I believe
it is the reaction to Plavix. From what I read, I MUST stay on Plavix,
Ticlid probably not a good substitute. I'm fiddling now with Benadryl
and Pepcid. I read a post somewhere that someone had success with Altarax.
Anyone had any similar issues?
John A Gowing, Melbourne, Florida, USA, January 14, 2007
• George, you are correct -- there have been documented
cases of Coenzyme Q 10 (ubiquinone) interacting with Warfarin, reducing
the anti-coagulant effects of Warfarin below the therapeutic level. Haven't
found specific studies on Plavix, aspirin and ubiquinone, but one might
be concerned that it could negate some of the antiplatelet qualities
of those. You can get an INR (International Normalized Ratio) test done,
to determine if in fact the ubiquinone is affecting your thrombin levels.
Forum Editor, Angioplasty.Org, January 14, 2007
• My cousin had a medicated stent implanted 2
months ago and was put on 75mg Plavix and 325mg aspirin daily along with
Zocor .. unknown mg .. and has just spent the last 3 days in the hospital
after coming down with a horrific rash with blotches all over his body
and then started to shake uncontrollably! They took him OFF of the Plavix
and switched him to Ticlid .. and while he is still in the hospital,
is beginning to see the rash and blotching subside. BE CAREFUL PEOPLE!!
Doctors don't always know what the meds will do to you. ASK QUESTIONs
and KEEP A DAILY LOG ON WHAT YOUR SYMPTOMS OR LACK THEREOF ARE as you
take new meds. I myself have 5 stents, 4 without meds and the last one
with meds. Nobody ever told me what kind, so I can't relay that info.
I take 75mg Plavix and 81mg coated aspirin along with a Protonix to keep
the BURNING sensation out of my esophagus and abdominal tract!! Thank
goodness they discovered Protonix .. I was in agony before taking it.
I also take a Cozaar and 1/2 of a bisoprolol every night before bed.
I experience several situations from these meds. Insomnia, mild headaches,
some ear ringing (not continual), extreme mouth dryness upon waking (IF
I was able to sleep!), lack of energy, eye irritation, NIGHTMARES and
continual stream dreaming if I can sleep. I used to take a 100mg Co-enzyme
Q 10 daily along with Folic Acid and 50mg B-complex and 1000mcg B12 ..
after my second heart attack and starting on the Plavix/Aspirin combo
.. I read somewhere that taking the Co Q 10 could cause either CLOTTING
OR SEVERE BLEEDING .. so I stopped taking it. NOW I FEEL SO RUN DOWN
.. when I took it, I felt like I was 10 yrs younger. IF anyone knows
the truth about taking Co Q10 with Plavix/Aspirin .. PLEASE LET ME KNOW!
Thanks
George D., cardiac patient/relative of cardiac patients, New Jersey,
USA, January 14, 2007
• 48 yrs old, DES Stent
10-06, 80% LAD blockage. On Plavix, Aspirin, Vytorin. Had blood vessel
swell huge on inside of forearm then hematoma spread out about half dollar
size. Happened also on leg below knee. Doctor thinks it has to do with
my meds + my workout program (body builder, but nothing extreme). Has
anyone else had this thrombosis vein swelling problem? Curious, Janelle
Janelle, Del City, Oklahoma, USA, January 10, 2007
• I had a stent inserted
after an angioplasty on the 11th Dec. 2006. Three days later I couldn't
stop itching. As I have R. Arthritis I was on an anti inflammatory which
I thought might have caused this. I stopped this and the itching continued
for a few days then stopped, though my skin feels sensitive. Everything
I eat tastes strange and metallic. My arms and hands are so bad with
R. Arthritis that I now can't dress myself, do my hair or look after
myself. As I am registered Blind with Glaucoma this is very worrying.
I was not told about needing Plavix before the procedure and am now worried
that I could have more problems with my eyes . I am 53 years old and
have had many ops to keep my sight. I am hoping to see my cardiologist
to help with my not being able to look after myself. As I live on my
own my boyfriend and young daughter are trying to help me. Has any one
had similar problems?
