A female doctor talking with an older male patient

Q. I had a heart attack. My HMO sent me to a hospital 40 milles away. A stent was inserted and Plavix was prescribed for three months and I was to see a local cardiologist in 3 weeks.
The local cardiologist directed me to stop taking Plavix. Three months later I had another heart attack which became much more complicated. I was admitted to two different hospitals four different times within two weeks. The stent was replaced and I was advised to take Plavix for 12 months. What are the standards for taking Plavix? -Seattle Senior

A. We felt unprepared to answer your question about Plavix (clopidogrel) ourselves since this is a complex and somewhat controversial issue. To do you justice, we consulted two of the country’s leading cardiologists. They would prefer to remain anonymous, but they are without a doubt authorities in this field. Here are their comments:

CARDIOLOGIST # 1:

“The CURE Trial (NEJM 2001) showed a 20% reduction in recurrent MI [heart attack], death and stroke when given for 12 months after an acute MI.
“It’s appropriate therapy for this patient assuming there are no unusual bleeding risks.”
“It is hard to say whether stopping Plavix led to the second heart attack… but it is a reasonable question to ask.”


CARDIOLOGIST # 2

“Always hard to say much without seeing the patient to know all the factors involved, but the general recommendation is dual anti platelet therapy for at least 3 months, and in general one year for drug eluting stents, although the data for this are equivocal.”

We followed this answer up with more questions:
So… does this mean that at one year and one day after a patient gets a drug eluting stent he should stop Plavix?
Plavix isn’t completely benign. Given that the data are equivocal…what kind of recommendations make
sense? Do you think we will we ever have some clarity on this rather crucial question?
CARDIOLOGIST # 2’S FOLLOW-UP ANSWERS:
“85% of major decisions lack high-level evidence. The trials are being done. Plavix isn’t benign but a thromboses [clogged] stent is a disaster.”
“How long to take a chronic treatment is a problem in every field and good trials of stopping are rarely done.”
“There are really good observational studies with conflicting results.”
“Stents are changing and the duration probably should change as a function of 2 factors: 1) stent type; 2) underlying risk of a new event (mostly determined by extent of CAD [coronary artery disease]).”
“For today’s DES [drug eluting stents] I would continue for one year and then assess; if all was stable, I had a good exercise tolerance, no symptoms and no multi vessel disease I’d stop at that point.”
“The trials are in process.”


Ultimately, the decision will depend upon your own cardiologist, but clearly this is a controversial topic and one that is in flux. Thanks for asking a very important question for which is there no perfect answer at this time.
You should be aware of some of the side effects associated with Plavix (clopidogrel). If you develop any symptoms while taking this drug please contact your MD promptly!

PLAVIX SIDE EFFECTS:

  • Bleeding (special danger with NSAID pain relievers like ibuprofen or naproxen-GI bleeding!)
  • Itching
  • Blood disorders
  • Serious allergic reactions
  • Skin rash (contact physician immediately!)

Join Over 75,000 Subscribers at The People's Pharmacy

Each week we send two free email newsletters with breaking health news, prescription drug information, home remedies and a preview of our award-winning radio show. Join our mailing list and get the information you need to make confident choices about your health.

  1. BNLFLA
    florida
    Reply

    Had MI in 1997. Treated with balloon angioplasty No Stent, No blood thinners, no aspirin. Just Mevacor 20mg. All was good for 13 years – then angina in 2010 led to placement of coated Stent. Unable to take Thinners due to allergy. Back on the table having an Infarction in 2013 with big clot at entry to the coated Stent. A second non-coated bare Stent was placed. Now taking clopidogrel with allergy meds every day. Wish I knew what I know now in 2010. I would never have allowed stents to be used. I had a good outcome 13 years without Stent, without clopidogrel, and without problem. There was no reason to expect a better outcome with foreign objects in my artery. Once you have the 1st stent the rejection process ensures you’ll be getting more frequent problems, poor quality of life, and more stents until the stents finally finish you.

