Current Postings on This Page (134):
my father had undergone angioplasty on 27 march 2012 on 10 April he again was admitted for chest pain ,in diagnose and check angio blood clot was confirmed , after doctors treatment clot is bursted, seeing the critical blood sample were send for lipoprotein and homocystine results found homocystine was 3 times normal limit. mean time re angio confirmed clot again in no time doctor placed a stent under stent to avoid clot ........................kindly suggest the treatment and comment on the process doctor taken please advice
mukesh, India, April 16, 2012
Hi this is Hopeful in Georgia you are correct about 2 days after my post the pain stopped, which made it about 6 weeks after stenting. I haven't had any more pain since that time. I even walk on my treadmill and is fine, so may there is hope for us all!!!!!!!!!!!! Thank You, Hopeful
Hopeful in Georgia, Buford, Georgia, USA, April 1, 2012
Hopeful in Georgia -- You've posted to a topic on stent thrombosis. Check out a more appropriate topic, "Not Feeling Well After Stenting". You'll find that various pains after stenting in some patients are not uncommon, but they do go away with time. The question is whether these pains are angina and whether something is amiss with the stent that was placed. If you suspect this or are concerned in any way, consult your cardiologist, if only to rule out anything serious.
Angioplasty.Org Staff, Angioplasty.Org, March 20, 2012 |
I had a stent in Oct. 2011 it collapsed another in Feb 2012 am still having chest, jaw, arm,and shoulder blade pain. At first it was every day real bad now I am having skip days without pain but it comes back. I mean one day none the next pain again. Anyone know if this is normal and will the angina ever go away????
Hopeful, Buford, Georgia, USA, March 14, 2012
HA from Saudi Arabia -- The answer to your first question depends upon the specific stent. Our interview with Dr. Giulio Guagliumi discusses this very issue, and specifically refers to the ODESSA clinical trial he conducted, measuring stent strut coverage at six months, using Optical Coherence Tomography (OCT). The Endeavor stent had almost 100% coverage, better even than bare metal stents -- however because it showed more tissue growth, it also showed more neointimal hyperplasia, tissue growth inside the stent which may or may not have clinical implications for restenosis. The Cypher stent had the most uncovered struts, more than 8%. We are looking forward to continuing information on the newer stents since that trial was conducted. As for a medical test for coverage, that would be OCT -- however, this can only be done during an invasive catheterization procedure and, even then, it's not 100% clear if the tissue covering is actually endothelial cells or fibrin.
Angioplasty.Org Staff, Angioplasty.Org, March 12, 2012 |
How long does it takes for tissue to cover DES ? And how we can get reassurance that DES is now covered (Medical tests)?
HA, Kingdom of Saudi Arabia, March 10, 2012
vmaxdude2000 in Rochester -- Although your post is a bit off-topic (not about stent thrombosis) there is no question that a proper diet is of great importance -- would that patients with significant coronary artery disease could reverse all that with diet. But modern medications have worked wonders in reducing the progression of heart disease and, when they aren't enough, intervention with balloons, stents or surgery. That being said, diet, exercise, stopping smoking -- these are all extremely important in reducing the risk factors that are under our control.
Angioplasty.Org Staff, Angioplasty.Org, February 9, 2012 |
Everyone here should read the best seller Eat to Live, by Dr. Joel Furhman. It's your diet that is killing you! Change your diet and reverse heart attacks and diabetes and get off the medication. Trust me get this book and you will understand. The medication you are taking is treating the symptoms not the cause. The money you save by not taking medicine you can use to by fruits and vegetables. NUTRIENT DENSE FOODS! IT'S simple. Plus will you will lose a ton of weight.
vmaxdude2000, Rochester, New York, USA, February 9, 2012
Patty in Florida -- Were you prescribed Plavix after a stent was implanted? If so, when was the stent put in? After a drug-eluting stent, patients should take Plavix for one year. This is to prevent stent thrombosis (a blood clot inside the stent, which can cause a heart attack). We urge patients not to change any medication without consulting their cardiologists. Easy to say, but in the U.S. healthcare system, not always possible, as your story shows. Check out our Forum Topic on "Financial Assistance for Plavix and Other Prescription Drugs" -- you might find some help there.
Angioplasty.Org Staff, Angioplasty.Org, February 1, 2012 |
i have went off Plavix due to not enough money lately. my concern is now when i refill my Rx will i have a problem with it. I'm really worried. can anyone help ease my mind. thanks.
Patty, Fort Meade, Florida, USA, January 30, 2012
msm8143 in Virginia -- Clotting inside the stent (stent thrombosis) is an acute event. In other words, it happens quickly and the resulting event is pretty immediate and usually an emergency situation. If you read our Topic on "Not Feeling Well After Stenting", you'll see a number of posts relating to pains after stenting. Some of these will go away in time but, as we always recommend, if you are concerned or especially if the pain feels like the angina you had prior to stenting (and you are describing that) you should contact the interventional cardiologist who did the procedure and discuss this issue. And keep the zforum updated on what you find out, so others may benefit.
Angioplasty.Org Staff, Angioplasty.Org, January 18, 2012 |
I had a stent inserted 4 weeks ago and felt better than I have in years. I have been on Plavix and 2 baby aspirin daily. However, the last week I have had intermittent episodes of the same chest discomfort and dyspnea I had prior to the angioplasty. I finally took a nitroglycerin tab yesterday that relieved the discomfort for about 30 minutes. I can't imagine the stent would have clotted and there were no other areas with any blockage. I don't want to take any chances but don't want to undergo another cath if it isn't necessary.
msrn8143, Virginia Beach, Virginia, USA, January 18, 2012
Lance from Miami -- how
long ago had you gotten your second most recent stent before you stopped
the Plavix? And what type of stent was it (Brand name if you know it)?
Angioplasty.Org Staff, Angioplasty.Org, January 7, 2011
I recently had another stent put into my RCA
(right coronary artery) that makes number 7. I had stopped taking the
plavix for approximately 3-4 weeks and I developed blood clots in the
artery and had to have a stent put in. The doctor told me that Plavix
and I are married for life. It seems that since I had my first heart
attack in July 2003 and have taken Plavix all that time why after only
3 and 1/2 weeks would I develop clots?
Lance from Miami, Miami, Florida, USA, January 6, 2011
Martin from Australia -- was your heart attack
caused by a blood clot?? Or had your previous stents restenosed (blocked
up with tissue growth, etc.)?? There's a big difference, even though both
result in a blocked artery. The blood clot occurs quickly, often causing
a heart attack. Restenosis occurs more gradually over time. A nuclear stress
test (a.k.a. perfusion imaging) may show if the heart is
not getting
enough
oxygen or
blood flow.
A CT
scan may show if an artery is blocked, but sometimes is not able to image
well inside of a stent (the metal in the stent causes artifacts on the
image).
Angioplasty.Org Staff, Angioplasty.Org, July 14, 2010
I'm 49 and pretty fit, non/smoking/non-drinker
but with hereditary high cholesterol and family history of thrombosis.
I just had a second heart attack
after 'boot-camp fitness class. My right artery was 100% blocked and they inserted
two DES stents in the same area they had placed one DES 4 years ago. My cardiologist
has now put me on plavix for life to counteract blood clotting which seemed
to have 'come from nowhere, no probs with Plavix and is covered under
Austhealth
care. My concerns are that stress tests etc are not picking up anything prior
to both heart attacks and i have minimal symptoms beforehand with maybe some
slight chest pain etc. Looking into CT scans as a better option for forewarning
and interested to hear from others who have had multiple stents and perhaps
I need bypass if there are any further problems. It is always the same
right artery
that is blocked. Also exploring link to lots of air travel bringing on problems?
Cheers, martin
Martin Stapleton, Sydney, Australia, July 8, 2010
Maria from Australia -- an angiogram (diagnostic
only) will show if your husband has a significant blockage that is the
cause of his problems. After that you can discuss with your cardiologist
the options and whether a stent will help. Perhaps your cardiologist "suspects"
a blockage and assumes he needs a stent, but that should be a decision
you all make together. As for nothing getting cured, people on these Forums
writing with only problems, etc. -- we've written about this before, but
patients who post here seem to do so specifically because they have a problem.
There are hundreds of thousands of patients who get stents and interventions
who are fine and who get relief from angina or, in the case of emergency
angioplasty during a heart attack, they have their heart muscle preserved.
Angioplasty.Org Staff, Angioplasty.Org, July 7, 2010
Hello my husband has been tired the last 3
weeks, bit breathless. Cardiologist said probably has hereditary heart
problem like his father. Booked him for an angioplasty in 3 days, we
are scared by what we have read, Doc wants to give him a stent. Husband
has
bad oral hygiene for yrs, scared of dentist, I just read on the net
inflammation triggers liver into making masses of cholesterol, in order
to protect
the body from bacteria in gums. Have you guys had bad teeth or gum
problems preceding heart disease. I am feeling reluctant to support him
in having
the angioplasty done now, you all seem so frightened and nothing has
been cured, nothing is better. What the hell are these Cardiologists
doing to you all. I am in business and if I can't guarantee my work
I shouldn't be in business, and if I done the wrong thing by someone
I
would need to rectify it, and be accountable for it. For 3 days now
My husband has been taking a nutritional supplement called Proargi-9,
invented
by Dr. J. Joseph Prendergast, Nobel Prize winner from the High Desert
Heart institute, in USA. If I lived in USA I would go there, this DR
is committed to humanity, he reversed his own AVD.
Maria Seed, I'm a wife and mum,, Toodyay, Australia, July 2, 2010
RN from California -- are you by chance taking
a statin drug. These have known side-effects of muscle and joint pain for
some. Haven't heard of this problem with Effient.
Angioplasty.Org Staff, Angioplasty.Org, June 15, 2010
I had five Xience V stents in LAD & CX implanted
in Sept 2009, then two weeks later they attempted to unblock the arteries
in both legs, but was only
successful with one, my dr prescribed Effient 10mg, I have had very bad pain
in the legs and ankles since, mainly in the one that was unblocked, I had tried
PT with no improvement, I went off my Effient for 4 days and did have some relief,
but I am concerned about blood clots, how long am I going to have to take this
medicine, I believe it is causing my problems with my legs.
RN, El Centro, California, USA, June 4, 2010
Late stent thrombosis risk increased if stent
crosses another artery? I have a huge 32 mm Taxus Express II in my proximal
LAD that crosses another coronary artery. I am 4 years out now and doing
very well on Plavix and aspirin. My cardiologist seems ambivalent about
stopping DAPT - stop if I want or stay on it as long as no problems.
I never see any data or even comments about if the risk is increased
if the stent crosses another artery. It seems to me that the coating
of the part "in the open" not against an artery wall would be more difficult??
What is known about this? I also know that thrombosis increase with stent
length, and 32 mm is looong. I'm 62 and still have teens at home and
want
to do what I can. Thanks!
JW MD, Shelbyville, Indiana, USA, May 20,
2010
I have 2 Bare Metal stents since Dec 30th 2009
went off Plavix after four weeks and stent plugged up they went in and
opened it back up. Now doctor wants
me on Plavix for 6 mos to a year but I have bare metal stents is this right?
Having a hard time with this drug starting to itch and makes me feel awful
most of the time. Doctor wants to put me on a new drug that is only a
year old in
the states it's Effient but may cause internal bleed more than Plavix. I'm
also am a bleeder so I have to be very careful. And I'm very scared anyone
have any
suggestions?
Victoria, Chino, California, USA, April 27, 2010
With the exception of finance, accidents and
surgery associated problems, what, if any, are the long term issues
associated long term use of Plavix, Low dose Aspirin and Warfarin? ie
10 years or
more.
