pa235
08-07-2007, 10:07 PM
:angel: Hi everyone,
My husband had a heart attack two years ago, had two medicated stents put in. He was on Plavix for one year the Dr. took him off the med and two weeks later he had another heart attack caused by a blood clot from the stent. He had by-pass surgery but was in very bad condition so they only by-passed the one stent. Plus he suffered a small stoke during the procedure.
He is seeing a new cardio, due to the fact the other one never returned phone calls or answered questions drectly.
He has been on coumadine for a year, yesterday the Cardio told him he was confident that he could stop the coumadine and just take the 81 mgs. aspirin. He said clots from the medicated stents can happen up to four years after the implant but normally happen in the first two years. My husband is quite anxious about going off the med. so i am asking for your opinion on this.
Thanks, Linda
My husband had a heart attack two years ago, had two medicated stents put in. He was on Plavix for one year the Dr. took him off the med and two weeks later he had another heart attack caused by a blood clot from the stent. He had by-pass surgery but was in very bad condition so they only by-passed the one stent. Plus he suffered a small stoke during the procedure.
He is seeing a new cardio, due to the fact the other one never returned phone calls or answered questions drectly.
He has been on coumadine for a year, yesterday the Cardio told him he was confident that he could stop the coumadine and just take the 81 mgs. aspirin. He said clots from the medicated stents can happen up to four years after the implant but normally happen in the first two years. My husband is quite anxious about going off the med. so i am asking for your opinion on this.
Thanks, Linda
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Lenin
08-08-2007, 09:28 AM
He is seeing a new cardio, due to the fact the other one never returned phone calls or answered questions drectly.
Hi Linda,
That sounds like typical doctor's denial after the spit hits the fan with a patient...they can behave like children with their hands in the cookie jar.
I think stopping the coumadin on your cardio's recommendation is a good one but if so I would NOT trust 81 mg. aspirin and would opt for a full sized 325 mg. tablet.
He COULD go half way and take very small doses of coumadin, as low as 2 mg./day) WITH the aspirin. I presume he has had his INR regularly measured? (Do you know what number he was running?)
<<After that heart attack at year one, I can understand the reason for your apprehension.>>
A proviso: I am not very well versed in Coumadin, so DO trust the cardiologist (except for the aspirin ;)).
Hi Linda,
That sounds like typical doctor's denial after the spit hits the fan with a patient...they can behave like children with their hands in the cookie jar.
I think stopping the coumadin on your cardio's recommendation is a good one but if so I would NOT trust 81 mg. aspirin and would opt for a full sized 325 mg. tablet.
He COULD go half way and take very small doses of coumadin, as low as 2 mg./day) WITH the aspirin. I presume he has had his INR regularly measured? (Do you know what number he was running?)
<<After that heart attack at year one, I can understand the reason for your apprehension.>>
A proviso: I am not very well versed in Coumadin, so DO trust the cardiologist (except for the aspirin ;)).
pa235
08-08-2007, 10:04 AM
Hi Lenin,
Again, thank you for your reponse.
I do not know what his inr was but he was monitored regularily and his coumadine switched to more and less quite often. He never went more tha one monh without having it checked.
I mentioned to the Cardio about a higher dose of aspirin but he said 81 mg. was suffiecent.
His coumadine doage went from 1 to 2/12 mgs days, depending on his inr.
I can understad his fear but have no idea what to tell him. this Cardio is excellant, he gets checked thoroughly every time he goes, either a ekg, a echo or a stress echo. his last echo his ef was 70 %.
Again Thank You for your help, Linda
Again, thank you for your reponse.
I do not know what his inr was but he was monitored regularily and his coumadine switched to more and less quite often. He never went more tha one monh without having it checked.
I mentioned to the Cardio about a higher dose of aspirin but he said 81 mg. was suffiecent.
His coumadine doage went from 1 to 2/12 mgs days, depending on his inr.
I can understad his fear but have no idea what to tell him. this Cardio is excellant, he gets checked thoroughly every time he goes, either a ekg, a echo or a stress echo. his last echo his ef was 70 %.
Again Thank You for your help, Linda
started04
08-08-2007, 08:43 PM
:angel: Hi everyone,
My husband had a heart attack two years ago, had two medicated stents put in. He was on Plavix for one year the Dr. took him off the med and two weeks later he had another heart attack caused by a blood clot from the stent. He had by-pass surgery but was in very bad condition so they only by-passed the one stent. Plus he suffered a small stoke during the procedure.
He is seeing a new cardio, due to the fact the other one never returned phone calls or answered questions drectly.