  2. Tom
    Greensboro, NC
    Reply

    Plavix is known for severe bleeding risks, including delayed bleeding (bleeding at some period of time after an injurious incident). My father received a stent and was advised he would need to take Plavix for 6 months to a year. A few weeks after getting out of the hospital, he had a fall in the kitchen but caught himself against the countertop. He didn’t hit his head, but the jarring motion itself while being on Plavix caused a subdural hematoma which was not discovered until 3 months later when he started experiencing headaches and stroke-like symptoms (paralysis of right arm/hand, slurred speech and sometimes the inability to speak at all) due to the buildup of blood and resulting pressure on his brain.

    He then had to endure a craniotomy to remove the blood mass that was causing the pressure. Another complication was that the surgeons had to wait over a week before they could perform the craniotomy until the Plavix and low dose aspirin were out of his system…. all the while the stroke-like symptoms continued. There were multiple complications that arose after the craniotomy, causing additional trips to the hospital. It also took him several months for him to regain use of his right hand.

    Obviously, he had to stay off of the Plavix after the craniotomy. He was later placed on a different blood thinner, and the cardiologist told us that Plavix is notorious for causing delayed bleeds. I have since learned that an uncle and the father of a friend of mine also experienced subdural hematomas (and subsequent cranial surgery) while taking Plavix. Plavix serves an important purpose following cardiac procedures, but based on the experience with my Dad, I would try to come off of Plavix at the 1st possible opportunity if it was me. I would also consult multiple cardiologists for an assessment of the risk/reward of staying on Plavix for any extended period of time.

  3. jc
    ny
    Reply

    I had m.i. in 199 -I was giving baby aspirin – in 1992 had severe stomach bleed 6 bag;s of blood. In 2005 my jaw-neck were frozen, rush to hospital, 5 stents were inserted – was given Plavix 75mg. in 2005 and I still take on doctor’s orders-I am still on Plavix. I was 64 at the time -I am 74 and still take it – my doctor told I have no choice because I can not take asprin–jc

  4. FreddyT
    Florida
    Reply

    I am stopping Plavix after one year as of March 2014. Reason; After an drug -eluting stent in the right coronary artery which was totally occluded I have been on Plavix since and since have had 13 units of blood and 22 infusions of Iron. Doctor finally said OK to stop Plavix but to continue 81 mg aspirin. Now I have read a new study that may give me 3 months before another heart attack may occur (maybe).
    Well that’s my story. Pray for me. Thank you, FreddyT

  5. Poh Paat Lall
    New York
    Reply

    I had one stent 11 months ago. I am on plavix and baby aspirin.
    After about 8 months I noticed black, tarry stool. Suddenly , one morning I vomited ‘coffee grounds.’ I was placed in emergency , given blood transfusion (6 bags) and a protonic for the stomach acids. I was told that when I vomited I tore my gullet which caused excessive bleeding. But, what caused the tarry stool which was weeks before I vomited? Where did the coffee ground vomitus come from? I did not eat before swallowing the tablets.

  6. Robert
    Indy
    Reply

    New to the forum here. It looks good and it looks like we are all part of an experiment on how long to take the various blood thinners IE: Plavix – I believe low dose aspirin should be continued for life for CAD Patients – and seems safe as long as you are generally healthy. The half-life of aspirin is 12 hours, so I take one AM and one PM.. One thing for sure… find a good heart doc and do what they say. With stents 12 months on Plavix seems to be the gold standard. Then decide, what is my bleed risk. If you fall down the steps you may have serious internal bleeding. I notice people generally don’t list their age (I’m 64) and if you have other issues such as smoking, drinking, diabetes, etc… that will impact decisions on meds. I believe I should stop Plavix and the doc agrees after extensive CAD testing. I will stay on my aspirin, stay active and eat as good as possible. (If it tastes good, spit it out).

  7. Patricia M
    california
    Reply

    I had mild heart attack 9/20/14. A stent wasx placed. The odd thing was according to my cardiologist the angiogram showed a third small vessel had colapsed, where normally there are two. He stated there was also no build up in the main arteriesy. I do not have hbp, diabetes, obese, slightly over weight, no family hx oh heart desease, cholesterol was 225, now 127. I did quit smoking. I have been taking 75mg of plavix. I really want to stop this medication.

    • Robert
      Reply

      Stay on Plavix for one year. Aspirin ?? Unless you are a bleed risk. Only your Doc can say what to do. Good luck. If no adverse reactions to Plavix stay on it, its a good med.

