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Plavix (Clopidogrel) and Surgery

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I had a stent and need to take the anti-clotting drug Plavix for at least 3-6 months. I need to have surgery? Should I stop the Plavix?

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Current Postings on This Page (57):

• Supplyguy1944 in Illinois -- Most studies we've seen indicate 7-8 days for the effects of Plavix (clopidogrel) to stop. Here's one from the journal Pharmacotherapy, titled "Management of Antiplatelet Therapy for Minimization of Bleeding Risk Before Cardiac Surgery."
Angioplasty.Org Staff, Angioplasty.Org, December 23, 2012

• Been on Plavix since 2004 had 3 stints 2003 followed by triple by pass...2004 stroke and TIAs while not on Plavix. 2010 1 stint still on Plavix Now i have an inverted papilloma and the removal is planned for 01/08/13. Cardio wants 5 days off Plavix and resume after 24 hours. Bleeding after biopsy was 18 hours. Is 5 days long enough so bleeding is not a problem during surgery?
SUPPLYGUY1944, Cary, Illinois, USA, December 21, 2012

• SB in Dubai and Ron in North Carolina -- Needing surgery after a stent implantation is one of the biggest conundrums of this field. You need an operation and the surgeon requires you to be off antiplatelets because he is concerned about bleeding complications. At the same time, early cessation of antiplatelet therapy is associated with an increased risk of stent thrombosis (blood clotting inside the stent) which can be fatal one-third of the time. There was a recent study about using a fast on/off antiplatelet drug called Cangelor, made by The Medicines Company, but this drug is not approved in any market. So it remains a balancing act of how urgent is the surgery, can the surgery possibly be done without stopping Plavix and how thrombogenic is the particular stent (how prone to clotting) which is something that depends on the type of stent, the length, diameter, location, etc. We recommend that patients try to have their surgeon and cardiologist speak to each other about the risk-benefit.
Angioplasty.Org Staff, Angioplasty.Org, July 4, 2012

• I had a Cypher Sirolimus Select™ Plus implanted on my LAD a month and taking Plavix 75 plus aspirin 150.I have to have a groin hernia surgery. The hernia seems to have developed suddenly. Hernia surgeon and cardiologists say going off Plavix and aspirin for a week before and two days later will not cause problem. Is this true as in the middle east difficult to believe as their are no avenues to suing a surgeon or cardiologist for wrong advice.
SB, Dubai, United Arab Emirates, July 4, 2012

• I had my 6th stent replacement in Feb 2012, (done in 4 different procedures.) I have done well with each procedure. Part of my "therapy" is exercise. I have developed a debilitating issue with a knee that can only be resolved by a "Knee Replacement". My cardiologist has said that I am unable to stop my Plavix until the 1 year mark. I am now at the 6 month mark. My life has frankly become one of intolerable discomfort. I am unable to walk any distances, certainly no exercising, resulting in weight gain and accompanying depression that is not the norm for me. I hear/read that alternatives are available for patients who are required to stay on Plavix and who have as well a need for surgery. I am in recovery (32 years) and limited on the medications I am able/willing to safely take for the discomfort. Frankly, the greater of my concerns is the "situational depression" I am experiencing. It is excessive and not my norm. I can't believe I could tolerate a 6 month wait for intervention.
Ron Wright, Charlotte, North Carolina, USA, July 3, 2012

• Concerned in Canada -- Some of the antiplatelet activity of clopidogrel remains for about five days after stopping. Was clopidogrel (Plavix) prescribed to you after a stent? In any case, before stopping a prescribed medication, make sure to consult your cardiologist. He/she may be able to prescribe an equivalent drug. Read our topic Plavix, Aspirin and Stents for more info.
Angioplasty.Org Staff, Angioplasty.Org, July 3, 2012

• When you stop taking Plavix, how long does it stay in your blood stream for, I have stopped taking Plavix now, as I am highly allergic to it, But certain foods I take, I break out more now , than I did before, I am allergic to most foods, & now will be taking a test for medicinal products, they use in Hospitals. Thank you for your ans, Cheers Concerned
Concerned, Just concerned about my health, British Columbia, Canada, July 2, 2012

• Babs in South Carolina -- Recommendations from all professional medical associations involved are to always clear such decisions with your cardiologist first. It may be that he/she can consult with the other specialist who wants you to stop taking Plavix, and find a way to accomplish the medical procedure without endangering you. But again, always discuss these issues with your cardiologist -- and don't stop taking Plavix without his okay.
Angioplasty.Org Staff, Angioplasty.Org, June 30, 2012

