Plavix or bleeding?

• By Threesacharm
• Reply 3442024
• October 8, 2012 at 6:08 pm
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What country are you in? That makes a difference in how long you take plavix. In Canada, it is normally one year for des stents and shorter for bare metal. In brazil, six months to one year. You are also taking a fairly high dose of aspirin. So I would ask about that as well, why you are on 325 mg. some people do take that much, but I think many of us are on 81 mg. I would think that with your ulcer history and history of bleeding plavix would be contraindicated for you, but you need to talk to your doc. American doctors are choosing to keep patients on plavix indefinitely until the determination is made of what the optimal term for plavix is. That answer does not come for another year or so. Even then, the study only looks at 24 and 30 months, there is no study presently underway that I can find that looks at plavix longer than thirty months. You have already taken it longer than that, so there has been no study that says it is safe to take for longer periods of time. The reason American docs have decided to keep people on it long term is because it was noticed, in a study that some people had late stent thrombosis after the one year mark with des stents, so in 2005, it was decided at a cardiology convention in the US that to avoid this all patients would be kept on indefinitely until a study could be done to figure out what the time should be. The study was started a couple of years ago. Here is the couple of problems I have with the presumption. Millions of people are kept on plavix to prevent late stent thrombosis past one year. The percentage of late stent thrombosis is less than one percent. The risk of serious bleeding with plavix ranges from 7-14%, it is dependent on other factors as well. Does this make sense? I think the reason for this is......cardiologists deal with late stent thrombosis......gastro bleeding, not their problem. My second problem is that prior to 2005 des stents were first generation, we are, since then, using second generation stents and they are not the same, not the same med on them, different platforms. Anyway, I came off plavix three months ago and I was glad. I was a little nervous at first but it sure feels great. I was able to wean off protonix and domperidone and my tummy feels great. I think you have a good case to take to your doc but I really think you should have talked to him first. Wishing you the best.

• By 4slowgirl
• Reply 3442506 · In reply to 3441985 by Pchyk
• October 8, 2012 at 9:36 pm
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I was put on the high dose because of the severity of the heart attack and because of the stents. The gastrointologist that scoped me and found the ulcers put me on the most powerful PPI on the market and one that would go with plavix. I needed plavix and asprin for my heart and protonix to help keep ulcers from forming. Catch 22. The stomach problems are listed as a side effect from plavix as well as asprin and blood in the urine is listed as a serious side effect of plavix on their site. Been on all for 3 years now and the stomach and urine problems started about one year ago. If you look on the plavix site it will tell you that if you have blood in the urine to stop it immediately and contact your Dr. It also states on their site that another serious side effect of plavix is GI bleeding that can and has caused death. Figure if I stay on low dose of asprin and protonix to help my stomach along with all the natural foods that thin the blood, I at least will feel better. The heart association still says that if you had Drug E Stents that you stay on Plavix for at least 1 year and I have been on it for 3. I will talk to my Dr. about all this when I see him on Thursday. Thank you

• By Threesacharm
• Reply 3443110
• October 9, 2012 at 6:32 am
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I had an xience stent, with everolimus, if that is what you mean by drug e. and I was taking protonix (we call it pantaloc here) I am also taking the coated 81 mg aspirin. After coming off plavix I was able to discontinue the protonix. I think you are probably right, especially since the info supports your decision, I am just always happier when the doc knows first. Given that, I think if I were in your shoes I would not agree if he told me to keep taking plavix. Your body, your risk. Being proactive and informed is good. I have reached the ninety day mark after plavix, so I guess I don't need to worry about plavix rebound. Good luck with the doc, I think you are smart to question continuing this awful drug.

• By 4slowgirl
• Reply 3444411 · In reply to 3443110 by Threesacharm
• October 9, 2012 at 2:04 pm
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Thank you for the post. I see the Dr. this Thursday, so will fill him in on what's going on. Two years ago he told my dentist I could go up to 7 days without Plavix in order to have oral surgery. I ended up not needing it but thought if 2 years ago I could go 7 days without it then it wouldn't hurt me to go 6 days now till I saw him. When the bleeding in the urine started, the first place I went was to my urologist because at that point I didn't relize it could be from the Plavix. When all tests came back neg. and he realized I was on Plavix, that is when it came up that that might be the cause. I spent 4 days before I stopped taking it doubled over with stomach pain but I knew I had an appointment coming up in a few days so that's why I decided to see if I would feel better without it till I saw my cardiologist. That's where and why I am where I am now. BTW, the 2 stents I have are Cordis Sirolimus-eluting coronary stents. I really appreciate this site and all your comments. It means alot to me.