Sally, England, January 10, 2007
• Ellen -- the FDA-mandated labeling for drug-eluting
stents states that Plavix (clopidogrel) and aspirin should be taken for
3 months if you have a Cypher (sirolimus) stent and 6 months if you have
the Taxus (paclitaxel). That's the FDA, and whether or not to change
this language was the subject of a major debate during the recent FDA
stent safety panel meeting. The current recommendations from the three
major professional organizations (the American Heart Association, American
College of Cardiology and the Society for Cardiovascular Angiography
and Interventions, collectively known as the AHA/ACC/SCAI Guidelines)
restate these minimums, but add that ideally patients at low risk for
bleeding complications should be given Plavix for up to a year. Some
cardiologists now prescribe Plavix for longer, some for life. Again,
this assumes the patient is at low risk for bleeding.
Paul from New Hampshire (posted on November 28, 2006)
wrote in again regarding two questions that have not been addressed in
the Forum. So we'll try. The first, "is it possible to check to
see if all the stents have properly endothelialized?" Short answer: "not
easily". There is a technology called intravascular
ultrasound, which takes ultrasound images from inside the artery.
It's sometimes used during stent placement by cardiologists who feel
it offers reassurance that the stent has been fitted correctly (for more
on this, read the recent feature on Angioplasty.Org, titled "Intravascular
Ultrasound (IVUS) Imaging Technology May Help Lower Rates of Late Stent
Thrombosis"). It should be possible with this technology to
also go back in later on and see if the stent struts have been covered
by the endothelial layer. This would have to be done during an angiogram,
so it's an entire interventional procedure, done in the cath lab. Theoretically
this could be done if there is a strong enough reason (there are risks
associated with all medical procedures, even minimally invasive ones)
not to mention the expense.
Paul's second question was "I'm wondering if a
voluntary bypass might be a good idea considering the DES danger? Would
a bypass make a difference if the stents thrombosed later on?" Bypass
surgery is major surgery with risks associated with it. Unless there
is an urgent reason to have it, I doubt if any physician would recommend
doing this on a "voluntary" basis. Certainly not, considering
the risk of late stent thrombosis is very small, much lower than the
mortality/morbidity risk of any major operation.
Forum Editor, Angioplasty.Org, January 10, 2007
• how long after stent deployment should patients
without a heart attack patient without any further problems take plavix?
Ellen, Indiana, USA, January 10, 2007
• Jane -- couldn't agree with you more. Unless,
of course, it's an emergency situation, patients should be consulted
and queried strongly PRIOR to stent placement about allergies, ability
to tolerate aspirin and Plavix, etc. What does your cardiologist say
about your husband's allergy to aspirin. Plavix and aspirin act differently
as anti-platelet drugs. Secondly, all package inserts for all stents
(bare metal AND DES) clearly state that stents are contraindicated in
patients with known allergies to stainless steel. Finally, how to tell
the difference between drug allergies and drug-eluting stent? We are
participating in a study (see sidebar) to find a test that will do just
that. If you think this might be the case, send an email for more info.
Forum Editor, Angioplasty.Org, January 8, 2007
• On Jan 30th, 2006 my
51 year old husband has a des stent put in (Cypher). He had a triple
bypass 3 years ago, but the artery they did not bypass was slowly closing.
He has been on Plavix the last 3 years and now he is red from head to
toe. He is itching and feels like he is going crazy. He is very angry.
As a Registered Nurse he felt that he should have been consulted regarding
what they would put into his heart (this should be for any patient) before
and not after the fact. We have an appointment with his primary care
dr. tomorrow. I called the Cardiologist today and they told me to get
him to his primary care Dr. WHY? I feel the cardiologist should see the
after effects of his work. I am not blaming the Cardiologist. My husband
is a diabetic and this is supposed to be the best stent for him. I do
have a couple of questions though. My husband is highly allergic to aspirin,
goes into shock if he takes it, so if he goes to another drug like plavix
without the benefit of aspirin will that be enough? The second question,
has anyone ever had a reaction to the metal in a stent (des or bare metal)
The reason I am asking is there are times when a metal watchband will
make my husband's arm break out, and this rash was on his body within
8 hours of the de stent being put in. I guess i have 3 questions. How
does a physician tell the difference between a plavix reaction and a
person's body actually not tolerating the stent for what ever reason.
Thank you very much.