• I've been on Plavix since April 2009 also aspirin 325mg, during this time I've had 12 coronary stents placed, due to restenosis of several of the stents , My cardiologist told me due to extensive nature of my heart disease she will not allow me to stop the Plavix except for emergency's and then for only a few days, it's only been three months since last placement, another doctor wants to give me a injection in the cervical spine and wants me to stop, what risk would be involve if I pause the Plavix long enough for the procedure is there other options that need to be taken.
Babs, Lexington, South Carolina, USA, June 29, 2012

• I had my most recent (of two) DES placed on November 17, 2011. I'm on Plavix and aspirin (81 mg). After having a lot of blood work done in connection with my heart problems, it was discovered that I have a benign tumor on a parathyroid gland. I suppose I could live with it; however, I've read that this condition (hyperparathyroidism) can cause high blood pressure, heart problems, depression, fatigue, osteoporosis (I have them all. So, I've elected to have the surgery, which is scheduled for next Tuesday, June 12. My surgeon contacted my cardiologist, who okayed my coming off the Plavix for a week prior to the surgery, once I'd been on the Plavix for at least 6 months. I'm nervous being off the Plavix (now day 4), but I'm reassured by the low incidence of complications. I'm trying to be positive. I asked my cardiologist's nurse what to look for if I was going to develop a problem being off the Plavix. She said I would have the same symptoms I had prior to my heart attack. I just wanted to let readers know that things are going well for me so far; I'll be glad to get back on the Plavix immediately after the surgery. Do the symptoms differ between restenosis and thrombosis?
Becky, Biloxi, Mississippi, USA, June 9, 2012

• GR-Fran in Canada -- Plavix (generic name: clopidogrel) is an antiplatelet drug, also called a "blood thinner". Antiplatelet drugs (Plavix, Effient, Brilinta, aspirin) are prescribed for several indications, one of which is for a year or more after a drug-eluting stent is placed (less for a bare metal stent): they keep the blood from forming a clot inside the stent, a potentially serious even fatal event. However, the opposite is the case for any major surgery, and your father's AAA repair is certainly in that category -- the surgeon wants to miimize the risk of bleeding, so typically patients are asked to stop any blood thinners prior to surgery. The conflict (the subject covered in this Forum Topic) occurs when a patients needs to stay on Plavix, aspirin, etc. because of a stent, but also requires major surgery. If your father has had a stent within the past year, stopping Plavix may be an issue. In cases such as these we strongly recommend that the patient has his/her interventional cardiologist (the one who placed the stent) speak with the surgeon about the safety of stopping Plavix. The one year minimum duration of Plavix and aspirin after stenting is a recommendation; each indivudual's risk is a bit different. But definitely consult his cardiologist about the surgery.
Angioplasty.Org Staff, Angioplasty.Org, May 10, 2012

• My father is set to go into the hospital to have an aortic aneurysm repaired, and was asked by the surgeon to cease the use of Plavix one week prior to the surgery. Why does he have to suspend the use of Plavix? I would appreciate any info... thx.
GR- Fran, Alberta, Canada, May 10, 2012

• Worriedone in Florida -- If you had stents, are on Plavix and diabetic, you should consult with your cardiologist about the upcoming surgery and stopping Plavix because neither we nor any web site can give medical advice in place of a licensed healthcare professional. That being said, there have been observational studies showing an increase in events immediately after stopping Plavix, although this has not been proven. Guidelines call for a year of Plavix after a drug-eluting stent, less for a bare metal. Yours are most likely bare metal stents since drug-eluting stents were not approved in the U.S. until 2003. However, there have been studies showing benefit, especially to diabetic patients, of continued Plavix.
Angioplasty.Org Staff, Angioplasty.Org, May 6, 2012

• 69 yr old female, 5' 2" 160, had 3 stents in 2001, diabetes since 2006, have been on Plavix since 2001. I am scheduled for diverticulitis resectioning. What do I need to know?
worriedone, Deland, Florida, USA, May 6, 2012

• Rover in Pennsylvania -- Haven't heard of a Plavix-cancer connection. Some patients are on Plavix for a very long time, since it can reduce risk factors for heart disease -- some cardiologists even prescribe life-long Plavix after stenting, since they are concerned about very late stent thrombosis. The main adverse effect of Plavix is bleeding. If your cardiologist feels you no longer need to be on the drug, that's there's no benefit, then we would listen to his recommendation.
Angioplasty.Org Staff, Angioplasty.Org, April 1, 2012