Tel, United Kingdom, March 28, 2009
Alex -- your questions are the topic of much
discussion in our other topics on "Plavix
and Aspirin" and "Plavix
and Surgery", listed in the right hand column. Guidelines
call for Plavix to be used at least 6 months after DES implantation;
many
cardiologists are still concerned about very late stent thrombosis
and so have continued Plavix in their patients for longer, assuming
there
are no complications from it. Aspirin is recommended for life, again
unless there are complications. Surgeons usually request Plavix to
be stopped a week or so before surgery, but these issues should be
discussed
with BOTH your surgeon and cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, March 23, 2009
I am 46 years old. I had DES-stents placed
in mid LAD and proximal first diagonal in January 2005. I started taking
Aspirin/Plavix every day since then. My cardiologists always tells
me to take it forever. Because of financial problem, about nine months
ago
I stopped plavix for 5 weeks and then restarted it again but taking
it every other day. Now I want to stop it completely. What are the risks
of stopping plavix (late thrombosis) given my history and the fact
that
I am taking it every other day? Does the risk end at any time or continues
for life? If I stop it today, how many days later I could have a surgery.
I already
appreciate your help. Thanks.
Alex, Los Angeles, California, USA, March 19, 2009
Hello, I am 56 and have 21 stents and had open
heart, 5 grafts in 2002. Since 2002 I have had stent clots every 2 to
3 months with new stents placed
each time or balloon angio. The most recent 3 days ago, I was in construction
and was fit until I could do no exercise without pain and have since gained
some weight. I am considering having another open heart to redo the grafts
and start
again, this could buy me some time. I have also had at least 7 heart attacks
and my ejection fraction is 50%. Maybe someone has some advice since the Doctors
have very little.
Ken, Missoula, Montana, USA, February 1, 2009
Katie -- we're very sorry for your loss. The
jelly-like substance sounds like it might be thrombus (a.k.a.
blood clot) but the situation you describe sounds somewhat complex and
it's hard to tell from your description exactly what occurred. Having
two stents "collapse" simultaneously is uncommon, only because
stents are pretty strong, once expanded fully. As for Plavix, normally
antiplatelet or antithrombin drugs are given intravenously during a stent
placement, specifically to avoid clotting. But these are complex medical
issues and impossible to describe without specific knowledge. If you
haven't, ask the interventional cardiologist to review the case, just
to set your mind at ease as to what occurred.
Angioplasty.Org Staff, Angioplasty.Org, December 28, 2009
Can anyone tell me if they have heard of anyone
who went off the Plavix for a few weeks, went back on it for at least
a month and then had a major heart attack during a heart catheterization?
What was found was a "jello" like substance that was taken
from one of the stents. Also, keep in mind that the patient had already
undergone one heart cath a few days earlier in which two additional stents
were put in and angioplasty was used for the drug coated stents. At that
time, the two new stents collapsed and they had to go back in for another
heart cath days later which is when the heart attack occurred. The patient
died two days later after being placed on a ventilator and balloon pump.
I need to know if anyone else has heard of this just to understand what
happened to my Mom.
Katie, Dearborn, Michigan, USA, December 21, 2008
Patrick -- This is a topic on stent thrombosis
which is very different from your described problem. Total occlusions
are one of the final challenges of angioplasty. There are
ways of getting
through
them and negotiating the blockages, using ultrasound, magnetic guidance
and retrograde entry (coming in from the opposite or even both directions).
But a chronic, old, calcified total occlusion (i.e. "like cement")
cannot be opened at present -- also because the occlusion is very old,
your
circulation has already developed collaterals to supplement the flow.
Angioplasty.Org Staff, Angioplasty.Org, December 6, 2008
I had posted under another thread on this forum
in February of 2007 regarding the total blockage in two stents that I have
in the LAD artery. A reference was
made in response regarding ongoing research on the topic of "chronic total occlusion".
My cardiologist informed me that the blockage was "like concrete", and I have
another stent in the RCA, as well as collateral arteries that have helped. Are
there any updates regarding possible solutions to the total occlusion? Has anyone
heard of a way to unblock DES that are completely blocked "like concrete",
according to my Cardiologist? Thanks.
Patrick, Costa Mesa, California, USA, December 6, 2008
Has there been any more conclusive research
on the plavix rebound problems? I've had a medicated stent for 2 years
and I'm still taking plavix. Is there any kind of weaning off protocols
for safely discontinuing plavix? I will be discussing this with my cardiologist
but wanted the benefit of any research you
may have. Thanks.
Jack, New Hampshire, USA, November 25, 2008
To Ben H. in Mass,
Ben, if you are concerned, then invest your own time to learn! This fantastic
website has a wealth
of information, your topics were discussed numerously, all you need to
do is read and learn, take charge of your
own life. You wrote "heart stopped briefly". Although you did not say so, I assume
that it was your own heart, so own it, damit, take charge of that ticker of yours.
You listed drugs that others prescribed for you, but you did not list any other
instructions. I suspect that your doc also instructed you to do some of the following
- quit smoking, loose weight, exercise, reduce stress, yatta, yatta, yatta. The
sooner, the better. Ben, we are in this together, this website facilitates it
well, but it is a forum for sharing, not some free doctor thing. You made it
last July, just as I made it couple years ago. Here are some optimistic words
- cooperate, or even compete with your doc!!! How? When he prescribes Lipitor,
take it as prescribed, but when he prescribes diet and exercise, beat his targets!
It is something you can live with. Finally, IMHO, just in case the doc did not
say so, make sure to take the Plavix and aspirin with food, not on empty stomach.
Tom, California, USA, November 25, 2008
Hello fellow stent owners - I am 41 years old
with 25 stents and I have advanced heart disease. I recently started
a blog on the subject. You can read
my story at http://www.lumponablog.com/?page_id=371.
I have linked to angioplasty.org as I have found it to be one of the best sites
on the internet concerning PCI. I hope my story will encourage others to hang
in there.
Lumpy, Austin, Texas, USA, November 13, 2008
For those who are worried about stent thrombosis,
while using a DES stent, AND YET want the benefit of a lower restenosis
rate, when using a DES as compared
to a bare metal stent, you may want to consider using the latest DES that has
just been approved in Europe, i.e. the Nobori DES by Terumo and the Bio-Matrix
by Biosensors Intl. Both DES uses a bio-degradable polymer, and the manufacturers
claimed that the DES will revert to a bare metal stent in 6-9 mths. However,
if you do consider this, please seek your doctor for advice. Rgds Desmond
Desmond, Singapore, November 12, 2008
Ben --
We spent last week in Washington at the cardiology conference where
the Danish
study was presented. We will be posting an article soon
about the Medtronic Endeavor safety issue, but the short story is there
is
no increased risk per se with this stent because the study only reported
up to one year and very late stent thrombosis (what the FDA and everyone
else has been concerned about) is defined as stent thrombosis that happens
AFTER one year. With the CYPHER and TAXUS stents, there has been seen
an increase in thrombosis of about 0.5-1% more per year -- but the Medtronic
Endeavor has reported a significantly lower rate of very late stent thrombosis
(VLST), about 1/6 of that -- and the data show it basically flattens
out after a year, with no increase in VLST. The Endeavor does have a
higher "Late Loss" (narrowing of the stent diameter) which hasn't translated
to clinical differences in most other trials. The investigators, as well
as many of the panel members, were surprised at the Danish study results,
not so much that the Endeavor was less good than the CYPHER (the figures
for the Endeavor were similar to what's been seen in other trials) but
that the CYPHER results were so good -- uncharacteristically so.
Angioplasty.Org Staff, Angioplasty.Org, October 26, 2008
If I may ask, has anyone here had experience
with EuroCor's Taxcor stent
system?
S., Massachusetts, USA, October 26, 2008
Like so many of us, I have had a DES fitted
what is now 18 months ago, and I continue to take Plavix and Aspirin.
I just cannot understand how the medical
profession, both stent manufacturers and cardiologists, have not come up with
a definitive statement between them, about just what we are expected to do.
I for one am not in a position, to make a judgement, and I think it irresponsible
of them to say nothing.
tel, UK, October 25, 2008
I had an MI on July 10 2008. Heart stopped
briefly on cath table. An Endeavor DE stent was placed in LAD. On July
13, while still in the hospital, there was a repeat blockage, and a
second catheterization took place. I have now finished a ten-week cardiac
rehab
course, and have had no symptoms of a possible repeat blockage. I am
concerned about the conclusions of the Danish study of Endeavor vs.
Cypher stents which was released last week. What is the best way to be
aware
of the latest developments and/or possible recommendations for modifying
my present treatment (Plavix, aspirin, Lisinopril, Lipitor, Metoprolol)?
Thank
you.
Ben H., Massachusetts, USA, October
23,
2008
It is Oct 2008 I am going for 2 LAD stents and
not decided whether to get DES or not ? what is the general opinion now.
RG, Shelart, New York, USA, October 4, 2008
Hello all, well I always thought that I was
in great shape for a person nearing 50. Always ate well (too well!),
non-smoker, regular exercise. I started having severe angina whilst climbing
up one of the many cathedral towers in Barcelona. I did not think much
of it because the pain just came and went. Months later, I was in Bali
just sitting on the beach having a drink and had another attack which
was much stronger and the pain lasted longer. My wife insisted I go get
a check up. To cut a long story short, I eventually had a angioplasty
then had 2 BM stents 1XCAD, 1XLAD done in Switzerland. About 2 months
later had restenosis in 1 of my stents and had to get a DES. Now, 7 mths
later am told that the artery I had the DES is still blocked and that
I have to consider a bypass graft. Does this ring a bell with anyone?
I am from Singapore and live in Switzerland and do not understand swiss
german very well so, I consider myself to blame for not taking the time
to understand what is being done to me and just trusting the doctors
advise. Plus, I am a cinematographer and am always on assignment in different
countries so, I did run out of Plavix in Bali for about 14 days.Some
of you guys must think I have a death wish. I have since kept myself
well informed and would like to hear from anyone with the same symptoms
and who had to have a bypass graft after getting stents. Thank you and
stay well.
Steve L., Switzerland, August 9, 2008
My husband just had a stent put in and is taking
plavix. The docs did not explain the risks of coming off plavix or
how long he would be on it, or that if he misses a few doses he could
have
a heart attack. That is so that they can get more people convinced
that it's a great drug before they know whether it is great or not.
The docs
get free materials, food, trips from the drug companies and they
also are into helping patients. And to do this they need patients that
they
can include with their research. That is why we all get partial or
incomplete info by docs who want to try this stuff. Now is my husband
stuck on plavix
forever
or what? No one explained any part of what I read in this site.
Marilyn S., Massachusetts, USA, June 27, 2008
Walt -- thanks for writing in. July 2007 was
just prior to when the issue of increased tendency of late stent thrombosis
in drug-eluting stents (DES) surfaced. We've seen DES usage drop from
90% to the low 60's. Again, the occurrence rate is very small (but
try telling that to a man who fell into a snow bank and almost died).
There
may have been very good reasons for placing DES in your arteries --
remember that bare metal stents definitely have a higher risk of restenosis.
But
your point is an important one -- that patients should be fully informed
about the implications of each type of device, so they can make an
educated choice.
There is definitely a cause for concern about the increased
risk of late stent thrombosis
with
DES,
especially when paired with a recent study stating
that Plavix
may
have
a rebound
effect,
causing a doubling of the risk of thrombosis and heart attack with the
90 days after stopping. As you point out, patients who have had
a stent thrombosis are more likely to get one again -- that's because
some people are more likely to form clots due to genetics, lifestyle,
lipid profile, etc. And that may be why stopping Plavix for even as little
as two days had such a negative impact. Obviously you are someone who
should be on Plavix long-term, assuming there are no bleeding or other
complications. What does your cardiologist say?
Angioplasty.Org Staff, Angioplasty.Org, April 28, 2008
My name is Walt and I had a major cardiac event
July 7, 2007 and they found two blockages, 90% and 70% in the same artery.