• By Threesacharm
• Reply 3444622
• October 9, 2012 at 3:22 pm
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Everolimus is a derivative of sirolimus, an immunosuppressant. What is really cool about it is that it is rapamycin, discovered as a fungus in the soil in one place on earth, Easter island. Rapanui it was called by the indigenous people. Not really that important but I thought it was cool.....
I know the stomach pain of which you speak, I had it too, they had to give me a pink lady, lidocaine and pepto. Works great but numbs your tongue and throat. Good luck with you doc appointment.

• By 4slowgirl
• Reply 3444912 · In reply to 3444622 by Threesacharm
• October 9, 2012 at 5:04 pm
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That's very interesting and thanks--will let all know how my Dr. appt. goes

• By Threesacharm
• Reply 3445759
• October 9, 2012 at 10:48 pm
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See if I can get this link right, very interesting and new article.
HttpHarvardpartnersinternational.staywellsolutionsonline.com/HealthNewsLett ers/69,H0812f

• By 4slowgirl
• Reply 3447510
• October 10, 2012 at 3:03 pm
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Just out of curiosity, can anyone tell me why, if Plavix only remains in your system for 33 hours after you stop taking it, that a Dr. would have you go off it for 5-7 days before a medical procedure that could cause bleeding?

• By Threesacharm
• Reply 3447582
• October 10, 2012 at 3:34 pm
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The effect on the platelets is a permanent one, so if a platelet is exposed to plavix, that platelet is slippery. It takes about ten days for all the platelets affected atop be gone and new ones that are not plavix affected are present. So although plavix is out of your system, you still have affected platelets. So at five days, it would be approximately half of them, and so on, but of course nothing is perfect like that, but they have established a safety zone of 5-7 days, at that point the bleeding risk is significantly reduced.

• By 4slowgirl
• Reply 3447837 · In reply to 3447582 by Threesacharm
• October 10, 2012 at 5:09 pm
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Thank you for the info on Plavix. On every plavix site I looked up they all said 33 hours so it was a bit confusing. They should hire you to write their info pages . I now understand.

• By Threesacharm
• Reply 3447925
• October 10, 2012 at 5:43 pm
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Thanks. Heart disease kind of gets to everybody in different ways. For me, I find it comforting to try and understand the science behind the drugs and the disease.

• By 4slowgirl
• Reply 3453423 · In reply to 3447925 by Threesacharm
• October 12, 2012 at 4:22 pm
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Went to see my cardiologist yesterday and explained to him about my stomach cramping and blood in the urine. He told me to get off the Plavix. I asked him how long it is recommended to stay on it and he told me he likes his patients, if they can, to stay on 1 year and a month. The heart associations guideline for DES is 1 year. I asked him if I needed to wean off of it-he said no. I asked if it would increase my chances of another heart attack-he said no that after 3 years of being on it that there was obviously no guarantee I would not someday have another attack but that being on or off plavix at this point would have nothing to do with it. I then asked if he thought the blood in the urine was for sure from the plavix and he said if my urologist could find nothing else wrong then the answer would be yes. Basically he told me to stop the plavix, continue with the asprin and the protonix because of the asprin and the fact that I tend to get ulcers easily. With all the changes in my life style I have made I should be fine. I will now replace the plavix with natural blood thinners--garlic, krill, fish oils, cod liver oil, olive oil, cinammon and many more items that can be found on line under natural blood thinner foods and supplements. Thank you so much for all your feed-back and hope what I've been through helps someone else. Will keep everyone posted as time goes on about how I feel.

• By Threesacharm
• Reply 3453748
• October 12, 2012 at 7:18 pm
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So the question is, why if he likes his patients on it for a year and a month, are there so many cardiologists telling people it is forever? Seems weird. Don't worry, I am off it and doing fine, lots of people do. And then, there are people on plavix who have heart attacks. Wishing you good luck, make sure you are getting your vitamins with being on protonix long term, and talk to your pcp about calcium and protonix.

• By 4slowgirl
• Reply 3454146
• October 12, 2012 at 10:39 pm
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What he basically told me was since the latest report that came out was keeping people who had DES put in, to stay on Plavix 1 year. My Dr. always hopes his patients will be able to stay on it that long and as he said, he likes to add that extra month on top of it. Because there are some Dr.'s and even some studies that show that it is best to stay on it for 2 years or longer, he once told me when I asked him how long I would be on it, his answer was-as long as you can. Some Dr.'s believe you should be on it for life and there are no new recommendations since the 1 year conclusion came out. I did not start having any stomach or urine problems till I was at the 2 year mark and it was ME that went to my urologist for the problem and I never informed my cardioliogist about the blood till this time. If I had put 2 and 2 together then and told him I am sure he would have taken me off it then. You have to understand, my entire life I have had many times where trace amounts of blood in my urine have been found which started periodic testing on and off for years. I just figured that since nothing was ever wrong that the only difference this time was that I could actually see the blood. I know my Dr. was just trying to keep me on it as long as I could handle it just in case future studies show it best to be on longer than a year. Bottom line of what he said when I left yesterday was--I literally was saved by my husband when I just stood up and collapsed on the bed and he did chest compressions on me till the ambulance got here, then my heart Dr. saved me again when he cleared my clots and inserted the stents, then I was saved again by my GI Dr. for deciding to keep scoping me till he found out where I was bleeding out from. They ALL told me it was a miracle I lived at all. I remember none of this and was out for almost 5 days. I owe so much to my cardiologist and I thank him for keeping me on the drug in trying to protect me, but as I left he said--you are fine, you've been on it for 3 years so go out and enjoy your life. People will continue to have heart attacks whether on or off plavix but with the lifestyles I have changed I feel I have a second chance at life (even at age 71) and I am going to enjoy every minute of it. Thank you so very much and may God Bless all of you.

