Plavix After DES - Heart Disorders Message Board

donsabi · 01-23-2009, 08:38 PM

Last February I had a DES placed and was instructed that I must take Plavix for one year. I am now in a new location and a new cardiologist and MD. I ask my MD if it was alright to discontinue the Plavix after the year which will be mid February. He told me to check with my cardiologist who hasn't given me an answer. He keeps saying there isn't any data. From the posts I read on the web it seems that most cardiologist are afraid to make a call allowing the patient to make the decision. I thought I would run this last bottle of 90 out and discontinue taking it. Has anyone had any problems with discontinuing Plavix? Comments appreciated, thanks.

Beefsteak · 01-24-2009, 08:51 AM

Hi Don, Well, there can be a rebound effect after stopping it - which is possibly why the specialists are uncertain and/or have different opinions. The rebound means that for some cases the likehood of stent thrombosis increases for a period after stopping - before gradually decreasing again. As far as I know this has not been fully researched. The SAFEST option would seem to be to continue taking the Plavix, however many patients are keen to stop it either for the cost saving (that may depend on where you are and your insurance), or for health reasons esp. the side effects they don't enjoy! Thin blood is not much fun and can be quite a health hazard in itself!
The prudent answer might be to taper off over say 6-12 months. All this depends of course on how you are financially, and any issues you might have with continuing to take it.
Hope this helps in some way.
Beefy

nosa47 · 01-24-2009, 12:08 PM

Quote:

Originally Posted by donsabi

Last February I had a DES placed and was instructed that I must take Plavix for one year. I am now in a new location and a new cardiologist and MD. I ask my MD if it was alright to discontinue the Plavix after the year which will be mid February. He told me to check with my cardiologist who hasn't given me an answer. He keeps saying there isn't any data. From the posts I read on the web it seems that most cardiologist are afraid to make a call allowing the patient to make the decision. I thought I would run this last bottle of 90 out and discontinue taking it. Has anyone had any problems with discontinuing Plavix? Comments appreciated, thanks.

Hi Don:

Many posts were written on this subject on these boards. I suggest doing a research on "stopping plavix" and reading these posts. You will find that some patients stopped after the recommended period of about 12 months (including myself) with no problems. Some stopped after a shorter period of time. Some continue to take the plavix on the advice of their doctors indefinitely. So it is really a call that you will have to make based on your own circumstances and how well you are taking care of yourself as far as life-style i.e. diet, exercise, smoking, cholesterol, etc. with consideration given to whether you are diabetic or have a propensity to clotting or restenosing easily along with other possible factors that only your cardiologist can determine. You mentioned that your previous cardiologist had instructed you to take plavix for one year. Does he still feel that way?

From my own experience, I know it was a very hard decision to stop, even though my cardiologist did not give me the impression that it was really a big deal, and once it was time to stop it, I did so and it has been almost two years. But every patient and every doctor is different. Hopefully, after you research the posts you will get a much better idea and will be able to determine the best course of action for you to take. Best of luck

donsabi · 01-27-2009, 01:01 PM

Thanks for you posts. My current cardiologist simply said the protocol with a DES is Plavix for six months. Now there seems to be some controversy as to the effectiveness of Plavix. Some reports indicate that Plavix is no more effective that low dose aspirin. It is difficult to make a decision when there is nothing definitive and the medical profession seems to want to dump the decision on the paitent, in my case, me.

Beefsteak · 01-28-2009, 07:56 AM

Don,
Your cardiologist said HIS protocol is to stay on plavix for 6 months, but I think you will find the more usual protocol is for 12 months.

The reduced effectivess of Plavix you refer to can occur, apparently (with rather limited and debated evidence so far), when also taking PPIs (proton pump inhibitors, eg Nexium). This would mainly apply to those stent patients being treated for stomach ulcers or some gastrointestinal bleeding problem.

The way I view it is this - the risk of stent thrombosis is statistically quite high - and higher of course if there are concomitant risk factors like smoking, diabetes, previous heart attacks, high blood pressure, family history, etc. ANY medication, including combinations or dual treatments, that helps reduce that risk is therefore very important. The standard treatment is Plavix and aspirin. This is not the strongest or most effective blood thinner - it is the safest, and best tolerated treatment, while being reasonably effective. It is used every day by millions of people. Drugs like ticlopidine (a relative of plavix), are much better blood thinners but the associated risks are considered too high for general use. Ticlopidine treated patients have about half the risk of stent thrombosis, compared to those on plavix. (Remember Warfarin or Coumadin is a great blood thinner, but was originally introduced as rat poison! The rats literally bleed to death internally.

) But I have certainly thought about Ticlopidine - a 50% drop in stent thrombosis is mighty attractive! And each time I think about it I think about the rats - definitely NOT a good way to go!

The bottom line is these decisions are important and must be weighed up with your risk factors, your general health, and what you are prepared to accept. Everyone IS different - doing your own research can pay off.
Beefsteak