On 07/09/2007, they implanted
two TAXUS drug eluting stents with absolutely no explanation to the difference
between BMS and DES, nor any information about that I would have to be on Plavix
with Aspirin the rest of my life. I am on three other meds also. I also had a
pace maker/defibrillator put in the next day. On Jan. 6th, 2008 I had a stent
thrombosis with absolutely no warning. I fell into a snow bank next to where
I was washing my car to die, but the defibrillator shocked me three times to
get my heart started again. (The Dr. showed me the read out from defibrillator
of the event.) (One week prior to the stent thrombosis I was out of Plavix over
the weekend -- 2 days -- huge mistake.) Went back to hospital to find 95% and
70% blockage at both TAXUS stents in just 6 months. Stent thrombosis
in most cases
is fatal where restenosis is more gradual in forming. It looks to me like the
drug companies win in both cases, triple cost of stents, (about $2,500 each)
and the addiction to Plavix for life (about %1500 per year) or die. If I would
have known then what I have research now, I would have never let them implant
drug eluting stents the first time. They replaced the stent blockage at the TAXUS
stents, with the BMS half in the TAXUS stent and half in the vain. I now find
out that if you have had a stent thrombosis, you have a 1 in 6 chance of having
another. Not look forward to another shocking experience. By the way one week
later, Jan. 13, 2008 while watching TV, my defibrillator shocked me four times
for no reason at all. My heart was working just fine. What are my options, I
am 66 years old, never smoked,
200
lb. six foot and thought I was in great health.
Walt Beermann, Primerica Financial Services, Denver, Colorado, USA, April
17, 2008
This research would certainly explain my experience.
Had a Taxus DES fitted to my Circumflex artery in December 2005 after
silent MI. Only 45 at the time. On Plavix for 12 months. 73 days after
stopping Plavix had a heart attack whilst driving my car circa 70mph.
Fortunately was passing a hospital at that moment in time, parked the
car by the Emergency entrance, walked in and was treated immediately
(by clot busting drugs). Pain to treatment was 27 minutes so got away
with no damage to my heart. Angioplasty 36 hours later could find nothing
wrong with me or any sign where the thrombosis had occurred, but good
condition of arteries suggested a Late Stent Thrombosis. Have been
on Plavix since. I don't smoke, am pretty fit and lead a relatively healthy
lifestyle. Will be interesting to see whether further research will
provide
evidence to support this illuminating
research.
David, England, February 8, 2008
The Study -- I have had two stents placed some
10 months ago, am taking Plavix. This new study gives us the raw figures
but analysis of what those numbers
mean may take some time. I don t believe one can yet point the finger at Plavix,
(Clopidogrel) For any drug that protects against clotting, one would expect
the number of thrombosis events in patients to increase significantly
when it is
discontinued. The very reason for taking the drug is because patients have
conditions which put them at risk to the formation of a clot. In other
words, had they not
been on Plavix, many patients would have thromboses over a period of time,
which were prevented by the drug. Plavix protects against thrombosis
but does not fix
the underlying condition, so if those conditions persist, when the drug is
discontinued the events finally occur, crammed up like a concertina in
the months following.
I would agree that if you have taken the drug following stent implantation,
it would be wise to have a final thorough checkup and consultation as
advised by
our forum editor before discontinuing. Maybe someone can advise as to how this
may be best accomplished.
Keijo Musto, Jamberoo NSW, Australia, February 7, 2008
To All Patients
On Plavix: take note of a very
important new study published in today's Journal of the American
Medical Association. The finding are basically that there may
be a "rebound effect" when you stop taking Plavix -- so
for a period of around 3 months immediately after you stop, the risk
of your blood clotting and having heart attack, is DOUBLE what it
is later on. And this effect was seen no matter how long the patients
were on Plavix: 3 months, 6 months, a year and more. And the authors
studied over 3,000 patients.
This does NOT mean you should not take Plavix. The
benefits of the drug, especially for stent patients, are well-documented.
It means that there needs to be more research as to what this effect
is and possible strategies for going off Plavix -- for example, slowly
reducing the dose, or increasing aspirin during this period, etc. The
advice to patients that the co-author of the study gave to us at Angioplasty.Org
is that if a patient has finished their prescribed dose of Plavix, they
should discuss with their cardiologists whether they should continue
or not, especially in light of this study.
Of interest to us also is the fact that a higher risk
of blood clot mean that possibly that at least some of what has been
seen as "stent thrombosis" might be related to this rebound effect of
Plavix, and is not a problem with the stent at all.
Angioplasty.Org Staff, Angioplasty.Org, February 6, 2008
D/Sir.Dr Ashok Seth of MAX Heart and Vascular
Research at SAKET N DELHI did Angioplasty and he told me after the check
angio that it is thrombosis and not restonosis.Why it was not removed..
is because i have some Ulcer at the small intestine which cause me to
become anemic and right now it is under treatment of a Gastroenterologist
Mr Vivek Raj also from Max. after 2-2.5 months. Dr. Seth has asked me
to come again and then my Angiography and stent removal will take place.
What I am really worried is that what is the reason for thrombosis and
what steps
are required for its prevention.
Dr Bishwaranjan kumar, Bihar Govt, Bihar, India, February 4, 2008
Dr. Kumar -- are you sure your cardiologist
called it "thrombosis"? Stent thrombosis is defined as a blockage caused
by blood clotting (the causes of which are several) -- but blood clotting
happens pretty dramatically and needs to be opened immediately (a clot
tends to block the entire diameter of the stent/artery, usually causing
a heart attack). How did the thrombosis clear? Perhaps he/she meant "restenosis",
which is the growth of tissue
-- something which usually takes a bit of time to occur, and can be partial,
causing anginal pain, but not an infarction (heart attack). We assume
you are remaining on aspirin and clopidogrel (Plavix).
Angioplasty.Org Staff, Angioplasty.Org, February 2, 2008
I am 51 yrs old with absolutely no history of
smoking/drinking/obesity/BP etc. I maintained 70 kgs wt for last 5 yrs
though I was chronically Anemic due
to gastric ulcers.On december 14 2007,I had a severe pain during sleeping and
after which I underwent angioplasty and 2 DES where put.One on the LAD (100%
block) and one on the right minor artery of the heart. After 25 days,on
the 21st of
january 08 during the period which i took all precautions about drugs (clopidogrel,
aspirin and all such drugs etc)and food, i was experienced same anginal pain
during normal activity and saw my cardiologist who said it is very rare but your
LAD (bigger) one stent has been reblocked due to thrombosis. While he could not
explain why?and whether it will repeat ..i am really worried about my fate..pl
help me ..i am really worried..What steps/tests should i take more?what will
happen to me? will i die early ?man i have lot of responsibilities to handle
as I am only 51 yrs
old with 2 kids and a old father.
Dr Bishwaranjan kumar, Bihar Govt, Bihar, India, January 31, 2008
EM from Greece -- it's really hard to say why
you had these heart attacks just months after stopping Plavix, but stayed
tuned to this site -- we're going to be covering this and other issues
with Plavix and stents in the very near future.
Angioplasty.Org Staff, Angioplasty.Org, January 31, 2008
Well I haven't got the strength to read all
posts here but I would like to state my experience in a few words. I
had a heart attack at the age of 23. No explanation was given (apart
from smoking) but I had a DES inserted. A year later I was told to stop
taking Plavix. Two months after that I had a second, nearly deadly attack.
Back on Plavix for a year and again two months after stopping taking
it a third attack. Luckily I was 10 minutes away from the hospital. I
was on the spot treated with PTCA and the doctors saw that the stent
was fully 100% clotted. Thank god the doctor after frustrating tries
managed to save me and placed a second DES on top of the first. Now 2.5
years have past with no problems and Plavix along with aspirin is more
important than food and water. But the psychological effects from all
that...far beyond description. No one ever explained to me what was going
on and I came to find the truth months after the third attack on 09/2005.
People ask persistently more than one doctors for information. DES help
thousands of people but that 0.6% or 3% or whatever "small" number of
people (0.6% x 3000000 des/year=18000 people) is risking their lives.
I just
got lucky...
EM., Athens, Greece, January 23, 2008
R. from Wisconsin -- call the interventional
cardiologist who did the stenting and report your symptoms. There may
be other things at work here. Stent thrombosis (or blood cltting
in the stent) is a pretty acute event, that is, it happens quickly, and
is pretty dramatic. But don't hesitate to call your cardiologist. That's
why he/she is there.
Angioplasty.Org Staff, Angioplasty.Org, January 20, 2008
I developed restenosis and was restented on
Dec.31, 2007. This time with Cordis stents. Since that time I have had
increased shortness of breath and the
pressure in my back has increased, although it is not painful enough to go
to the ER, yet. what should I be looking out for and when is it an Emergency?
I
take the big 4 meds for stents and am on time and never miss. I am getting
more anxious every day.
R., Hartland,Wisconsin, USA, January 11, 2008
MikeS -- we hear you. The area of aspirin or
clopidogrel resistance in patients is as yet relatively new. There are
tests out there (some made by San Diego-based Accumetrics), but an article
in the Journal of the American College of Cardiology last November, titled
"Platelet
Function Monitoring in Patients With Coronary Artery Disease"
observed that the current tests are far from perfect and that this field
urgently needs better research.
Angioplasty.Org Staff, Angioplasty.Org, December 20, 2008
Playing catch up since Feb. 2006 post. July
4th LST (clot in stent) thrombosis in RCA Full metal Jacket I spoke
of. i ask that no stents be placed before lat 2 of six they put 2 in
lAD
anyway . As I predicted (again) November 2007 LAD stent Thrombosis
in stent while on Plavix and aspirin. Each time (3) I suggested an MI
was
soon following my chest pain and even told docs where to find the clot.
Seems pretty predictable that the next will be in the last stent placed
in RCA . I can set my clock about 4 months after i tell them and within
11 months of placement. I was told they would bypass prior to a post
op cath that apparently cleaned me up as i felt better immediately
and for almost 9 months after. It seems that if they did cathed/or angioplasty
every six months that it may have unclotted at least buying me a few
more months before a total clot. This sounds strange but i bet that
left
untreated i can again predict another in 12 months or less. Simply
stated I feel it long before they see and believe it and this last clot
cost
me a third of my heart muscle . I can't afford for them to keep foot
dragging while I suffer months before. I will not allow anyone to stent
me again and need an expert dedicated to the truth regardless of the
politics. I am neither an Idiot Savant nor Idiot and tired of the Pharmafantasies
docs rely so heavy on . Aren't there markers that can predict clots.
MI/s or a 64 slice imaging option. I asked 3 docs over a year ago to
test me for plavix and aspirin resistance. None had heard of it then
and even to date after asking again none have referred me to a lab/office
or modality that does this .Any new predictors that can compete with
my our suffering especially ones that these lazy docs can actually
believe when they refuse to listen to the patient, I have fired the stent
profiteers
and several docs attempting to restent me. I am concerned that doubling
the plavix will actually harm me as well as many other meds they now
suggest. Again thanks for supporting those trying to help us. (Note:
This post has been edited for length and content).
MikeS, Stent clotter, Florida, December 16, 2007
F. in Lebanon -- millions of patients have had
drug-eluting stents put in. Stent thrombosis (clotting) only happens
very rarely.
It is important to keep taking your meds, especially Plavix and aspicot
(a form of aspirin) so your risk is reduced. Recent studies have shown
no greater
risk in
drug-eluting stents than in the older bare metal types -- and stents
have been helpful to many patients in relieving pain. Stents also provide
pretty much the same help as open heart surgery, in the right patients.
Are you having any adverse symptoms? By the way, stents cannot be "taken
out" because they become part of the artery wall.