He has been on coumadine for a year, yesterday the Cardio told him he was confident that he could stop the coumadine and just take the 81 mgs. aspirin. He said clots from the medicated stents can happen up to four years after the implant but normally happen in the first two years. My husband is quite anxious about going off the med. so i am asking for your opinion on this.
Thanks, Linda
Hi Linda, Warfarin (coumadin) is a strong anti-coagulant, that is sometimes prescribed when aspirin is ineffective. Your husband should have a test to determine clotting time with any medication for peace of mind and better management of clotting medication.
There is a risk of Reye's Syndrome and that can be fatal and cause damage to major organs (liver and brain), and recent studies indicate that the risk of Reye's Syndrome increases with the amount of aspirin taken.
Follow doctor's regimen for 81 mg aspirin, and because your husband appears to be vulnerable to clots, it may be wise to determine clotting time for proper management on an on-going basis. That would be the appropriate treatment to narrow the odds of further clots.
My husband had a heart attack two years ago, had two medicated stents put in. He was on Plavix for one year the Dr. took him off the med and two weeks later he had another heart attack caused by a blood clot from the stent. He had by-pass surgery but was in very bad condition so they only by-passed the one stent. Plus he suffered a small stoke during the procedure.
He is seeing a new cardio, due to the fact the other one never returned phone calls or answered questions drectly.
He has been on coumadine for a year, yesterday the Cardio told him he was confident that he could stop the coumadine and just take the 81 mgs. aspirin. He said clots from the medicated stents can happen up to four years after the implant but normally happen in the first two years. My husband is quite anxious about going off the med. so i am asking for your opinion on this.
Thanks, Linda
Hi Linda, Warfarin (coumadin) is a strong anti-coagulant, that is sometimes prescribed when aspirin is ineffective. Your husband should have a test to determine clotting time with any medication for peace of mind and better management of clotting medication.
There is a risk of Reye's Syndrome and that can be fatal and cause damage to major organs (liver and brain), and recent studies indicate that the risk of Reye's Syndrome increases with the amount of aspirin taken.
Follow doctor's regimen for 81 mg aspirin, and because your husband appears to be vulnerable to clots, it may be wise to determine clotting time for proper management on an on-going basis. That would be the appropriate treatment to narrow the odds of further clots.
Lenin
08-09-2007, 10:11 AM
pa,
There is pretty good documentation showing that about 25% of people in the general population do not get clot prevention from 81 mg. aspirin and many cardiologists are beginning to recommend 2 x 81 mg. aspirin as minimal.
Your husband has shown that he is PRONE to clotting...witness the stent clot that happened 2 weeks after stopping the anticoagulant meds. Coincidentally that is exactly the amount of time it takes to get new unprotected platelets after aspirin therapy.
Thus he must be judged high risk for another clot. He must be kjudged quite apart from the general population.
Someone at high risk of clotting with a proclivity for easy clotting (aka medicated stent) had best do MORE than the run-of the mill minimum that is prescribed for the general population.
How horrible would you both feel IF he switched to just 81 mg. aspirin and threw another clot with another ensuing MI. And of course there would be yet ANOTHER cardiologist who won't return your calls.
For anyone who has taken aspirin and coumadin along with aspirin over a two year period, a 325 mg. aspirin will produce ZERO chance of bleeds.
IF your husband had never had a cardiac clot my thinking might be diffferent, but I think ignoring the fact that he HAS HAD such a clot, the cardiologist should apply a different standard of care...does he need to have a HOUSE fall on him? Remember, your husband STILL has another identical medicated stent with circulation through it...is it unreasonable to assume that your husband's blood stream is dealing with that stent in a very similar manner?
I hope that stroke passed without permanent symptoms. Was it an occlusive stroke(clot) or a hemmorhagic stroke (bleeding.)
There is pretty good documentation showing that about 25% of people in the general population do not get clot prevention from 81 mg. aspirin and many cardiologists are beginning to recommend 2 x 81 mg. aspirin as minimal.
Your husband has shown that he is PRONE to clotting...witness the stent clot that happened 2 weeks after stopping the anticoagulant meds. Coincidentally that is exactly the amount of time it takes to get new unprotected platelets after aspirin therapy.
Thus he must be judged high risk for another clot. He must be kjudged quite apart from the general population.
Someone at high risk of clotting with a proclivity for easy clotting (aka medicated stent) had best do MORE than the run-of the mill minimum that is prescribed for the general population.
How horrible would you both feel IF he switched to just 81 mg. aspirin and threw another clot with another ensuing MI. And of course there would be yet ANOTHER cardiologist who won't return your calls.
For anyone who has taken aspirin and coumadin along with aspirin over a two year period, a 325 mg. aspirin will produce ZERO chance of bleeds.