• I am a 69 yr. old male. I had a heart attack in 2003, had 2 stents placed and an AICD installed. I have been on Plavix and 81mg aspirin ever since. I had a hernia repaired 4yrs. ago, AICD replaced 6 mo. ago. I was diagnosed and surgically treated for non-aggressive urinary bladder cancer last month (it presented itself with urinary bleeding..) The tumor was successfully removed with no need for chemo or radiation treatments.... For all of the surgeries took me off Plavix for 7days prior to each one and restarted. In an annual visit to my cardiologist after the bladder surgery this week, I discussed my surgery and his 1st. ??'s were "did it present itself with bleeding"...he then said 9 yrs. was a long time to be on Plavix, and told me to stop taking it.. Could the Plavix have caused the bladder cancer?? Was I on Plavix longer than needed?? Thank you.
Rover, Pennsylvania, USA, March 30, 2012

• Toks -- Are you a physician? This is a very complex subject. Heparin and Integrilin are anticoagulants that are used intravenously in a hospital setting. Integrilin is a IIb/IIIa inhibitor and, when used, is usually administered along with clopidogrel (Plavix) or another similar antiplatelet drug. But these are done in-hospital, since the patient needs to be monitored carefully for side-effects, possible bleeding complications, etc. Different hospitals and cardiologists will use different "cocktails" to achieve optimal anticoagulant therapy -- this also depends on the clinical status of the individual patient.
Angioplasty.Org Staff, Angioplasty.Org, February 26, 2012

• Just a quick question. I know it is possible to use Aspirin/heparin together with Integrilin post PCI. What is your take in using Plavix and Integrilin concurrently?
Toks, New York, USA, February 25, 2012

• Getting a stent is not technically surgery. It is an interventional procedure so there is no large "open" incision. There is a needle puncture, through which the catheters, balloons and stents are inserted. This puncture site, most likely in the femoral artery (leg/groin) is closed using manual compression or a vascular closure device, such as Angio-Seal. While there are complications associated with femoral access site bleeding, they are less than 5% or so.
Angioplasty.Org Staff, Angioplasty.Org, February 9, 2012

• I am going in for a stent in my leg, My Cardiologist put me on Plavix and aspirin for the surgery. Is it safe to these drug's prior to surgery.? What about bleeding after the surgery.?
Eddie, East Kingston, New Hampshire, USA, February 6, 2012

• JohnT in Virginia -- The danger in going off Plavix for stent patients is that of stent thrombosis (clotting of blood inside the stent). Guidelines recommend staying on Plavix and aspirin for a year minimum. Your case is somewhat different, since you are not being prescribed Plavix for a stent placement. We're not sure why your neurologist is making the case for 6 vs. 7 days, but we would recommend that your neurologist and surgeon talk to each other and resolve this. No reason why you should be caught in the middle.
Angioplasty.Org Staff, Angioplasty.Org, January 11, 2012

• I am caught between my Neurologist and my surgeon. My surgeon wants me off of Plavix for 7 days, which I've been on for 4 years because of a stroke. My neurologist only wants me to stay off Plavix for 6 days. In the mean time I have a bulging disk located in the L4/L5 region of my spine. It causes me quite a lot of pain which can be corrected by trimming the disk off the nerve. Is there any real difference between 6 and 7 days when it comes to taking Plavix orally once a day?
JohnT, Retired, Richmond, Virginia, USA, January 11, 2012

• J.G. in Gillette -- Your cardiologist is the point man on this one. He knows your situation, how many stents, where they were placed, how long the blockages were, etc. -- all of these are factors in your "stent thrombosis risk". Workmans' Comp doesn't understand the risks of a stent thrombosis (blood clotting in the stent) which is significantly lessened by Plavix. A stent thrombosis can be serious, in fact fatal more than a third of the time, again depending on which artery. All guidelines recommend not stopping Plavix unless surgery is critical (not elective). Some recent studies have postulated that 6 months on Plavix may be enough, but again, that depends on the location, length and type of drug-eluting stent.
Angioplasty.Org Staff, Angioplasty.Org, December 31, 2011

• I am a 60 year old male and had a drug-eluting stent installed Sept. 1 2011, Nov. 4, 2011 while at work I developed 2 herniated disks. I am on Workmans' Comp with the injury. My cardiologist said I could not come off Plavix to have an injection or surgery for 1 year as it wasn't a surgery that was deemed mandatory or life threatening. Workmans' Comp said yes I could come off Plavix for 5 days, have the surgery, and then go right back on Plavix with no problems or complications. Is this true or is there a percentage of risk and what percent would it be. From what I understand from what I have read and was told I don't fill comfortable in consenting to have the surgery in till after September. What are your suggestions or recommendations?
J G, Gillette, Wyoming, USA, December 26, 2011