Angioplasty.Org Staff, Angioplasty.Org, November 30, 2007
I put 2 cypher stents in 4/9/07. Taking plavix+crestor+aspicot
100mg+metformine
850mg+omega3&6. When reading what people say I have been afraid from the future.
Can I take off the 2 stent by surgery& find
another way for my artery. Thanks.
F., Lebanon, November 30, 2007
Bob -- for more information on the Endeavor,
as well as the upcoming Abbott DES, and their purported advantages, read
our feature, "FDA
to Review Abbott's XIENCE™ V Drug-Eluting Stent".
Angioplasty.Org Staff, Angioplasty.Org, November 7, 2008
Looks like Medtronic and its Endeavor is no
better than other current DES's. How can the FDA let a product that is
at best equal to, but appears to be worse than, the current products
available go to market. Would really like to see some feedback from Physicians
defending this product.
Bob Puckett, Snellville, Georgia, USA, October 24, 2007
Martin -- a deeper understanding of this problem
is what everything is looking for. For example, most cardiologists prescribe
Plavix and aspirin now for 1-2 years or life. But a study out of Milan
showed no statistical benefit past 6 months. However, when asked how
long they currently prescribe the dual antiplatelet drug, Dr. Cieffo,
who
ran the
study, said 1 year, at least. Some believe that the cause of stent thrombosis
is incomplete healing, where the endothelial cells are not able to cover
the metallic surface, which is thrombogenic. Others feel it is mal-apposition,
where the stent was underdeployed from the start. Dr. Antonio Colombo
of Milan discusses this in his interview with us about Intravascular
Ultrasound (IVUS). others feel it is a specific small subset of patients
who have some type of tendency for thrombosis, as yet unidentified. Go
to our Drug
Eluting Stent Center for
links to various articles on this site that may help you.
Angioplasty.Org Staff, Angioplasty.Org, August 7, 2007
hello together, what i need is a deeper understanding of the mechanisms
that lead to stent thrombosis. Why does the agglomeration of platelets take place?
can you give me some answers or references where i can find information regarding
my topic? thanks in advance...martin
Martin, Hannover, GERMANY, August 5, 2007
The reason for my posting is I have noticed
that in the past 3 months issues with DES have almost gone away. There
has been nothing on the internet. I have not seen any response to Rep.
Waxman's request
for information from BS and J&J. Maybe its just our goverment is that slow, I
don't know, but they wanted the info in two weeks, that was over 4 months ago.
BobPuckett, Snellville, Georgia, USA, July 30, 2007
WOW, Sounds like Medtronic may have got it right.
These articles about their new DES really come in at the right time.
Hope they are successful in getting on with business and getting FDA
approval. I have been real skeptical about having another DES implanted,
but this is really exciting and hope they are not holding back any information.
If there trials are legit, and I think they are, BS and J&J can hang
it up in areas they compete. It's nice to know there is a better way,
not just BS and J&J's way.
Bob Puckett, Snellville, Georgia, USA, June 2, 2007
Kim -- great story demonstrating that non-cardiac
docs are beginning to get the message about Plavix and drug-eluting stents
and are changing their procedures accordingly. Really a must-read for
all. We are cross-posting your reply to the Plavix
and Surgery topic as well.
Angioplasty.Org Staff, Angioplasty.Org, May 24, 2007
Thank you for responding to my post! His Cardiologist
insisted that he not go off his medication for any amount of time until
he hits the 12 months then only for 5-7 days. I consulted with his doctors
at Johns Hopkins and UCI. They both agreed to perform an endoscopy under
twilight conditions while on his medication. Dr. Canto at John Hopkins
wrote me the following: Doing mucosal biopsy on ASA and possibly plavix
is not a problem. It is only if we dilate or do EMR that there would
be a risk of bleeding. The American Society of Gastrointestinal Endoscopy
has recommended that ASA and NSAIDs do not need to be stopped. We are
getting his checkups at UCI, so we don't have to travel to Baltimore
every 3 months. The plan was to only take biopsies if they saw something
that looked questionable. And if then, only 1-3 rather than 8-15 like
they usually do. Everything went well and his esophagus looks clean.
Therefore, no biopsies and probably no cancer! But I have to say this
puts us in a precarious position. Looking back now, I know why the Cardiologist
looked alarmed when I told him about his cancer treatments, the first
time I met him in the operating room after the surgery. He told me he
did not know about it. It should have been in his chart. It was the ER
but we had been in there only a couple of months before because he could
not swallow, results of the PDT (cancer treatment) scaring - somewhere
things did not get communicated. The Cardiologist is one of the best
doctors around, I am told. But knowing that EMR or dilations are a problem
is worrisome as my husband has had EMR and PDT for his cancer in August
06 and as had 9 dilations from December 06 to March 07. Now we just have
to wait and PRAY for the next 10 months that he stays cancer free and
he doesn't need to be dilated!
Kim, California, USA, May 24, 2007
Kim -- Back in January, the six major professional
organizations, dealing with cardiology, surgery and even dentistry, issued
a joint "Science Advisory" regarding the concerns over premature
discontinuation of antiplatelet therapy. Recommendation #2 was:
"In patients who are undergoing
preparation for percutaneous coronary intervention and are likely to
require invasive or surgical procedures within the next 12 months,
consideration should be given to implantation of a bare-metal stent
or performance of balloon angioplasty with provisional stent implantation
instead of the routine use of a DES."
This Advisory was widely reprinted and featured in
Circulation, the official journal of the American Heart Association,
and elsewhere. And the recommendations were not particularly new -- these
ideas had been circulating for some time (see our own "Patient
Advisory" which we posted four months earlier). You can read
more about the "Joint Science Advisory" in our January 29,
2007 article, titled appropriately: "New
Advisory: Will Stent Patients and Their Doctors Get the Message?".
Unfortunately, in your husband's case, it seems that the interventional
cardiologist had not gotten the message.
So what can you do? Read our news piece and the advisory,
which is linked to. Print it out and bring to your husband's oncologist.
Some surgeons and dentists have been performing certain procedures, even
with the patient on Plavix -- or making some sort of adjustment, very
temporarily. As the Advisory states, have the cardiologist and surgeon
talk to each other. Just because it's standard practice to have patients
go off Plavix and aspirin prior to a surgical procedure (even a biopsy),
doesn't mean it can't be done -- certain measures can perhaps be taken
to control the bleeding -- this, of course, varies from doctor to doctor
and procedure to procedure. But not keeping tabs on a potentially deadly
cancer does not seem right. Let us know what you find out..
Angioplasty.Org Staff, Angioplasty.Org, May 15, 2007
Has anyone ever known anyone that had a Drug
eluting stent put in even though they were going through other treatments
for cancer? The cardiologist at the ER put a stent in my husband because
of chest pains. But did not read his chart about his history of esophageal
cancer. He had cancer treatments at Johns Hopkins 6 months earlier and
his last test was cancer free. But he is on a strict every 3 month biopsy
check, as esophageal cancer is known to return. Now, he is very limited
in getting these checks and if the cancer does return in the next 10
months we can't do anything about it. This cancer is very deadly and
can not be left untreated. Aren't the doctors required to screen a patient
before they place these type of stents? Wouldn't a bare stent been the
answer for him? I would like to know if anyone has any information regarding
this. Thank you, Kim
Kim, California, USA, May 14, 2007
Angioplasty.Org has written two articles regarding
the ACC reports of the COURAGE trial, which is not really about drug-eluting
stents at all. But they do deal with the question of stents vs. drug
therapy and can be found here: "Don't
Cancel Your Angioplasty or Heart Stent Yet, Say Patient Advocates" and "Answers
to Top Ten Questions About Stents and Angioplasty vs. Drug Therapy".
Angioplasty.Org Staff, Angioplasty.Org, April 12, 2007
What is your take on the meeting of the ACC
07 summit held in New Orleans this past weekend? Sounds like a lot of
physicians still are uncertain exactly what to do. Not that they can't
take the safe route, but are unsure exactly what the consequences are
of using DES's in the long term. I keep seeing that everyone is saying
to take plavix and aspirin for 12 months, I've been on them 24 months
and my doctor will not even discuss me coming off of them. By the way
I have moved and my address is different than previously posted.
Bob P., Snellville, Georgia, USA, March 28, 2007
Regarding what is off label and on label use
of drug-eluting stents, here is the FDA statement of indications (i.e. "on
label use"):
-
The CYPHER Sirolimus-eluting
Coronary Stent is indicated for improving coronary luminal diameter
in patients with symptomatic ischemic disease due to discrete de
novo lesions of length ≤30 mm in native coronary arteries with
reference vessel diameter of ≥2.5 mm to ≤3.5 mm.
-
The TAXUS Express Paclitaxel-Eluting
Coronary Stent System is indicated for improving luminal diameter
for the treatment of de novo lesions ≤28 mm in length in native
coronary arteries ≥2.5 to ≤3.75 mm in diameter.
By de novo, the FDA means lesions not previously treated.
Any other use is technically off-label.
Angioplasty.Org Staff, Angioplasty.Org, March 17, 2007
Thanks. I don't know why I kinda got mixed up.
My DES's were actually 3.5mm in Diameter. You're right -- one was 8mm
long, the other was 24mm long. I had these implants after a heart attack.
Is that considered "off-label"? Thanks, Bob
Bob P., Georgia, USA, March 15, 2007
Bob -- stents have two measurements: diameter
(or width) and length. A large coronary artery is around 4mm. When you
refer to 8mm, you are talking about the stent length -- and 8mm is the
shortest length stent made. When your cardiologist is discussing using
BMS in "small" vessels, we'll bet he/she means "short
length blockages"; likewise when the cardiologist says "large" vessels,
he's probably referring to "long" vessels. Long vessels (i.e.
long blockages) are more prone to restenosis, thus DES is preferred.
Angioplasty.Org Staff, Angioplasty.Org, March 14, 2007
Well, had my visit to the cardiologist Friday.
Brought up the DES controversy and he really didn't want to talk about
it too much. But one thing he did say was that they plan on using bare
metal in the smaller vessels and DES in the larger ones. That tells me
they have a totally different way of thinking than they did when I had
my DES implanted 30 Dec., 2004. You see, the Diameter of my stents were
8mm. Seems small too me. Any comments?
Bob P, Lawrenceville, Georgia, USA, March 6, 2007
Wish all this information was available 20 months
ago, maybe I wouldn't be one of the people with Stent Thrombosis who
almost died. May 4, 2005 at 3:00am I had severe heart and chest pains.
My son called 911 and I didn't think I was going to make it to the hospital.
The results, blood clot in my DES. I am now totally disabled and cannot
do much of anything. Have had defibrillator implanted and struggle every
day to survive, both physically and financially. You see, Social Security
doesn't understand or care. That makes it all the worst. I had been unemployed
30 days before the thrombosis. Only the second time in over 40 years.
Luck of the draw I guess. I want people to understand what can happen.
My doctors have been great taking care of me and making sure I had the
medicine I needed, however they have never discussed the DES or ST with
me. Guess they have their reasons, I will however mention it next week
when I see both of my Cardiologists. By the way, I was implanted with
2 each TAXUS Express 2 stents on December 30, 2004, the day after a myocardial
infraction. Maybe if I had the information we have today, it wouldn't
have happened. I know I was on Plavix after the implants, I am just not
sure if I had quit taking them. It is possible that I quit, as my financial
situation was going down hill fast. I will need to check back with the
pharmacy to see. I have not quit taking it since the clot and I do take
aspirin everyday. Also my ejection fraction is +-25%. One other thing,
I had a bare metal implant in July of 2002 after a heart attack, no problems.