IF your husband had never had a cardiac clot my thinking might be diffferent, but I think ignoring the fact that he HAS HAD such a clot, the cardiologist should apply a different standard of care...does he need to have a HOUSE fall on him? Remember, your husband STILL has another identical medicated stent with circulation through it...is it unreasonable to assume that your husband's blood stream is dealing with that stent in a very similar manner?
I hope that stroke passed without permanent symptoms. Was it an occlusive stroke(clot) or a hemmorhagic stroke (bleeding.)
pa235
08-09-2007, 10:51 AM
Hi Lenin,
My husband's stroke happened when they were doing a cath, i assume while they were trying to break the clot up a piece broke loose. he has no permment damage from the stroke.
This is why he so frighteed to go off the coumadine due to the fact he had the 2nd attack 2 weeks after being taken off Plavix.
This new cardio has a excellant reputation, spends time with you asks and answers questions. he has done a stress echo and two regular echos xeveral ekg's in the last year. He told my husband he has very little damage from
the attacks, his ef was 70%.
He is scheldiuled for a nuclear stress in Feb. He does have a 60% blockge n an other artery that never shows up on a stress test. He has a strong family history o heart attacks and strokes.
This is a hard call to make even though we have confidence in this cardio and he is confident that my husband can go off the coumadine. My husband is going to dicuss this with our g/p before he stops the med.
Thanks fo you time, Linda
My husband's stroke happened when they were doing a cath, i assume while they were trying to break the clot up a piece broke loose. he has no permment damage from the stroke.
This is why he so frighteed to go off the coumadine due to the fact he had the 2nd attack 2 weeks after being taken off Plavix.
This new cardio has a excellant reputation, spends time with you asks and answers questions. he has done a stress echo and two regular echos xeveral ekg's in the last year. He told my husband he has very little damage from
the attacks, his ef was 70%.
He is scheldiuled for a nuclear stress in Feb. He does have a 60% blockge n an other artery that never shows up on a stress test. He has a strong family history o heart attacks and strokes.
This is a hard call to make even though we have confidence in this cardio and he is confident that my husband can go off the coumadine. My husband is going to dicuss this with our g/p before he stops the med.
Thanks fo you time, Linda
started04
08-09-2007, 12:57 PM
My point is to MANAGE with medication and that requires knowing your patient's physical and mental condition, taking appropriate tests, clinical observation, and weighing the risk/benefit. EVERY patient has different circumstances.
Coumadin is recommended to prevent as well as treat blood clots. Apparently, the aspect of treating blood clots is in the doctor's opinion no longer necessary, and blood thinner is sufficient at the present stage of the patient's health considering risks.
Actually the best preventive therapy is the combination of aspirin/plavix up to two years with some patients and possibly longer. Take the low dose of aspirin as the doctor recommends and blood test for effectiveness. Go from there! Take it or leave it! Street pharmacology notwithstanding.
Coumadin is recommended to prevent as well as treat blood clots. Apparently, the aspect of treating blood clots is in the doctor's opinion no longer necessary, and blood thinner is sufficient at the present stage of the patient's health considering risks.
Actually the best preventive therapy is the combination of aspirin/plavix up to two years with some patients and possibly longer. Take the low dose of aspirin as the doctor recommends and blood test for effectiveness. Go from there! Take it or leave it! Street pharmacology notwithstanding.
Connie122516
08-10-2007, 11:01 AM
For what little it may be worth, I had a stent placed almost 3 years ago now, and I'm still on two (2) 81 mg aspirin and Plavix. My cardiologist is of the school that those of us with medicated stents should be on this combination indefinitely, or at least until decent research is done which shows what is really going on with late-stent thrombosis (which is what your husband apparently had). My understanding is that the jury is still out, and that no one really knows what the risks of blood clots are, or how far out they occur, or what the best long-term treatment is. I've accepted the fact I'm an unwilling guinea pig whether I stay on Plavix or not (since as far as I know, the long term effects of Plavix are not known).
Personally, I'm with Lenin on this: if I had great faith in the cardiologist and were in your husband's shoes, I'd probably stop the Coumadin, but I'd definitely be taking at least a regular aspirin (325 mg), not a baby one (81 mg), and getting blood clotting tests done.
Personally, I'm with Lenin on this: if I had great faith in the cardiologist and were in your husband's shoes, I'd probably stop the Coumadin, but I'd definitely be taking at least a regular aspirin (325 mg), not a baby one (81 mg), and getting blood clotting tests done.
pa235
08-10-2007, 01:06 PM
Hi,
Just wanted to say that that a friend of ours had two medcated stents and has been on plavix for over three years. he has multiple clots in both his legs. He has been hospitalizd several times with the clots. Never had a clotting problem before. I thought that is what plavix was for to prevent blood clots. You are dammed if you do and dammed if you don't with these medicated stents.