• DixieTN -- We would strongly suggest that you try (and this may be difficult) to have your cardiologist and gynecologist consult with each other. A known side-effect of Plavix and aspirin is bleeding. Since you started having your bleeding problems within a few months of starting Plavix and aspirin (a.k.a. Dual AntiPlatelet Therapy or DAPT) this may be the cause. While guidelines recommend that patients with drug-eluting stents continue on DAPT for a year, if the patient is experiencing major bleeding (requiring a transfusion, which you got) then that may be a reason to stop. BUT, this is a very very big issue among cardiologists and there is much debate at the very top about when it is safe to stop DAPT. Do you know which type of stents you received? For example, a recent study done of Medtronic's Endeavor DES concluded there was no difference in 6 or 12 months of DAPT. Your cardiologist is being cautious because he doesn't want a blood clot to form inside the stents, causing another MI -- however, you've gone almost 8 months now. We can't give you medical advice, but our best suggestion to, as we said, have your docs talk to each other. And let us know the outcome....
Angioplasty.Org Staff, Angioplasty.Org, December 8, 2011

• I am a 47-year-old female a major MI in the LAD in April, 2011. Two DES were placed. Within a few months my menstrual periods became unmanageable, heavy and with such clotting that I was forced into a homebound state. Most recently the bleeding lasted over 7 weeks, on Nov. 30 the gyno prescribed Progesterone to stop the bleeding, with the intent of preforming a Hysteroscopy, D & C and Uterine Ablation. She contacted my Cardiologist for surgical clearance, he responded with a refusal to D/C the Plavix or Aspirin 81mg for even a day. On 12/5, I reported to a local ER dept with shoulder/left arm pain. I was admitted. My enzymes, echo, and EKG were all clear. Consequently, I was given 2 units of blood, raising my hemoglobin from 7.2 to 11.6. Upon discharge the attending Cardiologists gave instructions that I should follow with my cardiologist within 2 weeks (I WILL!) and to D/C the Plavix and Aspirin immediately. I am not comfortable stopping the Plavix and Aspirin. And am so confused about handling the uterine bleeding/surgical correction issue. Any thoughts or input?
DixieTN, Tennessee, USA, December 7, 2011

• PJD -- the American Dental Association put out an advisory several years ago that it was not necessary in most cases to discontinue Plavix and aspirin for tooth extraction. They, of course, weren't talking about 7 at once. Your family doctor's suggestion seems in line with the ADA. -- and BG Shankara from India, your brother has a complex clinical situation and it would be best for his kidney doctors and cardiologist to consult as to the best route. Angioplasty requires the use of contrast for seeing the x-rays, and this may be ruled out due to his kidney failure. Surgery may be the preferred way to go but, again, these are decisions you should all make together with your doctors. And you say 3 valves are blocked...do mean 3 arteries?
Angioplasty.Org Staff, Angioplasty.Org, November 20, 2011

• MY BROTHER IS 54 YEARS AND THREE VALVES ARE BLOCKED HE IS SUFFERING FROM BOTH KIDNEY FAILURE IS UNDER DIALYSIS TWICE A WEEK IS ALSO HYPERTENSION & HIGH DIABETIC IS IT OK TO GET ANGIOPLASTY IN THIS CONDITION AND CAN HE GO THROUGH FOR KIDNEY TRANSPLANTATION KINDLY LET ME KNOW. CAN HE SUSTAIN?
BG SHANKARA NARAYANA, BANGALORE - KARNATAKA - INDIA, November 19, 2011

• I was put on Plavix 2 yrs ago after problems showed up in a stress test. I have not had a stroke, heart attack or a stent. I take 325mg aspirin and Plavix daily and need to have 7 teeth extracted. My cardiologist will only agree to having an oral surgeon (which I can't afford) do this. He is afraid I will have a stroke because he says I will have to come off the Plavix. My family doctor says he sees no problem if I just have one or two removed at a time. Any comments?
PJD, Durham, North Carolina, USA, November 3, 2011

• I had a stent inserted in one artery on 12/15/10 and have been on Plavix since then. I've had no side effects at all. I now need a TURP for an enlarged prostate and may not be able to wait the full year. Since I've been on Plavix for 9 months, can I do without it for 7-10 days to have this procedure or is the risk too great?
Jack, Wilmington, North Carolina, USA, September 27, 2011