• By Threesacharm
• Reply 3454493
• October 13, 2012 at 5:58 am
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It will be good when they finish the new study on plavix since then they will have a definitive answer. All of us here are blessed to have survived our heart event. I often think of the ones who did not, and yes, we owe many people for saving us. The drugs are hard, all of them, but good for you for figuring out what the issue was. 71 is not old nowadays and I sincerely wish for you a long and joyful life.

• By elphinstone2054
• Reply 3455913
• October 13, 2012 at 6:08 pm
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I am confused! Most of you are taking plavix & aspirin, & blaming plavix for the bleeding. I don't believe anyone blamed aspirin. I had a heart attack 2 years ago, & in the hospital, I was put on plavix & aspirin, then I passed black stools, so was immediately taken off the aspirin. not the plavix. Plavix is the only drug I take along with 1/2 of a beta blocker pill. I now have heart failure & follow the diet for that---no salt, low sodium. So, I have been on Plavix for 2 years===I tried the generic brand & got a terrible rash on my upper back, so am back on regular plavix.

• By Threesacharm
• Reply 3455973
• October 13, 2012 at 6:47 pm
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Yes, aspirin can cause bleeding too, and in some people it does but plavix is that much a bigger risk for bleeding. They probably took you off the aspirin first because if you had a stent, the plavix is a bigger deal for that first year. I see you are in Canada, which the protocol is normally plavix and aspirin for the first year, and then aspirin alone. Why this is different for you I have no idea. Frankly I have never heard of it being done this way here, I would think it is an individual choice of your cardiologist. As well, it may be related to your age as well, or to your individual medical needs, we are all a little different. I know that people who are allergic to aspirin can take plavix alone, I have seen some people here say that before. Maybe they tested you and this was your issue. The generic plavix came out four months before I was to be done with it so I chose to stay on the name brand. I did have to cover the difference in cost between what my plan paid for and the plavix brand. I am sure you doc is probably doing what they consider in your best interest.

• By elphinstone2054
• Reply 3456069 · In reply to 3455973 by Threesacharm
• October 13, 2012 at 7:38 pm
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Thank you for your reply Threesacharm. I did have 3 stents, but they couldn't operate, because I was told 2 & possibly 3 of my valves are not working properly. I get short of breath when I exert myself, but otherwise no complaints.

• By 4slowgirl
• Reply 3456270
• October 13, 2012 at 9:22 pm
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You are right in saying that asprin causes bleeding. I am well aware of that. Because I took so many excedrins (Which have asprin in them) I am sure it had something to do with the ulcers that they found in me after my heart attack that were all bleeding. The reason for the excedrin for so many years is that I suffered severe migrains for 40 years and it was the only thing that helped them as I was not going to take the prescripted drugs for them as they were very dangerous, at least back then. This is why I put in my original post that my entire adult life at least 1 out of every 3 physicals I had done, they would always find trace amounts of blood not visible to the naked eye, in my urine. Because of that I have had many bladder & kidney tests done of which they could never find the reason as to the blood. If you look up the side effects of Plavix it states that a serious side effect of the drug is GI bleeding, and dark or bloody urine. There have been people who have literally ended up with severe bleeding from Plavix. I was also told that if you always did bleed more than most people that plavix would just make the bleeding much, much worse. That is why they have people go off the drug prior to surgery. I will remain on the asprin and my protonix, which is helping my stomach with not getting any more ulcers. If I have the choice of bleeding a little with asprin or seeing bloody urine in the toilet, I prefer the asprin. That's why the minute I told my cariologist I had bloody urine he said---stop the Plavix. I hope I have cleared this up as to my situation.

• By Threesacharm
• Reply 3456353
• October 13, 2012 at 10:10 pm
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I am glad for you, and I think you handled it really, really well. Lots of people won't be proactive like that and that is one of the important things we learn here, to be our own advocates, to question, to learn. There sure is a learning curve with heart disease, I don't think I have ever in my life had to learn so much so quickly, especially in such a life or death situation. Good for you.