Bob P., Georgia, USA, February 21, 2007
Mike -- thanks for the clarification. And your
questions are good ones. As for the dosage of Plavix, current recommendations
are 75mg daily -- the antiplatelet action related to your blood, so dosage
isn't increased for a greater number of stents. Also one has to be careful
to watch for bleeding problems. We assume you are doing what you can
to reduce risk factors, like proper diet, exercise, no smoking and staying
on prescribed meds. As for bypass, this is a question for your cardiologist.
There is thought that certain more complex cases may do better with surgery
-- and the "full metal jacket" you speak of won't "weigh
you down" but it can complicate the ability to do a bypass. But
there may be very good reasons why bypass surgery was not recommended
for you originally -- and reblockage is something that occurs with surgery
as well -- many surgical patients end up having a reblocked vein graft
opened with angioplasty and stents. But these types of decisions are
complex and the answers very specific to each patient. They would best
be answered by a cardiac surgeon AND an interventional cardiologist who
have your records and angiograms in front of them. In some institutions,
these specialties wind up competing with each other (the surgeon believes
that bypass is the best, the cardiologist always votes for stenting)
but more and more, these specialities are working together, hopefully,
to provide the best treatment pathway for the patient. Let us know what
you find out and keep in touch.
Angioplasty.Org Staff, Angioplasty.Org, February 20, 2007
Editor, As you mentioned I do know the Physical
Difference as well as having been told prior it (chest pain ,vomiting,
shortness of breath then VTach) was all in my head. Without a doubt my
100 percent clot (SAT) within the second stent caused a heart attack
and brief stint with death, coding and multiple dif included I wasn't
however, familiar with the visual /diagnostics in a docs determination
or visual observation of thrombosis. The 1st stent was restenosis in
a DES, The second behind it was to fix the problem. The second however
Clotted 11 months later and two more placed after the THROMBOSIS in the
aforementioned second stent. Thanks for explaining the visual differences.
How much plavix does six stents require? How long? And at this point
how many stents before one should have a bypass being that stenting in
this case seems to raise the risks of even more clotting especially when
4 of 6 are in the same artery (two which have failed already) Again the
1st was restenosis the second was clearly Thrombosis. Does watchful waiting
run the greater risk and chance of another SAT and even death? Won't
The full metal jacket eventually weight you down? It seems that previous
clotting within stent 2 might indicate that stent numbers 3 and 4 in
same vessel share increased risks of Thrombosis given the combined effects
of other DES's within the same vessel. My questions here are simple,
why not bypass now before another clot kills me? Why wait? And why let
anyone stent again?
Mike S, Florida, USA, February 12, 2007
A belated reply to Bill
in Maine -- you are correct. The figure for increased risk of late
stent thrombosis in drug-eluting stents over bare metal stents is usually
quoted at 1 in 200. This is overall. However, it all depends on what
study you look at. There are many -- and their results are different.
Many were presented at the FDA Panel stent safety meeting in December
and there is no agreement -- a group has redefined what should be categorized
as stent thrombosis, so that's changed things. One thing seems clear.
There is a slightly elevated risk of this in drug-eluting stents. It
may be that the risk only exists for certain patient populations. What
patients need to do is stay on their prescribed antiplatelet therapy
and make sure to read our "Patient
Advisory"
Angioplasty.Org Staff, Angioplasty.Org, February 10, 2007
Mike -- As the patient in whom this occurred,
you would definitely know the difference between restenosis and thrombosis.
Stent thrombosis occurs in a very immediate and usually sudden way. The
platelets start to clot and very quickly you get intense chest pain,
as in an acute heart attack. The blood clot needs to be opened immediately
or the heart muscle will infarct and die -- this is why stent thrombosis
is fatal 30-40% of the time. Late stent thrombosis is a cause of concern
in drug-eluting stents, which is why staying on Plavix (or Ticlid) and
aspirin for a year or more is so important.
Restenosis is something that occurs over time, as the
scar tissue builds up inside the stent, something that occurs less in
drug-eluting stents than in bare metal ones. Ultimately, the stent may
become blocked, but often, the patient may feel the return of angina
in his/her heart -- a stress test may be done, followed by an angiogram,
and then usually a second stent is inserted inside the old blocked one.
This is one of those technically off-label uses, but most studies have
shown putting a DES inside of a previously restenosed stent to have the
best outcomes. Occasionally, the patient may not sense the stent blocking
up, and it may progress to a heart attack or acute coronary syndrome.
According to a recent Cleveland Clinic study, this occurs about 30% of
the time when there's restenosis. But the death rate is nowhere near
that of thrombosis. By the way, your confusion is shared by many. Even
Dr. Fogoros, the heart expert at About.Com, constantly refers to late
stent thrombosis as "late
restenosis". It's not. It's a totally different biological process.
As for proof, if it's thrombosis, there's usually a large fuzzy grey
blob on the angiogram completely occluding the artery -- restenosis is
darker, denser, more discrete. Our guess, from your description, is that
you had in-stent restenosis. Was the stent that restenosed a bare metal
stent? Did they put in a drug-eluting stent to fix it?
Angioplasty.Org Staff, Angioplasty.Org, February 10, 2007
I have recently had in-stent thrombosis (11
months later) this stent was placed behind one that was then called Restenosed?
How exactly does one tell the difference? How can a person be sure that
even when told it's stenosis it's not thrombosis. Given the money and
politics here, how can we tell who's telling us the truth? It seems that
some docs would rather call a clogged artery or occluded artery than
get into the Clotting Ring Of Fire especially after the patient complains
early of symptoms. [Post edited for length]
Mike S., Florida, USA, February 6, 2007
John -- thank YOU for providing the information
which can be communicated on this Forum. We welcome other patients to
share these types of stories. We're also posting this on the topic concerning
Plavix and Surgery.
Angioplasty.Org Staff, Angioplasty.Org, February 6, 2007
I just wanted to share my experience. I had
a DES implanted in October and I'm on Plavix, Lipitor etc. Last weekend,
I broke a back molar and it needed to be pulled. I was concerned with
bleeding complications due to the Plavix. The oral surgeon said as long
as I was not on Coumadin, he felt comfortable pulling the tooth. So he
pulled the tooth. For about 2 hours, I squeezed gauze on the spot where
the tooth was pulled and it stopped bleeding. Aside from some swelling
from pulling the tooth, all seems to be ok. Hope this information is
helpful. Thank you for providing this forum to communicate.
John, New Hampshire, USA, February 5, 2007
Lynn -- a recent study has shown that, even
though this technique is strictly speaking "off label" in the
U.S., the use of a drug-eluting stent to re-open a reblocked stent is
probably the best therapy. As for going off Plavix and aspirin for dental
work, read our latest
article about the joint "Science Advisory" -- the American
Dental Association had advised its members of the dangers of taking patients
off antiplatelet therapy and advises that much routine dental work can
be done safely without taking patients off their meds. It just seems
that many dentists have not gotten the message. Feel free, as patients,
to educate your dentists. Lynn, in your case, if you are back on antiplatelet
therapy, you should be fine. But if you are feeling anything uncommon,
by all means, report this to your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, February 3, 2007
I just have one question-If you have a DES that
has already been restented because of restenosis-now 2 DES in one artery-are
the chances higher it will happen again? I just had a stress test in
Nov.2006 after the 2nd stent and everything was clear. But since then
I have had dental work and was off Plavix/aspirin 5 days. You replied
to an earlier post from me about that but my concern is a slight squeezing
in my chest. That is how I felt before the 2nd stent was inserted which
also was after dental work July 2006. Thanks. you have been more helpful
than anyone!
Lynn, USC, Columbia, South Carolina, USA, February 2, 2007
On Feb.1 B. Parvizi you mention having by-pass
surgery after apparent late stent thrombosis in a DES. You indicate that
you hope this reduces the possibility of further late in-stent thrombosis.
I intend to discuss the possibility of by-pass surgery with my cardiologist
on my next visit, even though I haven't had an in-stent thrombosis. My
DES Stents were "off-label" and in complicated areas so I believe my
chances of in-stent thrombosis are unfortunately higher than average.
However, I would think that the bypass surgery would not lessen the chance
of in-stent thrombosis, but hopefully would lessen the chance of an MI
or SCA from the thrombosis, since blood-flow would continue around the
clot via the bypass. Is my logic correct? A problem those of us in the
U.S. might face who might request bypass surgery before experiencing
an in-stent thrombosis is that health insurance carriers might refuse
to pay for the bypass, since the stent is still functional.
Thomas T., Arizona, USA, February 2, 2007
I
am now at home recovering from my by-pass surgery. I only hope
that the by-pass of these two DES has now reduced the possibility of
further late in stent thrombosis . Clearly I am very disappointed that
the manufacturers of the DES are not taking such cases more seriously
and identify the patients at risk. To go through implanting two DES
2.5 years ago and then a heart attack followed by SCA, to find out
that some DES are prone to late stent thrombosis and be forced to have
a by-pass is just not good enough .The manufacturers have duty of care
to keep the public informed of such defects which could have cost me
my life.
Mr. Bahman Parvizi Ph.D., London, United Kingdom, February 1, 2007
To
Rick, New York, USA, January 1, 2007 I can only speak for myself,
but I have had 24/7 AF for over 8 years and so was already on Warfarin
(Coumadin) at around 5mg to keep INR at between 2-3. So when I had
my first stent a year ago I was bit concerned, with the extra addition
of Aspirin 75mg + Plavix 75mg per day. I never had any real adverse
effects (although i did cut myself once and it was a sod to stop, but
it did). So when I had my second stent fitted in Dec 2006 I was still
on all the above, but my cardios` own regime is to insist on 325mg
Aspirin for 6 weeks post op, then continue at 75 mg + all the others.
So far so good, so it is possible.
tm from UK, January 11, 2007
There's no test for thrombosis, but there are
certain clinical indications for a higher-than-normal chance of both
restenosis and thrombosis -- very long lesions, very eccentric (or craggy)
lesions, narrow arteries, diabetes, etc. But as for late stent thrombosis,
it is hard to determine who might be more at risk.
As for a hypersensitivity reaction, certainly anyone
with a known allergy to stainless steel or its components (e.g. nickel)
should not get any type of stent, bare metal or DES. Anyone with a known
allergy to the drug on the stent should not get that stent. As for the
more undefined (as yet) allergic reactions to the DES polymers, a cardiology
group we are working with is doing a study, in part to develop a test
for this type of hypersensitivity. It's the only group we know of investigating
this phenomenon.
Angioplasty.Org Staff, Angioplasty.Org, January 10, 2007
I'd like to ask if there are any tests or procedures
that could be performed on a patient before having a stent placed in
their heart to predict the chances of the occurrence of thrombosis or
a reaction to the drug-eluting device?
G. Ulmer, Ohio, USA, January 10, 2007
Dr. Parvizi -- certainly sounds like late stent
thrombosis. Cause of this is not really well-known, although Dr. Renu
Virmani, a pathologist in the Washington area, has done pioneering work
in determining that DES can cause delayed healing. In some individuals,
some of the metal struts in these DES stents don't get covered by a layer
of endothelial cells, and therefore are more thrombogenic, or prone to
clot formation. Why this happens in some individuals (relatively few)
and not in others is not known, but may have something genetic involved.
Best wishes for a successful outcome in your surgery and thank you again
for sharing your story with our readers. Let us know how thing go.
Angioplasty.Org Staff, Angioplasty.Org, January 7, 2007
Both the cardiologists at the A&E and my own
cardiologist after seeing the CD of my angiogram confirmed that although
there were some sign of scaring with in the stent it was not enough to
cause the MI and in stent blood clot must have taken place and it was
removed via the use of heparin in the A&E. It is for this reason that
my cardiologist is concerned that the in stent blood clot could happen
again and next time I may not be near a ''National Grid''. I am off to
the hospital this afternoon to bypass the stents tomorrow morning,( you
are correct stents can not be removed. It was my wishful thinking not
my cardiologists.) When I am out next week or so?!! if you are interested
I will be able to forward you copy of the CD.