• June 2007 I had a Heart Attack & had 1 Cardiac Stent implanted. Since that time I've had a total of 4 additional stents. I have been on Plavix 75mg, ASA, Simvastatin 80mg. since then with no lapses. I have been on other heart related meds off and on as needed. Just prior to my HA, I had major back surgery & fared very nicely :) Now I find I have an additional 4 ruptured discs directly above where my initial back surgery was and I am in desperate need of additional back surgery. Most days I am barely able to walk it's so BAD, not to mention the Sciatica is unrelenting & unbearable! My Neurosurgeon wants me OFF Plavix & ASA 1 full month prior to him performing my surgery. My Cardiologist says NO WAY at all even though my last stent was placed over one and a half yrs. ago. I would be OK with not having more surgery if my quality of life was even close to being bearable; but it isn't!! I can't even begin to recall the last time I slept more than 2 hrs @ a time; most nights I am lucky to get 4 hrs. broken sleep. Has anyone else run into issues like this, or even close? I'd love to hear from others and how things went for them. I also wonder what people who need emergency surgery do? Anyone??
Binky, Mt. Dora, Florida, USA, August 13, 2011

• June 21, 2007 I suffered a heart ATTACK @ AGE 49. a drug eluting stent was implanted due to 85% blockage. I was placed on a regime of Plavix and Aspirin, as well as Simvastatin. All actually went very well with no further incidents or complications until I found out through an MRI I have 4 ruptured discs in my lower back. I had back surgery in March 2008 with awesome results!! Then it seemed the bottom fell out. Since my first attack in 2007 I have had a total of 4 additional stents implanted, again all with great results. My Neurologist will NOT operate on my back until I can be off Plavix and Aspirin for one month. My last stent was implanted only 2 weeks ago, so now I start the one year count down all over again being on Plavix. My discs are SO BAD most days I can barely walk, sit or stand! Every second is gruesome I'm n so much pain! Through all this I am still working as I have no other choice. I have applied for SSD and been denied 3 times. (Appeal time is now in order) I feel I'm caught between a rock & a hard spot.... 5 stents, 4 severely ruptured discs and I am have to work as I have NO family who can pay my rent, food, electric, etc. anyone else in similar spot?
Willow, Orlando, Florida, USA, July 21, 2011

• My 75 year old mom is scheduled for a spinal fusion surgery in June. She has a 12 year old bare metal stent but she is only taking 325 of aspirin daily in addition to Zocor, but no Plavix. There seems to be much confusion about whether or not she should discontinue the aspirin prior to surgery. Any feedback would be appreciated.
Mike A., Chicago, Illinois, USA, May 23, 2011

• Don in Michigan -- Your doctor is correct in that Plavix does not have anything to do with reducing restenosis (blockage by tissue growing inside the stent). But it does have to do with preventing blood clots inside the stent, also called stent thrombosis, which is very serious (30% of the time it causes a fatal heart attack!). There are a number of patients who have posted to this and other topics who stopped taking Plavix prematurely and suffered for it. However, thrombosis is an acute event -- it happens in a very short period of time. In your case, since you stopped for a few days and suffered no ill effects, and then began again...you have not suffered any deficit. Just stay on Plavix and aspirin for the recommended time period.
Angioplasty.Org Staff, Angioplasty.Org, May 20, 2011

• I didn't see an Editor response re: resuming Plavix after a 4 day discontinuance post of May 7. Well, a different doctor told me something yet different today: "During the 4 days you did not take Plavix you were AT INCREASED RISK ONLY (from blood clots). There would not have been any appreciable increase in blockage during that period." Please give us the benefit of your knowledge regarding this issue. I'd really like to understand what risks we face during a brief interruption of taking Plavix.
Don in Michigan, Troy, Michigan, USA, May 18, 2011

• One other thing. While in the hospital during the last bleeding episode with all the excitement of different hospitals and doctors I believe I may have had my Plavix/aspirin 325 doses missed for 2-4 days. When I finally connected with a cardiologist from my preferred cardiology group, I mentioned to him I was worried about being off them for up to 4 days. First he asked me if I'd had any shortness of breath to which I answered no. So quickly? Then he really surprised me by stating if Plavix was missed for all 4 days it would be OK because upon resumption any new buildup which may have occurred during that brief period will be [in effect] cleared out as Plavix was now resumed. I was overjoyed but after reading all these posts I see no mention of this. Kind of a positive 'rebound' effect if you will. Ever heard of this? Now an unrelated question: my left foot/ankle/calf area are more puffy than usual today and the sensation of sore muscles is more too. Thinking I needed to walk some after being bedded up in hospitals so much I went out for a 1 mile waddle. Didn't make it far, I was feeling unstable [dizzy and yucky] enough to return to the safety of my couch. Any comments?
Don in Michigan, Troy, Michigan, USA, May 7, 2011

