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Stopping clopidogrel
Can anyone advise re stopping clopidogrel? i've been on this for a year and am due to come off it now. My GP said it was ok to just stop but I'v heard it is better to reduce gradually. I don't want to contradict my GP without any futher evidence.
Rachel,
I was stented at the end August this year and my Cardiologist said he normally put his patients on Plavix(clopid) for 1 year but because I had drug eluting stents which take longer to bed in, I had to be on it for 2 years along with my Asprin my heart.
However when I went to my rehab the nurse was alarmed and phoned my Cardiologist immediately on the spot as she was concerned with my unusual bruising......I was even bruising under ar-pits, between toes,soles of my feet etc etc. The worst was my legs and second my arms then my stomach.
I saw my Cardiologist and he said normally if he saw a case so bad as mine he would change to a different medication but with my past history of kidney disease, stroke and brittle asthma it was the best drug for me to be kept on. However he has said I must not stay on it for 2 yrs but must stop it at 9 mths post-op. If it had been a plain metal stent he would have stopped at 6 mths rather than 1 year with that type of stent.
Are you aware there are different types of stents which means the difference of 1 or 2 yrs.
I have regular blood counts to check the platelets, kidney function etc and my G.P. keeps a tight eye on things. I have developed Phlebitis in my legs which is very painful and will be stopping it next May..
I was with an Orthopedic surgeon today and he said there is no way he would do surgery at present while i'm still on it......stands to reason !!
Best advice is either from your cardiologist or your General Practitioner.
Best wishes, Winnie
I had a small heart attack 6 years ago which was treated by the insertion of a couple of stents. Does anyone know how long these are likely to last and when they reach the end of their life - what happens to them? In otherwords what symtoms will I have?
Has anyone had their stents replaced?
Sue
I had four stents fitted almost one year ago, I asked cardiologist the same question only to be told "for the rest of your life", 20, 30 years or more he said, get out and enjoy my life and stop worrying, I thought easy for him to say as I still get strange aches and pains, but my feeling is that if I get 20 years on stents do I still have another 25 after CABG, lets hope so!
I am not a doctor ... so I'm not giving any advice :-).
I had a quadruple bypass 5 years ago. As I was so young (47/48), the surgeon said to me, that the objective was to give the operation as much chance as possible ... and for it to have a '35 year outcome' ... not 10 or 20 years ... before a possible redo. Obviously I agree with that (!) - though I would still only be 83. Apart from rehab stuff, he recommended to the cardiologist that I continue with clopidogrel and aspirin for the rest of my life. He freely admitted that this was a 'punt'. The protocol at the time was for patients to come off clopidogrel 6 or 12 months after heart surgery (can't remember whether it was 6 or 12 months). The cardiologist thought it was worth taking the risk too.
Unfortunately as well as bruising easily I had a gastro-intestinal (GI) bleed after a few months. I didn't know then - but I do now. This causes black stools. Really this is not good because it means your gut is continuing to bleed. After a few days and a chance comment in a social chat with an old mate who is GP, I realised that I was possibly suffering from anaemia, and having a continuing GI bleed. This was confirmed by my GP.
It turns out that the combination of clopidogrel and aspirin is a very powerful antiplatelet (blood thinning) therapy. In fact it was too much for me. I came off clopidogrel straight away and now rely solely on aspirin. So far so good. I now also take a drug to protect my gut, a so-called proton pump inhibitor, lanzoprazole.
I checked articles in the BMJ (British Medical Journal). (I am not a medical doctor, but I have a research background.) The advice given by my surgeon and supported by the cardiologist was probably the best at the time. However there were questions appearing in the medical literature about the risks of long term dual clopidogrel and aspirin antiplatelet therapy. Because of the seriosness of my anaemia I actually yellow carded the drug combination (http://yellowcard.mhra.gov.uk/)
Whilst it is clearly beneficial after cardiac surgery, long term use of clopidogrel (especially with aspirin) does bring risks ... and so the protocol is to come off it sometime after a heart operation ... unless you happen to have an allergy to aspirin. For such people, clopidogrel may in fact be more appropriate than aspirin.
So the upshot for me was that coming off clopidogrel was essential. I was worried ... because my perception was that clopidogrel was important to the long term succcess of my surgery. But having looked things up, and discussed matters with my GP, cardilogist and surgeon, I am convinced the right thing was done. I don't bruise easily now :-).
If you have any doubts, don't be afraid to talk to your doctor ... or maybe a practice nurse to resolve your concerns.
Best wishes,
David