There was an article in our paper that no one should do plavix more than two years. But then of course tomorrow it will be something else.
My husband is still taking the coumadine, at least with that if there was a bleed they can stop it. He will discuss his options with our G/P on Monday.
From what the cardio said the tissure around the stent is grown tightly after two years and the risk of another clot are very low.
Thank, everyone, Linda
Just wanted to say that that a friend of ours had two medcated stents and has been on plavix for over three years. he has multiple clots in both his legs. He has been hospitalizd several times with the clots. Never had a clotting problem before. I thought that is what plavix was for to prevent blood clots. You are dammed if you do and dammed if you don't with these medicated stents.
There was an article in our paper that no one should do plavix more than two years. But then of course tomorrow it will be something else.
My husband is still taking the coumadine, at least with that if there was a bleed they can stop it. He will discuss his options with our G/P on Monday.
From what the cardio said the tissure around the stent is grown tightly after two years and the risk of another clot are very low.
Thank, everyone, Linda
started04
08-10-2007, 01:35 PM
For what little it may be worth, I had a stent placed almost 3 years ago now, and I'm still on two (2) 81 mg aspirin and Plavix. My cardiologist is of the school that those of us with medicated stents should be on this combination indefinitely, or at least until decent research is done which shows what is really going on with late-stent thrombosis (which is what your husband apparently had). My understanding is that the jury is still out, and that no one really knows what the risks of blood clots are, or how far out they occur, or what the best long-term treatment is. I've accepted the fact I'm an unwilling guinea pig whether I stay on Plavix or not (since as far as I know, the long term effects of Plavix are not known).
Personally, I'm with Lenin on this: if I had great faith in the cardiologist and were in your husband's shoes, I'd probably stop the Coumadin, but I'd definitely be taking at least a regular aspirin (325 mg), not a baby one (81 mg), and getting blood clotting tests done.
You don't know the effects of anti-clotting med unless there are tests. Really it is not a difficult concept to accept when there is an understanding that people have different physiology and react differently to medication.
Coumadin or any other taking anit-clotting medication SHOULD BE MONITORED BY A PROFESSIONAL often to determine optimum levels of the medication and weigh the risk/benefit ratio.
Monitoring (s/b often until stablized) involves determing the International Normalization Ratio (INR), normal therapuetic range is 2.0-3.0 to prevent anti-clotting and Pro Time (how well is the interactions with other drugs).
YOU, myself, or a professional should not be so arogant to assume a proper dosage. Why would you stop Coumidin, and why would you recommend a high dosage of aspirin? YOU should not be a guinea pig, and if you are taking anti-clotting med for a very serious condition without knowing your INR level, etc. you are not being a gp, you are not getting the proper evaluation and the proper medical treatment (possibly). Be pro-active for a proper evaluation. Don't remain uninformed and guess your dosage, nor base your opinion on what you read!
I agree with the doctor for a lower dose of aspirin.. And why would you suggest the highest dose prior to a test? The goal would the most effective dose at the lowest mg. :D That is the most efficient protocol to follow to determine proper dosage.:)
Personally, I'm with Lenin on this: if I had great faith in the cardiologist and were in your husband's shoes, I'd probably stop the Coumadin, but I'd definitely be taking at least a regular aspirin (325 mg), not a baby one (81 mg), and getting blood clotting tests done.
You don't know the effects of anti-clotting med unless there are tests. Really it is not a difficult concept to accept when there is an understanding that people have different physiology and react differently to medication.
Coumadin or any other taking anit-clotting medication SHOULD BE MONITORED BY A PROFESSIONAL often to determine optimum levels of the medication and weigh the risk/benefit ratio.
Monitoring (s/b often until stablized) involves determing the International Normalization Ratio (INR), normal therapuetic range is 2.0-3.0 to prevent anti-clotting and Pro Time (how well is the interactions with other drugs).
YOU, myself, or a professional should not be so arogant to assume a proper dosage. Why would you stop Coumidin, and why would you recommend a high dosage of aspirin? YOU should not be a guinea pig, and if you are taking anti-clotting med for a very serious condition without knowing your INR level, etc. you are not being a gp, you are not getting the proper evaluation and the proper medical treatment (possibly). Be pro-active for a proper evaluation. Don't remain uninformed and guess your dosage, nor base your opinion on what you read!
I agree with the doctor for a lower dose of aspirin.. And why would you suggest the highest dose prior to a test? The goal would the most effective dose at the lowest mg. :D That is the most efficient protocol to follow to determine proper dosage.:)