• Don -- glad to hear surgery is not necessary. As for your cardiologist and stopping Plavix, etc. just be aware that overlapping stents, narrow diameter stents and long stents are situations where there are slightly higher risks for thrombosis, so you should definitely consult with your interventional cardiologist about the risk-benefit of changing your meds. Maybe discuss a platelet reactivity test (blood test) to assess your risk level for clotting.
Angioplasty.Org Staff, Angioplasty.Org, May 6, 2011

• Thank you for your reply. No, I haven't discussed this with the Dr. who placed the stents, mainly because I think he should have checked my medical history which included a colon resection (and the implied colon issues). I think a bare metal stent may have been more appropriate since the Plavix usage can end within a month or two rather than a full year for the DES. I was in the process of trying to get approval from my new HMO doctor to change back to my original cardiologist. Correct, I was not on Plavix prior to the stent placement and I had no g.i. bleeding since I had my colon resection 10+ years ago so there most likely is a connection.My case has an update. Yesterday my long-term g.i. doctor (not available to me subsequently) told me surgery will most likely not be necessary given a diet change and time for my [probable] ruptured blood vessel to heal, about two weeks. Whew!
Don in Michigan, Troy, Michigan, USA, May 6, 2011

• Don in Michigan -- Have you discussed your situation with your cardiologist, the one who placed the stents? The main complication of Plavix and aspirin therapy is bleeding. The fact that you started bleeding two weeks after starting these meds suggests a possible link here (unless you were previously taking these drugs). The guidelines state one year of Plavix and aspirin, assuming the patient is not having complications. You should discuss this with your cardiologist AND have him/her consult with your colorectal doc. There is a risk of thrombosis to stopping these meds, but the risk-benefit needs to be discussed, with you as a partner in the decision. It may be that the bleeding will stop if the drug regimen is modified. But you need to discuss this with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, May 5, 2011

• Had 2 DES (Xience V) stents overlapped put in my LAD artery on 3/31/11. My diverticulosis started bleeding two weeks later and I've been in emergency three times since (now 5/5) for heavy bleeding from my colon. My Colorectal Dr. said I may need to have my entire colon removed unless the exact location of the bleed is determined by nuclear scan, something not yet successful pinpointing the location. I can't keep going into emergency every week or so, so I am thinking the colon removal (w/ostomy bag) may be unavoidable. Do I dare accept this surgery while staying on my Plavix (and aspirin 325)? Seems like I can't discontinue the Plavix for the week or three during/after the surgery until the post-surgical bleeding stops or heals. This is scary. Advice please.
Don in Michigan, Troy, Michigan, USA, May 4, 2011

• Merri in Florida -- Stent thrombosis itself is a rare event, occurring in less than 1% of cases at the one-year mark. With the second generation drug-eluting stents (DES) like Xience, Promus and Endeavor, it's even lower, about half. The recent RESOLUTE US trial showed a 0.1% ST rate. Also the risk for stent thrombosis varies with the individual's "platelet reactivity", the location, diameter and length of the stent (narrower and longer stents are more prone). You're probably fine and, as we've noted, the "Plavix rebound" issue has not been proven in any randomized trials (a couple small ones in fact showed no effect). Some cardiologists recommend staying on aspirin, but that's a question your cardiologist and the physician doing the colonoscopy should discuss.
Angioplasty.Org Staff, Angioplasty.Org, April 23, 2011

• Thank you for your reply. I have passed the one year mark with Plavix, so am in compliance with the guidelines. However, I am afraid to go off even for the 5 days after reading some of the posts. Are these incidents the exception or the rule? Any statistics on this? Many thanks.
Merri, Florida, USA, April 23, 2011

• Merri and Bocanh -- read through these posts and you see that recommendations following placement of a drug-eluting stent are to stay on dual antiplatelet therapy (aspirin plus Plavix) for one year, less for bare metal. There have been some concerns expressed about a possible rebound effect with Plavix, where the platelets become activated for a month or so after stopping, increasing risk for thrombosis, so some cardiologists have weaned their patients off it, gradually lowering the dose. However, this rebound effect has yet to be proven.