Bahman Parvizi Ph.D, London United Kingdom, January 7, 2007
Report of seeing Cardio: Told Cardio of pain
experience. He suggested I try Nicorandil as an alternative to Nitro
patches, and has scheduled a Stress Test for Feb. Stents fitted were
as follows: Original LAD Bifurcation was a Guidant Frontier Multi Link
(BMS) For RCA a Medtronic Endeavor (DES) Now getting odd pulsing sensations
in the back of my leg (not the same side as catheter entry??) Very odd.
Anyone any ideas?
tm from UK, January 6, 2007
Mr. Parvizi -- I think you're the first documented
case of late stent thrombosis from a patient posting in our Forum. We're
so glad you were in the right place! As for the course of action, it
is our understanding that stents cannot be removed via bypass (you'd
have to open the coronary artery -- we don't think this is possible).
Let us know if please if you find out something different.
We'd like to confirm one fact: that your stent had
a late thrombosis and not restenosis. They are two
different things. Thrombosis is a blood clot; restenosis is the reblocking
of the stent due not to blood clots, but to regrowth of the arterial
tissue -- if this occurs inside the stent, it is known as in-stent restenosis
and is often treated by placing another stent inside of the original.
Angioplasty.Org Staff, Angioplasty.Org, January 6, 2007
I am 62 years
old male.Had two DES in LAD in June 2004, stopped Plavix after 1.5ys
. On 21st Dec 06 while playing tennis had a mild heart attack, rushed
into A&E where I had SCA. It was matter of luck that I was in a cardiac
ward and was already wired up. Shock treatment brought me back and the
following day was in the Lab which showed that one of the stents had
Late Thrombosis and a small amount of blockage, so they have inserted
another stent partially within the existing stent. I am on plavix and
aspirin. I now have seen my own cardiologist (3rd Jan 07). He is very
concerned and is worried that this second stent will also close and he
is going to consult with other cardiologist for a possible by-pass to
remove the stents as he thinks that my body is possibly reacting against
the stents.My echocardiogram show no abnormality of the heart muscle
with 55% plus ejection fraction even after SCA. He is going to make a
decision in the next 24hrs of the next course of action. Any advise or
comments will be appreciated.
Mr Bahman Parvizi, London, United Kingdom, January 4, 2007
I'm confused about the
size of the increased risk of late stent thrombosis in drug eluting stents
as compared to bare metal stents. The number I see mentioned most frequently
is the increased risk is only 1/200. However is this a yearly risk. So
that over 2 years the risk is 2/200 and so forth...
Bill S., Maine, USA, January 3, 2007
Since I was put on Coumadin
for Afib my group of cardiologists felt that after being on plavix for
14 months post stents (three drug eluting in LAD) it would suffice to
stop the plavix and just continue on the 10 MG coumadin daily in combination
with 81 MG asprin....any thoughts regarding this combination and would
the plavix be just too much in this situation...
Rick, New York, USA, January 1, 2007
T.M. -- you describe something that has been
reported by a number of posters in the topic "Not
Feeling Well After Stenting" -- there are a number of possible
reasons -- best thing is to do what you are doing, see your cardiologist.
Please let us all know what you find out. Also, what type of stent (DES
or BMS and what product?) did you get?
Angioplasty.Org Staff, Angioplasty.Org, December 31, 2006
Hi All Some advice is sought please. I had a
DES fitted to my RCA on 4th Dec 2006. As far as I know all went well,
and indeed I had no problems at all following the procedure, until on
Xmas eve, when I was woken at 2am by a chest pain that was the same pain
in the same place as the original Angina. The pain subsided and i decided
not to call the Emergency service The next day I noticed that the pain
returned on the slightest exertion so I visited my Doctor who did an
ECG with nothing abnormal detected. He has put me back on the Nitro patches
I used before the Angio, which has indeed reduced the chest pain. I have
a scheduled meeting with my Cardio on 2nd Jan, and my question is what
sort of things should I be asking him in respect of what could have happened.
This is the second stent I have had fitted this year, the other being
a BMS on a bifurcation, which is apparently behaving itself, or at least
was. Thanks for any advice.
T.M., United Kingdom, UK, December 31, 2006
Lewis -- (1) read our "Patient Advisory" in
the right-hand sidebar to get the most detailed information on thrombosis
risk, but if you stay on Plavix and aspirin, you've lowered your risk.
Whether you stay on this regimen past a year (which is now) is something
you should discuss with your cardiologist. You did have a bleeding episode,
and the Plavix and aspirin definitely has a side effect of bleeding --
this is why surgeon request that it be stopped before surgery, a problem
for stent patients who need to stay on it. Talk to your cardio about
the risks/benefits and let us know what you both decide.
Angioplasty.Org Staff, Angioplasty.Org, December 29, 2006
I did not have an MI but after having difficulty
with center chest pain and unable to complete a walk my doctor referred
me to a cardiologist who did a heart cath to find a 96 , 60 and 40% blockages.
with the 96 in the RCA, the doctor placed a DES. After about six weeks
my energy level picked up. I began to feel better over all. I was placed
on Plavix and one low dose aspirin, and Advicor daily. This event took
place in Jan 06. All along I have had some episodes of chest pain or
angina. With an adjustment to my blood pressure med (Lotrel and Toprol)
I have much fewer problems. I am sorry to read about so many horror stories.
I recently experienced some unexplained bleeding out thru my bladder
for two days. (Extensive) The urologist ruled out tumor of bladder. I
have two questions.
1. Am I at risk for thrombosis due to the DES?
2. Could the Plavix and aspirin have contributed to my bleeding? Thank you.
Lewis, Florida, USA, December 5, 2006
Tom -- your concern is shared by many. (Read
our recent article "Patients
Worried About Safety of Heart Stents Turn To The Web" and also
our Patient
Advisory.) We also wrote a new feature about the Cardiosource editorial
(we interview Dr. Kaul, the lead author). It's important to keep perspective.
When you say that DES increases the odds of fatal MI's, we're talking
about a very small increase, less than 1% for thrombosis. The cause of
this increase is the matter of much debate and the subject of several
new studies recently launched. To some extent it reflects patients not
taking Plavix and aspirin long enough, or having to go off it for surgery
or other reasons, not realizing that the odds of thrombosis increase
with cessation of antiplatelet therapy.
At the recent TCT meeting a great debate among cardiologists
took place, but no one is saying that DES are terrible. For the right
patient, one with a higher risk of restenosis, they are a very excellent
device. In fact, ostial lesions are known to be associated with higher
rates of restenosis, so you may well be spared a second procedure or
other complications because you got a DES in those. What we, and a number
of cardiologists recommend, is that patients talk to their doctors when
they are discussing stents. If the doctor is recommending a DES, find
out why -- there are good reasons.
The criticism has been that they are being overused
in some cases, when the older bare metal stents might do just as or almost
as well. Also that the thrombosis issue may extend for a longer period
of time than previously thought -- again a matter for debate. Use of
DES in the US has dropped a bit -- it was almost 90% and now looks to
be heading to the lower 80%, maybe lower (in Europe it's more like 30-50%
DES). Stay tuned -- we'll be covering this very complex subject in more
depth in the near future.
Angioplasty.Org Staff, Angioplasty.Org, October 28, 2006
I do not wish to cause unnecessary concern,
but in view of all the negative commentary over the last few months regarding
the use of DES in place of BMS Stents, I am confused as to why a moratorium
on their use hasn't taken place. For example, a recent posting on Cardiosource
from two cardiologists is entitled: "Drug Eluting Stents: An Ounce of
Prevention for a Pound of Flesh". This commentary seems to reinforce
the contention that DES use increases the odds of serious and often fatal
MIs among DES patients over BMS patients. I had 2 Cypher DES stents (1
to the ostium of the left anterior descending artery extending to the
distal left main & 1 to ostial left circumflex artery extending to the
distal left main) and 1 Driver BMS stent (to the proximal left anterior
descending artery for treatment of dissection). They were all placed
at the end of Feb.'06, and in view of all this recent data, I doubt that
I would go that route now. Why do I still read on your site that DES
is still routinely being used?
Tom, Arizona, USA, October 19, 2006
Cheers Michael, and thanks for the kind words!
Great to hear your good results and appreciate your advice. As for when
should late stent thrombosis stop being of concern -- you've asked the
$64, excuse me, €64 question -- right now the FDA has recommended
3-6 months of Plavix and aspirin. Many cardiologists prescribe Plavix
for a year and baby aspirin for life. Some think Plavix for life. The
US FDA will be meeting in December to discuss this situation. We also
should have more info after next week's TCT meeting in Washington (we'll
be there, covering it).
Angioplasty.Org Staff, Angioplasty.Org, October 17, 2006
Your website is a wonderful source of information
for many like me who felt isolated after a MI. Mine happened late Oct
06 after recent diagnosis of angina which suddenly turned unstable. One
2.5mm 18mm DES (Taxus) inserted LAD and results little short of miraculous.
Keep up to speed via your site and others and get a little scared at
some of the stories esp DES late stent thrombosis. But try to keep a
sense of perspective. I urge all to follow the lifestyle changes esp
medication, exercise,diet and reduce stress - in that order. Never been
a smoker but if I was that would be top to quit. Question: At what stage,if
any, would late stent thrombosis cease to be a problem or at least insignificant?
Keep up the good work.
Michael W., England, October 16, 2006
Lawrence -- it's hard to diagnose such an occurence
long distance and without the imaging to judge. We have not heard of
stents "contracting" per se. Once a stent is expanded (via
balloon) it can't really shrink, but it can block up again. It's also
possible that the stents were not fully expanded to begin with. If this
happens, blood and tissue can build up in the small space between the
stent and the artery wall, not unlike a shoe that doesn't fit -- you
get a blister with a shoe. With a stent -- well, you get the point. Another
phenomenon sometimes seen is called an "edge effect" where
the edge of the stent becomes more prone to tissue build-up. If you have
two stents (and two edges) next to each other, but not touching, the
area between them might become more thrombogenic (prone to clotting).
Hard to say exactly what happened, but we haven't heard of exercise causing
anything like this. Exercise is a good thing.
Angioplasty.Org Staff, Angioplasty.Org, October 14, 2006
I received 2 Taxus stents in March of 2004 in
my LAD artery because of angina during strenuous exercise. On September
8 of this year, ten minutes after treadmill portion of stress test, I
developed a clot, received tPA, etc. and then was shipped to a different
hospital where the angiogram with ultrasound indicated that my stents
had contracted and that there was a fuzzy area between my two original
stents that was a possible source of the clot. The two Taxus stents from
2004 were re-expanded and I received two additional Cypher stents, placed
partially inside the original stents. Do you have any information about
drug eluting stents contracting? How often does it happen? What role
does it play in stent thrombosis and how would a person know that their
stents had contracted? Is it possible that exercise or vigorous exercise
might play a role in causing stents to contract?
Lawrence K., New York, USA, October 14, 2006
M. -- Ticlid is the brand name for ticlopidine.
It is an antiplatelet drug -- that is, it reduces the blood's ability
to clot. Ticlopidine or clopidogrel (Plavix) are always used in stent
patients after stenting. Some people have adverse or allergic reactions
to the drug (for more, see the Forum Topic on the right-hand side-bar "Plavix
and aspirin: dosage and allergic reactions")
Angioplasty.Org Staff, Angioplasty.Org, October 14, 2006
Hi all. My father who is 64 years old has been
a cardiac patient for some time now. He once had a mild attack which
caused some internal injuries and bleeding. He was told he could suffer
from thrombosis at a later stage. At his last visit to the cardiac specialist
treating him, he was prescribed Ticlid. I read a bit on this drug (http://www.drugdelivery.ca/s3649-s-TICLID.aspx).
