Coumadine ?? Help needed - Heart Disorders Message Board

pa235 · 08-07-2007, 07:07 PM

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

Lenin · 08-08-2007, 06:28 AM

Quote:

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

).

pa235 · 08-08-2007, 07:04 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

started04 · 08-08-2007, 05:43 PM

Quote:

Originally Posted by pa235

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.

Lenin · 08-09-2007, 07:11 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.)