  8. brian l.
    ny
    Reply

    I would never stop taking plavix after stent placement After an MI I had 4 stents placed I thought I was lucky not to have an open chest bypass My cardiologist stopped plavix after 1 month. After two years of asking whether any tests should be done as follow up, I asked my internist to run a stress test. My ejection fraction which was 62 after stent placement was down to 31. I have permanent left ventricle damage due to the stents clotting. I now have an internal defibrillating device. My ejection fraction is in the low 20’s. My advice is, if your cardiologist wants to take you off a blood thinner like plavix, find a new cardiologist. And demand a stress test after one year.

  9. rughoobur
    mauritius indian ocean
    Reply

    I have taken aspirin +plavix+atorvas +tildiem for 10 yrs. now gums bleeding. Could it be the side effect of any them? I have reduced plavix to 2 weekly, is it good idea?

    • M
      Czech republic
      Reply

      You must consult your cardiologist about the medication you are taking. 10 years is a very long time to take for plavix

  10. K C Jain
    Reply

    I had 70 % blockage and two medicated stents were put 10 weeks back. I stated the shortness of breath after two weeks and still continuing. This is all the time whether rest or activity During activity it is slightly more.
    I am on Plavix once a day, Aspirin 75 mg with BP and cholesterol reducing medicines. Please advise how to stop this breathlessness.

    • Robert
      RRfoto
      Reply

      I have 2 stents on Plavix 15 months now plus 2 low dose Bayer aspirin one AM and one PM. Omega fish oil, Vit E, Card Doc did stress test treadmill with nuke dye analysis to see if any issues. No probs so Doc said stop Plavix but keep the rest. I will replace Plavix with 1 glass of quality red wine with dinner. Shortness of breath may be a different issue (lungs COPD) get Doc to answer that. If you have stents stay on Plavix for about one year. Then ask. Keep track of blood pressure. Maybe a physical therapy program would help your breathing issues. Best of luck…

  11. T.E.
    Reply

    I have been on Cloplavix for 6 and a half years since having two stents fitted after an angina attack.
    The doctor that did the operation told me, that patients had a clot after stopping Cloplavix after six months, so I should stay on it for a year.
    I have a stress test annually (the next in 2 days time). The cardiologist who administers the test says there is no reason why I should stop.
    Three weeks ago I had an accident and severely lacerated my head and the blood loss was tremendous.
    In two days I will be asking if I can stop.

  12. JFC
    Reply

    All I can say is I had 2 regular stents for 2 100% blockage. Still have a 90% blocked artery. I have been on the same Rx for 11 years. I was given the option at 5 years to stop the Plavix. I was told by cardiologist that there was NO evidence to support continued use. I said NO evidence to stop either is there? So he gave the option and I have taken Plavix and full strength aspirin for 11 years now. Altace, Toperol XL, Zocor, Niasban, Fish Oil, Folic, Selenium, multi vitamin, I exercise, eat better not perfect. But I believe if it ain’t broke don’t fix it.
    I used to bruise much much more. Occasionally I do. But I am still kicking and I will take it as long as they let me. If something works I stick with it. I have heard too many people stop and low and behold another heart attack. I don’t want another one. It took 4 MI’s for them to figure out what was going on. So now I am going into year 12 of overtime. I was a heart attack volunteer so if anyone wants my advice for whatever it’s worth, feel free to comment.
    John

  13. LARS
    Reply

    Great forum. I am a 53 year old female – 3 DES stents inserted following angiogram. Had no idea what these were prior to the hospitalization. Was not given a choice between these and bare metal stents. Had one 95% blockage and another 85%. prior to stents – type 2 diabetes from gestational diabetes and 4 kg overweight – job stress but always had normal ECG and stress tests. Stents went in on the 3rd June 2014 following a week of jaw pain.
    Have been put on the following new drugs – 90mg Brilinta (ticageloar) twice a day; 100mg Aspirin ( spren); and Simvastatin 80 mg one at night. Today – 19 days I noticed a bruise on the inside of my left knee. Been reading this forum and it appears that you damned if you do and damned if you don’t. Although many of you have been on these combinations for years without adverse side effects. My cardiologist also mentioned being on the thinners for a year but on aspirin forever. It’s early days for me so will repost..

What Do You Think?

We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions. Comments that do not follow these policies will not be posted.