It says it is to reduce blood from clotting inside the veins. Has anyone
ever taken this medication and can tell me more about it?
M., Pakistan, October 6, 2006
Steve -- there are a few alternatives to clopidogrel
(Plavix) such as Ticlid -- you should discuss this with the interventional
cardiologist who did your procedure. Let him/her know you're having what
you think is an allergic reaction to Plavix. Also check out our Discussion
Topic on allergic
reactions to drug-eluting stents.
Angioplasty.Org Staff, Angioplasty.Org, September 28, 2006
I am 52 year old male, who thought he was in
good health until I had DES placed after MI in May 2006. I have become
increasingly worse over the past few months in several respects. After
spending weeks of stopping and starting the various drugs (plavix, aspirin,
topral, lisinopril, lipitor) I have pretty much concluded that the plavix
is causing most of my problems (sores in mouth, itching, hypersensitivity
of hands, feet, genitalia, unexpected reaction to heat and cold, fatigue,
lethargy, chest and back pain). I have found that stopping plavix for
one day every 3 to 5 days, gives me 2 days when I feel somewhat better,
but not good. My DES was placed as part of the Endeavor IV clinical trial
and the doctors refuse to tell me whether I have the Endeavor stent or
the Taxus stent because it is a blind study. I understand that I am taking
a risk by skipping doses of plavix, but I am not sure how much risk given
the frequency of my skipping the drug, and the unknown stent. Just in
the past week, i received a generic version of Plavix from my mail order
drug plan. It is a bit smaller, darker shade of red, and appears to have
diminished much of the allergy type reactions, itching hypersensitivity,
etc. However, there has been no change in the fatigue, lethargy, and
just general feeling bad. I find myself clinching my shoulders, arms,
and back as if i am trying to protect myself from injury, all day every
day. The cardiologists have been of no help whatsoever. My internist
has found that my red blood cell count, hemoglobin, hemocrit, and other
factors in CBC are low. He calls it a mild case of anemia and has treated
my with steroids twice. they have offered some temporary relief, but
only for a few days. This blood problem is presumably due to the 3 to
4 litres of blood loss incurred after my cardiac catheterization My femoral
artery was damaged about 2 inches above the catheter insertion point,
but the doctor did not realize it during the procedure. about an hour
after the procedure I became severely ill from the blood loss and had
emergency surgery. It has been almost five months and my blood tests
are still abnormal, although the results do go up a little each month.
Unfortunately that doesn't transfer to feeling a little better each month.
I am now barely able to function on a daily basis. I am still working,
but have to take at least one day off every week, and sometimes more.
Luckily, I get a lot of vacation, but it is about to run out. during
my hospital stay after the stent placement i was given 3+ litres of blood.
One of the bags made me sick and after about 45 minutes I made them stop.
they retested the blood and said it was OK, but I stalled letting them
continue for a couple of hours. Once they restarted the blood had been
hanging for too long, and they had to replace it with a new bag. After
they brought the new bag and continued giving me the blood without incident.
I feel certain something was wrong with that one bag. All of that explanation
to ask this question: could mis-typed or bad blood given months ago,
still be causing me problems?
steve shirk, , lawrenceville, ga USA, September 28, 2006
Just wanted to add my observations. I am desperately
sorry for all the people that seem to have had a bad reaction to stenting.
But remember. 'You have to be alive to complain' Personally I had two
Taxus Express drug eluting stents inserted on 30 May after becoming breathless
very quickly when walking. Now...never felt better. Aspirin, Plavix,
Bisoprolol,valsartan and Simvastatin are my cocktail. I may rattle when
I walk but at least I am walking. Come on guys, be positive, you are
still here. The only minor problem I have had is that when I went to
my General practitioner for a checkup he said he would take me off Plavix
after 3 months. I had to get my cardiologist to write to him and insist
on keeping me on it for at least a year and preferably, 2 years to life.
Best regards.
John K., United Kingdom, September 21, 2006
Dr. Khalil -- first generation DES have permanent
polymers -- there is some thought that the polymer does begin to break
down after a couple of years. The drug elution is supposed to only occur
in the first few months. DES like the CoStar (Conor Medsystems) is built
with a bioabsorbable polymer that in effect turns the stent into a bare
metal stent after 6 months. I think we'll be seeing more and more innovations
with biodegradable polymers or no polymers in the future.
Angioplasty.Org Staff, Angioplasty.Org, September 20, 2006
Hi, this is my second posting to you (the first
on 4-8- 2006) I read all the latest DES news related to LAST (late angiographic
thrombosis) the question is : Is there any way to avoid or at least delay
this event? Is there any way to transfer a DES into BMS? How long does
it take for a drug (in my case Zotarolimus) to be completely eluted?
Is there any way to accelerate the elution? Apart from strict compliance
with meds (especially the dual antiplatelet drugs) what else could be
done?In other words how can we wash out the drug and If possible together
with it the polymer? Cant we utilize the Tec of the CoStar to do so?
I believe that our BROTHERS MANUFACTURERS might have some solutions to
combat LAST?? I am very much obliged to your highly esteemed & useful
site. Long live DES suffers!
Abdwl wahab Khalil, Dr Nabil Pharm EnterprisesK, Khartoum, September
18, 2006
My cardiologist has told me on a couple of
visits that clopidogrel therapy wasn't really necessary for life. We
disagree. I told him that after 4 stents, I want to stay on it! My last
PTCA was in June, when 2 stents were placed in the LAD. I'm having oral
surgery in 3 days, and I was advised by both the oral surgeon and my
cardiologist to discontinue the Plavix 5 days before the surgery. My
oral surgeon said that I have a choice of staying on Plavix and bleeding
to death after the extractions ("we can't suture bones") or taking a
minimal risk of an infarction and stopping the Plavix. So I did. I stopped
taking it yesterday and won't take it again until after the oral surgery,
and until I stop oral bleeding. So you can imagine how nervous I am.
What a choice to have to make!!
M.S., Florida, USA, September 17, 2006
Stents are proven to be effective in : 'ST
elevation' heart attacks, compared to clot-busting drugs and in high
risk non-ST elevation acute chest pain episodes. BUT in stable angina
- Single vessel disease: stents do not reduce mortality and may increase
risk of future heart attack. In Multivessel disease bypass surgery is
superior to stents in reducing mortality, angina and repeat procedures
- though of course it's open-heart surgery. Overall, these procedures
are for those with symptoms of angina IN SPITE of anti-angina tablets.
what REALLY protects you from future adverse events are your aspirin
and statin tablets, not the stent, which simply opens your artery and
relieves angina.
Dr Mo Samuels, cardiology resident , University of London,
UK, cardiology resident (j.zaman@ucl.ac.uk), Sunday, September
17, 2006
Thanks to the forum editor for clearing that
up. I feel better about it now. It seems to be a case of pencil-whipping
numbers to generate a scare. We've seen it before. On the patients who
discontinued their antiplatelet therapy AMA, that's just common sense.
And pretty ill-advised of them. I saw my cardiologist in August and she
told me she plans to continue my clopidogrel therapy for life. I have
no problems with that, and I don't plan to miss a single dose!
Kevin, Patient, Albuquerque, New Mexico, USA, September
10, 2006
Kevin -- sorry, we didn't really answer one
of your questions, about the 16% increase being called "statistically
insignificant". First of all, Reuters was kind of mixing and matching.
The study referred to was not about stent thrombosis. It was about the
incidence of Major Adverse Cardiac Events (MACE) not just stent thrombosis.
A MACE is defined as death, heart attack or revascularization (having
to re-open the artery). The raw data from that study are that in the
Taxus stent group 2.6% of the patients experienced a Major Adverse Cardiac
Event (MACE) -- whereas in the bare metal stent group the number was
2.3%. This makes the actual increase 13% -- but given the quantity of
patients studied, the statisticians calculated a "p-value" that
is technically "NS" or "not significant". "P-values" are
a much better way to compare the groups and they are used throughout
these types of studies. They involve complex statistical analysis but
it basically comes down to, based on the size of the population studied,
the difference between 2.3% and 2.6% is "not statistically significant" because
the difference falls within the normal variation that might be expected
when comparing any two groups.
This was not the case for the Cypher stent, which showed
a 6.3% MACE, compared with 3.9% in the bare metal group, which was definitely
statistically significant. The figures quoted in the Reuters article
were for "relative risk" in which these percentages have been
adjusted, again using complex statistical formulae, in order to compare
them to each other.
But again, this study was not about the occurence of
stent thrombosi which Boston Scientific undertook on their own and determined
that, while small in numbers, the difference with bare metal stents was "statistically
significant".
Angioplasty.Org Staff, Angioplasty.Org, September 9, 2006
Kevin -- we have written two recent articles
about the increased risk of stent thrombosis with drug-eluting stents
and are working on a feature which we hope to have up over the weekend.
Check out the Drug-Eluting
Stent NewsCenter. Late stent thrombosis is a complex issue and the "higher
risk" is due to several things. More than a few patients in these
studies were found to have prematurely ended their antiplatelet therapy,
and this definitely increases the risk of thrombosis.
One big thing that patients can do is to be very conscientious
about maintaining their prescribed antiplatelet therapy -- usually aspirin
plus either clopidogrel (Plavix) or ticlopidine (Ticlid). The recommended
period for taking this drug regimen is 3 months for the Cypher stent
and 6 months for the Taxus -- and aspirin for life (aspirin has other
benefits for heart patients). However, most cardiologists -- and we bet
this number will increase even more after this week's news -- most cardiologists
prescribe antiplatelet therapy for a year; some for life. This can get
complicated if the patient needs surgery, which may entail going off
Plavix, etc. for a short while. We recommended ALWAYS consulting your
cardiologist before going off this medication during the time period
he or she has prescribed for you. By the way, late stent thrombosis has
been a concern since drug-eluting stents were introduced in the U.S.
in 2003. Angioplasty.Org wrote an editorial at that time, and has consistently
tried to publicize the critical importance of patients staying on their
antiplatelet therapy -- one of the few places on the net where this has
been done. Check out the "related topics" in the right-hand
column.
Angioplasty.Org Staff, Angioplasty.Org, September 8, 2006
This newsflash today is more than a little disturbing,
as I have two Taxus 2 drug-eluting stents in place. I happened across
it at Fidelity.com where I have a brokerage account. They confirm an
increased risk of blood clots/late stent thrombosis, and later dismiss
a 16% increase as being "statistically insignificant". They go on to
say that there is no increased risk to your health if you have one. How
can an increased clot risk translate as "no increased risk" to my health?
I smell a whitewash job. [Editor's note: here
is a link to Kevin's Reuters story that you can read without subscription.]
Kevin, patient, Albuquerque, New Mexico, USA, September 7, 2006
C.V.K. -- glad you got to the hospital quickly.
That was the most important thing! This topic is about "stent thrombosis" --
something that can occur AFTER the stent is implanted. But thrombosis
(clotting and blocking of the artery) is ultimately the cause of most
heart attacks. It sounds like the angioplasty and stent cleared up the
blockage. You call it a thrombotic occlusion (meaning the blood clotted
and prevented the blood flow). Our question would be: did the cardiologist
open up a physical underlying narrowing (stenosis) which may have provided
the impetus for the thrombus to collect and form? Most likely there already
was some type of obstruction in the ostial LAD. With that removed, the
chances of another thrombus are reduced, but, as we're sure your doctor
told you, if you feel anything out of the ordinary, especially for the
next few months, go see him/her.
As for a blood test, perhaps one that tested your clotting
factor, cholesterol, lipid levels, etc. We assume your cardiologist put
you on blood thinners like aspirin and Plavix, both of which will help
keep thrombi from forming. As for recovery of your full LV function,
that's something that your cardiologist would be better at answering,
if anyone can. So much depends on specifics of each patient. But "mild
LV function" is much better than it could be, so keep active, reduce
risk factors that you have control over, like diet and smoking, and take
the prescribed medications. Hope this helps.