Bocanh -- As for stopping after only one month, that definitely has been shown to increase the risk for stent thrombosis, if you have a drug-eluting stent. Have you discussed this with the interventional cardiologist who placed the stent? You should definitely do so and have him/her consult with your surgeon about the risks and possible alternative medications. This is a challenging situation, as you can tell from other posts here, and it needs to be solved by the cardiologists and surgeons working together. Please let us know what they decide. It may help other patients reading this Forum.
Angioplasty.Org Staff, Angioplasty.Org, April 22, 2011

• I have two DES and have been on Plavix and 81mg aspirin for just over one year. I have a colonoscopy scheduled and am advised to stop taking Plavix 5 days and the aspirin 3 days before the procedure. Cardiologist says this is OK. However, after reading these posts I'm very anxious about stopping Plavix. Are occurrences of thrombosis rare or common? Thank you.
Merri, Florida, USA, April 21, 2011

• on Plavix for only a month and now face lung surgery. Must go off plavix. can this be done safely?
Bocanh, Hanover, New Hampshire, USA, April 19, 2011

• My husband had 2 stents as was taking plavix & aspirin for 3yrs. He was advised to stop taking the plavix prior to his surgery. He had the surgery, and suffered a major heart attack while in the recovery room. He remained in the hospital for 3 months where he died from a 2nd major heart attack. My advice... do not stop taking plavix for any surgery!
Tess, Michigan, USA, April 5, 2011

• JT Palmer from California -- thanks for sending in the link. Two things: (1) we have an entire topic devoted to helping people get "Financial Assistance for Plavix and other prescription drugs" and (2) as we state in our disclaimer at the bottom of each page, "Opinions and recommendations expressed on the FORUM are solely those of their authors." So Angioplasty.Org does not necessarily endorse or recommend links posted by readers.
Angioplasty.Org Staff, Angioplasty.Org, March 13, 2011

• This post is in response to Susie's comment. I just wanted to say I'm very sorry for your situation and all you've gone through. If you haven't yet found assistance program for Plavix, you might want to checkout this plavix discount card program by Medsavercard. You also might want to try Rxfreecard. each one of these programs offer different discounts, so its worth trying them all. I hope you find something to help.
JT Palmer, Corona, California, USA, March 9, 2011

• We assume you are not taking Plavix because you have a drug-eluting stent. Stopping Plavix too soon after stenting can increase the risk of stent thrombosis, which is caused by blood clotting inside the stent. The artery suddenly becomes totally blocked and a heart attack ensures. 50% of the time this results in death. In a joint science advisory, issued in January 2008, the American Dental Association, along with all major cardiology groups, specifically advised their members that telling patients to stop Plavix for a tooth extraction was not necessary and that studies had shown that Plavix caused no increase in bleeding in most cases (Page 3, bottom half of right-hand column). You can read about this in our article, "New Advisory: Will Stent Patients and Their Doctors Get the Message?" Is there any downside to stopping Plavix in your case? You should definitely ask your doctor. Especially since you say you need to have "teeth" pulled, not just a single extraction. There have been concerns over a Plavix "rebound" effect, but there is controversy as to whether this is scientifically valid. Also, be sure you tell the dentist that you are on Plavix.
Angioplasty.Org Staff, Angioplasty.Org, January 28, 2011

• Taking 75mg plavix 1x day for 1 year and low dose (81mg) baby aspirin to prevent stroke. Need to have teeth pulled and free clinic only 1 day. Would it be ok to have tooth pulled while still taking these meds or will bleeding be too much? Thanks
Amos, Seminole, Florida, USA, January 28, 2011

• Handyman-dave -- Thanks for clarifying. As we've stated, current guidelines call for a minimum of one year of DAPT after placement of a DES. You are well past that point, but obviously your cardiologist has concerns, as you've said, given your past history. Just a point of clarification you you and other readers: there are two main ways a stent can become occluded: restenosis and thrombosis. And they are very different in the way they occur and in their treatment/ prevention. Restenosis is excess tissue growth inside the stent that then occludes the artery. Some tissue is necessary to cover the metal struts, but excessive growth is the specific process that drug-eluting stents were invented to stop -- the drug inhibits the tissue growth. (Read our Forum topic on "In-Stent Restenosis".) However the "cure" may cause another problem, one that is seen much less frequently: stent thrombosis. The drug in DES inhibits tissue growth and delays healing. It is thought that the platelets in the blood, sensing the exposed metal struts of the stent, may begin to aggregate, forming a thrombus or blood clot, which then blocks the arterial blood flow, often causing a heart attack. Thrombosis happens very quickly; restenosis occurs over time. DAPT (Plavix, aspirin, etc.) is used to minimize the risk of thrombosis. These drugs are not targeted to reduce the tissue growth seen in restenosis. A question you might ask your cardiolgist is what was the cause of your original occlusion. Again, nothing here should be used as medical advice, only as a starting point for a discussion with your doctors. We also again urge you to have your interventional cardiologist and surgeon talk to each other.
Angioplasty.Org Staff, Angioplasty.Org, January 28, 2011

