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How long to take Plavix after a DES in LAD
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cvcman posted:
what does the most recent studies say. I had an lad stent over a year ago. I am still on Plavix, I will discuss with my cardio Dr but was curious as to any recent studies
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cardiostarusa1 responded:
Hi:

It is typically 1 year of Plavix for drug-eluting stents (DES), though researchers say that continuing studies will prove or disprove a universal benefit beyond that. With the older bare-metal stents that are still being used, it is typically 1 month of Plavix.

Aspirin (at a dose that ones' cardiologist suggests) is sometimes added to the Plavix regimen, though it has a different mechanism of action, and can increase the risk of bleeding. Aspirin-alone may be applicable in some cases, and usually continues indefinitely after Plavix is stopped.

About Plavix

Plavix prevents platelets (a component of blood) from clumping together and causing a blood clot (thrombosis).

Platelets (thrombocytes), manufactured in the bone marrow, are small cells in the bloodstream that are part of the blood clotting process.

Plavix 'n Stents

Plavix-therapy is extremely important. As reported, early or late-stent thrombosis is the formation of a blood clot on the struts of a DES, occurring weeks, months, or even years, after implantation, which according to one study, leads to death about half the time.

DES delays a process known as endothelialization, in which a thin layer of cells gradually grows over and covers over the stent.

A study published in The Lancet, a prestigious medical journal, detailed 4 cases in which DES patients experienced a heart attack from stent thrombosis about a year after implantation, and shortly after stopping antiplatelet-therapy.

Studies have revealed that an increased potential for blood clot problems may continue on in some DES patients much longer than previously understood/realized, thus many interventional cardiologists are recommending Plavix for a year (or more), some indefinitely/for life, especially is one has had a heart attack or brain attack (stroke).

Bottom line

Coronary stents are just a Band-aid or spot treatment, as this does not address the underlying disease process and what drives the progression.

Most important, coronary artery disease (CAD) is a life-long unpredictable (which can exhibit periods of stabilization, acceleration and even some regression) condition, requiring a continuum of care.

Take care,

CardioStar*

WebMD community (since 8/99)



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Be well-informed

WebMD

Living with Heart Disease

Coronary artery disease (CAD)


CAD is a disease with no cure......

http://www.webmd.com/heart-disease/guide/living-with-heart-disease

Coronary artery anatomy

Starting with the LAD, the most critical, next to the ultra-critical LM.

http://www.heartsite.com/html/lad.html

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Good to know, for the primary and secondary prevention of heart attack and brain attack/stroke

Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel, or emerging) for atherosclerosis (typically affects the carotid, coronary and peripheral arteries), which includes age, gender, genetics (gene deletion, mlafunction or mutation), diabetes (considered as being the highest risk factor). smoking (includes secondhand and thirdhand), inactivity, obesity, (a global epidemic, "globesity"), high blood pressure, (hypertension), high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, LOW HDL (less than 40 mg/dL, an HDL level of 60/65 mg/dL or more is considered protective against coronary artery disease), high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).

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Quote!

"Be a questioning patient. Talk to your doctor and ask questions. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

- Charles Inlander, People's Medical Society
 
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James Beckerman, MD, FACC responded:
The current recommendation is to take plavix for one year after placement of a drug-eluting stent...but more data (and guidelines) are on their way.
 
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cvcman replied to James Beckerman, MD, FACC's response:
well ive been on Plavix and a full strength aspirin since 10/8/10 so over a year.... Im kinda nervous about stopping it due to the cases ive heard of sudden stent plugging after stopping plavix with des....
 
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cardiostarusa1 replied to cvcman's response:
"I'm kinda nervous about stopping it due to the cases I've heard of sudden stent plugging after stopping plavix with des...."

No doubt.

Definitely discuss ANY concerns or worries with your doctor.

If/when dreaded stent thrombosis does occur, as reported, it is almost always sudden (no advance warning), a quite dramatic event (crushing chest pain), and is associated with acute ST-segment changes on the electrocardiogram (ECG) waveform tracing, typically involving a large infarction (heart attack, death or necrosis of heart muscle), which may/can lead to sudden cardiac death (SCD).

Take good care,

CardioStar*

 
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Chyk41 replied to cardiostarusa1's response:
I am on Plavix and I have only one stent, but my problems come with where it is located. If anything happens to it,if I make it I go in for by-pass. My doctor was very up front about that, for me that is one two many if's to worry about. My HA left me with CHF and my EF is 40%. I will be on Plavix for the rest of my life or some form of it if I suddenly have a reaction to it.

Mt 1st Anniversary was 12/2/11, Friday. I have my good days and I have my bad days, but I have Days and I want a whole lot more. I can't listen to others and what their doctors' tell them I have to listen to my doctor and what he tell me. My cardiologist says he plans on me living for a long time and I believe him. I have too. I died once, I don't want to go that way any time soon.

Your nerves are telling you to listen to your doctor and not what people are saying.


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