Angioplasty.Org Staff, Angioplasty.Org, September 6, 2006
I am 41 years old slim built person. My BMI
is 22. There is no visible fat deposition at all. Had a good habit of
going for physical exercises daily like jogging / streching, games etc.
No pre history of any pain in chest. Suddenly on 18.08.2006 had a severe
myocardial infarction at 5am. The cardiologist did emergency coronary
angiography. Conclusion : CAD single vessel disease Type III - 100% Ostial
LAD throbomtic occlusion. Did primary PTCA + stent to LAD with 3.5x16mm
yukon DES at about 2.45 pm same day. The report read there was TIMI 2
flow in LAD which improved after intracoronary SNP injection. Final angio
showed good result. What does it mean? After 4 days, the Doppler echocardiography
shows 44% pumping efficiency (simpson's), Left ventrical wall motion
abnormal. Conclusion: mild LV dysfunction. The apical and mid septum
and anterior wall are hypokinetic (LAD territory). Left ventricle inflow
doppler shows altered A/E ratio indicating diastolic dysfunction. All
other things are normal.
Now my question is what are the chances for my heart
for recovering to its original condition? Is it possible?? if so how
long will it take to improve?? Secondly is there any blood test to determine
under what conditions or compositions of blood this thrombotic occlusions
occur??
C.V.K. , INDIA, September 5, 2006
Helpless -- first of all, you're not. You're
looking up information and trying to help understand the situation. It
sounds like your husband's is complex. We never recommend therapy or
give medical advice, and in his situation you should be discussing the
options with his doctor. BUT, what you are doing is very important: getting
information that will help you ask the right questions and understand
what your doctor is recommending. For example, what will a pacemaker
do to help him? We suggest reading over our article You
and Your Physician, -- make sure and write down a list of questions
that you need the answers to. Part of getting better is understanding
what's being done, what is the nature of your disease and, if you have
it, how to best manage it. Good luck and please let us know what you
find out.
Angioplasty.Org Staff, Angioplasty.Org, August 19, 2006
My husband had stents put in 4 arteries 2 weeks
ago. Now his pulse rate is high. Is this possible due to a clot. because
he is on dialysis and can't be dialysed because of his on-going pulse
rate being too high. He is on plavix -- should he also take the ecroin
aspirin, coumadin. Now the doctor talking about a pacemaker, please advise
ASAP, before it's too late to help him.
Helpless, Baltimore, Maryland, USA, August 17, 2006
T. in South Carolina -- stent thrombosis is
a condition that occurs in only 1 or 2 out of 100 patients. But when
it does, it occurs acutely -- sudden and unexpectedly -- and is usually
accompanied by pain -- it is, in effect, like a heart attack. It is very
different than restenosis, which is a gradual reclosing of the arterial
segment that was originally opened. The risk of stent thrombosis is greatly
lessened by taking your prescribed antiplatelet medication: usually aspirin
plus clopidogrel or ticlopidine (talk to your doctor about this if you're
not on it).
Angioplasty.Org Staff, Angioplasty.Org, August 8, 2006
My husband has had 5 heart caths in less than
a year. One stent in 11/05 2 more stents last week to extend the 1st
one. Another cath. last week because of a blood clot the Dr. says. He
could not climb steps without almost passing out. Now he has no energy
and I just read about the SAT. Any response on the energy. Can't get
anywhere with the Drs. Should we be concerned about the SAT?
T., South Carolina, USA, August 6, 2006
Kevin -- glad to hear your story. It's important
to emphasize that your "textbook" case is the norm for the
majority of patients. Where you're out of the norm is that you actually
wrote to this Forum with a positive outcome. As we've written,
pretty much all a reader sees here are the "horror stories".
We get these because patients who have not had a good experience often
can't get any resolution or information about their problem, so they
turn to the Net, Google their question -- and there we are! So what you
read here is a highly distilled and concentrated mixture of complications
and adverse events -- the Forum can be sort of like "The Complaint
Department".
That being said, it is our opinion that many, if not
most, of these reports are not to be found elsewhere. For example, how
many posters have formally reported these problems to the F.D.A.? It
is extremely important to keep information about complications in the
forefront because as Andreas
Gruentzig, the inventor of coronary angioplasty, said in 1985: "I
am speaking all the time about complications...Well fortunately those
complications are rather minor, in percentage. The reason I speak up
about complications -- it is not because it is such a major problem.
But it is always my major concern in selecting patients or treating patients." (see
the video clip.) He believed that complications were extremely important
in learning what went wrong in order to improve the procedure.
Angioplasty.Org Staff, Angioplasty.Org, August 6, 2006
These horror stories I've been reading here
have gotten me apprehensive, to say the least! My cardiologist painted
a much rosier picture for my prognosis. She basically said that in 6
months all heart muscle damage will have repaired itself, and my outlook
is excellent, especially now that I am on Lipitor. I have to agree because
I feel fantastic since the stents were implanted. I realize now how many
subtle, unidentifiable symptoms I was suffering from while I had the
two blockages. I feel rejuvenated, and am endlessly thankful for that.
I feel so bad for some of the people I've been reading about here. My
gosh, some of the complications are terrible. The thrombosis, the femoral
artery problems ...the sudden deaths, the whole slew of other problems
people here have experienced ..... I feel guilty having had such a stress-free
and positive experience having my stents installed. I wish there was
something I could do to help you all. Chalk my experience up as one of
the textbook cases. I am very fortunate.
Kevin, Albuquerque, New Mexico, USA, August 4, 2006
Lori,
Sorry to hear about your loss. Having been 1 year out from stent placement,
it would be acceptable to stop the plavix, but often for minimal invasive
surgery, many surgeons do not feel stopping the plavix is absolutely
necessary. Although no one would know for sure exactly how your mother
died, it would seem more likely due to pulmonary embolism than stent
thrombosis. She was at risk for pulmonary embolism due to recent surgery
and lying in bed immobile during the recovery period. With stent thrombosis,
although one can die, they usually have significant chest pain due to
an acute heart attack the moment you have stent thrombosis. The other
possibility of death is due to an abnormal heart rhythm causing sudden
cardiac death. If she had a weakened heart, she would have been at increased
risk for this. Obviously you will never know for sure what was the exact
mechanism, rest assured it was not a deviation from standard of care
to have had the plavix stopped 1 year after stent placement for upcoming
surgery. I do think that the likelihood of death was due to massive pulmonary
embolism, but obviously no one can be sure without having had an autopsy.
F. L., North Carolina, USA, July 26, 2006
Many thanks for your prompt reply and for the
data on the subject. It's nice not to feel alone out there - Keep up
the good work!!
Rick, New York, USA, July 19, 2006
Rick and others -- the topic of how long patients
sould stay on antiplatelet therapy (clopidogrel, a.k.a. Plavix) after
drug-eluting stent placement is a topic of great discussion within the
profession. There have been many symposia and PowerPoint presentations
about this subject, and opinion varies. A recent example is an unscientific
poll conducted earlier this month on a cardiologists-only web site which
asked just that question. About 100 cardiologists responded. Only 2%
of the docs answered 3 months and only 25% answered 6 months -- the current
FDA recommendations for the Cypher and Taxus stents respectively. So
only 27% of the cardiologists in this poll prescribe what the FDA has
stated as a minimum recommendation. 40% said a year. Over a third said "Plavix
for life". Does that mean you should stay on Plavix after a year? Not
exactly. Each patient is an individual with unique medical needs and
a specific clinical situation. For example, patients on the blood-thinner
coumadin present a different situation, and clopidogrel does carry a
risk of bleeding. That is why nothing you read on this (or other) sites
should be taken as "medical advice" -- these kinds of decisions
should be made by each patient's physician, with that patient's history
and medical records in hand -- in consultation with the patient, of course.
Angioplasty.Org Staff, Angioplasty.Org, July 18, 2006
When you say "late stent thrombosis"...what
is considered as late? One year ago had three drug eluting stents placed
in LAD. Since am now on coumadin for a-fib my group of cardiologists
feel that one baby aspirin plus the coumadin is sufficient and have advised
me that the plavix is no longer needed. Am a bit confused and would appreciate
your thoughts.
Rick, New York, USA, July 18, 2006
One year ago my mother
had a coated stent implanted and was put on Plavix and aspirin. Four
weeks ago she had out-patient arthroscopic surgery for a torn meniscus,
a procedure that lasted 10 minutes. She was told to stop plavix and aspirin
5 days prior. She died suddenly at home 20 hours after the procedure.
The death certificate stated a possible pulmonary embolism. We'll never
know for sure if that was the cause of death or a clot formed in the
stent (no autopsy). We're heartbroken. Just want others to be aware of
the danger of going off Plavix for minimally invasive procedures.
Lori, Charlotte, North Carolina,USA, June 1, 2006
Caren, yes, my father also died from a stent
(j&j) in 2003. He had the some thing your father had. I feel it`s the
stent that did it. I would like to have more feedback on this matter
too.
judy, levittown, New York, USA, May 6, 2006
Dear Caren -- Sorry for your father. I'm Gerrie
from Holland and 44 years old. In May 2005, I got a Taxus stent in the
left coronary artery. I experienced (sometimes) severe chest pain and
uncomfortable feeling caused by artery spasms by the stenting. After
half a year, the Plavix treatment ended. My blood became thicker and
in 10 days a had a mild heart attack. I was just on time in the hospital
to prevent an infarct. The heart attack (unstable angina pectoris) was
caused by blood clogging at the front of the stent. The clogging, no
longer prevented by the Plavix, was generated by artery wall injury caused
by the ever present artery spasms. A second stent was implanted and the
Plavix is continued. Now this time 30 April 2006, I still experience
chest contractions caused by artery spasms. Greeting from Holland and
don't hesitate to contact me.
Gerrie L., Netherlands, April 30, 2006
Caren, we are most sorry for your family's loss.
Sub-acute thrombosis (SAT) occurs in less than 1% of stents, and usually
within days after a stent is implanted. (There is another type, called
Late Stent Thrombosis, which is a different story -- see below.) What
happens in SAT basically is that the platelets can become activated by
the stent and then begin to aggregate at the stent site, causing a blood
clot or thrombosis. Antiplatelet therapy to prevent this is often started
prior to stenting, and is critical after stenting. The Plavix-aspirin
combo you indicated he was on is the recommended medication. All stents
have this risk. There has been concern about higher thrombosis rates
in the newer drug-eluting stents, and shortly after the CYPHER was approved,
the FDA issued a warning letter about this risk after deaths were reported.
We covered this topic in depth in our article "Unraveling
the CYPHER". But, after the situation was studied, the SAT rate
of the CYPHER or other drug-eluting stents did not seem to be higher
than that of bare metal stents -- in fact the CYPHER showed a 0.7% SAT
rate. The FDA withdrew its warning about drug-eluting stents. But SAT
remains a dangerous complication of all stenting. Sometimes it is caused
by the stent being in poor apposition, not conforming to the curves of
the arterial wall perfectly. This leaves a small "space" where
platelets can gather. Sometimes the stent is underexpanded. There are
several causes, not all predictable.
Angioplasty.Org Staff, Angioplasty.Org, April 22, 2006
Hello all, My father just passed away four weeks
ago. I spoke to the surgeon myself and he is sure that is was a subacute
thrombosis. He was on Plavix and 325 of aspirin. My father was somewhat
overweight and was "borderline" diabetes. I am trying to talk about this
and get some feedback. The research I have done on the internet puts
him in a very low risk of developing a clot. He passed 10 days after
his second set of stents. Any one heard of such a thing? Thanks, Caren
Caren, Austin, Texas, USA, April 20, 2006
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