• Sorry, that should have been 4/2009 and 8/2009 NOT 1999. (Too much hydrocodone for the pain down my leg I'm afraid.)The stent in 4/09 was a DES, the one 4 months later in 8/09 was a bare metal. The bare metal was twice as long as the DES and was applied over (inside of) the original DES. Given my history of tending to develop blockages when the Plavix is stopped even briefly, the cardiologist is afraid. I am told there is a strategy using Lovenox but am also advised it will not work for me. Any suggestions?
Handyman-dave, Harrisburg, Pennsylvania, USA, January 28, 2011

• Handyman-dave -- are you sure you got a drug-eluting stent in 1999? They weren't approved in the U.S. until summer of 2003, although you may have gotten one as part of an early clinical trial. Plavix and aspirin (Dual Antiplatelet Therapy or DAPT) normally is prescribed for 4-6 weeks after a bare metal stent or one year or more after DES. When did you get your last DES. We have recommended in the past that your interventional cardiologist and surgeon speak with each other to work out a plan -- which may involve going off Plavix briefly but staying on aspirin, for example. But they should talk to each other to clarify the medical issues involved.
Angioplasty.Org Staff, Angioplasty.Org, January 27, 2011

• After having a DES in 4/99 I re-occluded in 8/99 after stopping Plavix. They covered the DES with a bare metal stent and restarted the Plavix and aspirin. I developed stenosis in L4-5 with severe pain down left leg starting in 8/10. It has gotten progressively worse. I recently had angioplasty again at the stent site to open a developing blockage. I have found a neurosurgeon who can do a laminotomy and foramenotomy microsurgically but my cardiologist has no strategy to deal with getting off the Plavix to allow the surgery. I cannot live with the pain down my leg but am also told I cannot live without the Plavix. I have addressed the issue with them but am not given any hope. Any suggestions as to how to proceed?
Handyman-dave, Harrisburg, Pennsylvania, USA, January 27, 2011

• Susie from Tampa -- terrible story, we're so sorry. Two things: one, in a joint science advisory, issued in January 2008, the American Dental Association, along with all major cardiology groups, specifically advised their members that telling patients to stop Plavix for a tooth extraction was not necessary. You can read about this in our article, "New Advisory: Will Stent Patients and Their Doctors Get the Message?" A second issue is what's been called the Plavix "rebound" effect. It was the subject of a study we reported on just a month after the above advisory and it documented observational data where patients had twice the incidence of thrombosis and heart attack in the 90 day period after stopping Plavix. This occurred both in stent and non-stent patients. The rebound effect has been disputed by a couple small studies since, but the authors of the study have told us that the data show something is happening and more recent study has shown the effect is even more pronounced in the first 30 days. The studies authors, by the way, have read over this Forum and found the stories contained here to totally mirror their findings.
Angioplasty.Org Staff, Angioplasty.Org, January 6, 2011

• I stumbled on this site looking for assistance in paying for my husbands plavix. Our story is similar to may that are posted. My husband (57) went to the dentist in 2008 to have a tooth pulled. He had been taking plavix for over a year - he had a DE stent. The dentist called the cardiologist and he said to be off the plavix for 5 days. The day after he went to the dentist - he went down in the shower. Thank GOD I was home and called 911- he had 4 heart attacks before he got to the hospital. His stent collapsed and the other artery was 100% blocked. He was in a drug induced coma for seven weeks and we made it through all the complications. He has some brain damage from not getting any oxygen for over 5 minutes. He also has a pace maker/defibrillator implant. We have lost just about everything we worked 38 years to achieve. So just be careful when someone, even a physician, tells you to stop taking your plavix.
Susie, Tampa, Florida, USA, January 3, 2011

• Sharyn from Atlanta -- what type/brand of stents did your husband have implanted? And when exactly. Guidelines state that for bare metal stents 4-6 weeks of antiplatelet medicine minimum (many go with 6 months) and for drug-eluting stents it's a year. Bleeding is a known complication of any antiplatelet drug and, if a patient is prone to this, or is anticipating surgery, often a bare-metal stent is used so the patient can come off antiplatelet medication sooner. The reason antiplatelet therapy is used after stenting is to prevent the blood clotting inside the stent while the metal struts are still exposed. Over time, the endothelial layer of the artery grows over the stents.
Angioplasty.Org Staff, Angioplasty.Org, January 3, 2011

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