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Plavix (Clopidogrel) and Surgery 
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Current Postings on This Page (36):
• 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?
• 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?
• 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?
• 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? • 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? • 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? • 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?? • 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? • 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.
• 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. • 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 -- 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. • 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 -- 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. • 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. • 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. • 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 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. • 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. • on Plavix for only a month and now face
lung surgery. Must go off plavix. can this be done safely? • 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! • 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. • 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. • 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. • 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 • 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. • 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 -- 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. • 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? • 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. • 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. Forum Editor, Angioplasty.Org, January 3, 2011 |
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