Jane, Westerville, Ohio, USA, January 8, 2007
• J.B. -- we're assuming you're not talking about
a coronary stent, but one connected to the dialysis. Have you reported
this pain to your physician? Specific foot pain may be an indicator of
some type peripheral disease. Various tests can be done to diagnose the
cause, but we haven't heard of Plavix causing a pain in such a specific
location. We advise you see your doctor.
Forum Editor, Angioplasty.Org, January 8, 2007
• My husband is a dialysis patient. He has a fistula
and a stent had to be inserted two weeks ago. He now has severe pains
in the foot arch on both feet. It feels like razor blades are cutting
him. The only thing different is Plavix. Could this be the cause?
J.B., USA, January 8, 2007
• I am writing in response to my mother. She had
2 stents put in in July 2006. Three weeks later everything she ate or
drank tasted metallic. After more that than 3 months of testing and a
36 lb. weight loss we were to an end and did not think we would ever
find an answer. After talking to the cardiologist again and again I begged
him to take her off of Plavix and try something else. He put her on Ticlid
and I am so happy to say my mother is much better after being off Plavix.
It took about 3 weeks or more for the metallic taste to leave, but she
can eat or drink most anything. I don't know if this will help anyone
else, but we never dreamed it would be the Plavix.
Debbie Elder, Vincent, Ohio, USA, January 7, 2007
• Wil --
not taking Plavix and aspirin after implantation with a drug-eluting
stent is definitely not recommended. Just read any of the many articles
on this site -- the main risk factor for late stent thrombosis is non-compliance
with aspirin/Plavix. There is no data to suggest that aspirin has a negative
effect on healing -- it's main function is to keep platelets from gathering
together and forming a clot. And Gary, 50% blockage is a very grey area.
Most cardiologists probably would agree with yours. The question is whether
the blockage has a functional effect -- i.e. is it stopping blood flow,
causing ischemia to the heart muscle or putting you at risk for a heart
attack. Each case has to be evaluated individually. For example, a 50%
blockage in a alrge vessel probably isn't having a great effect, where
a 50% blockage in a narrow one might.
Forum Editor, Angioplasty.Org, January 7, 2007
• A generic company started to sell the generic
version of Plavix, Clopidogrel, against the patent in August 2006 and
should be off of the shelves by February. The generic version has caused
many issues with serious itching and rash. If you are having an allergic
reaction check your bottle and make sure you are on Plavix and not Clopidogrel.
Have your doctor write you a new script that has "Dispense as Written" on
it. Comment to Salim - Your cardiologist has kept you on Plavix and asa
for a reason and you see what happened with your brother. If you start
cutting the Plavix tablet in half it will not reach it's steady state
and will not have the effect that it has for you already. Plavix slows
the healing process with your stents and prevents the blockages. Also,
if you were to have a plaque burst inside your artery it would help to
prevent a heart attack or stroke. Please talk to your cardiologist before
you start changing your medication.
Educated in this area, Concerned for your health, Saginaw, Michigan,
USA, January 6, 2007
• To all patients with possible Plavix allergies
-- try Ticlid. It was the drug used before Plavix, but some patients
tolerate it better (and some worse). Ticlid is the antiplatelet drug
of choice in Japan. Certainly, do not go off your prescribed antiplatelet
medication by yourselves. If you are having problems, talk to your doctor.
Ask if there are alternatives. And share your knowledge by letting us
know.
Forum Editor, Angioplasty.Org, January 6, 2007
• I started Plavix after triple DE Stents in Jan.
2006. I was not aware of related problems until a urinary infection 11
mos. later. But now after stopping Plavix, other problems like flu or
allergy syndrome, itching, wheezing, are all gone. I have not felt this
good since the DES procedure.
Leo R, Montreal, Canada, January 4, 2007
• Started Plavix Sept 30, 06 and 81 mg aspirin
daily, have had a headache everyday since. No HB pressure, MRI, CT scans
all normal. Dr's don't know what is causing the headaches. Tempted to
go off Plavix and see if there is a change. Cardio is adamant that i
stay on Plavix and is convinced that Plavix does not cause headaches.
In general, they don't, but maybe in my case, they have. Your thoughts.
C.M., Nova Scotia, Canada, January 1, 2007
