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!)

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  1. Bill
    Palm harbor fl
    Reply

    I had a heart attack at 51 and had 2 stents inserted. Stayed on plavix for 6 months with baby aspirin. I bruised and bled more that usual but it beat the heck out of a heart attack. 3 years later I had another heart attack and the clot was between the two stents. They put in a new stent and told me i should stay on the aspirin and plavix the rest of my life. Heart stack free now for 11 years so in my case, I feel the plavix is doing its job with some bruising and I bleed more than normal but I’m staying on it. I feel for me it is the right course. Blessings to all. Bill

    • Dianne
      Reply

      Bill. You have just helped me make a very important decision. I am 52 and had a heart attack 6 years ago. 2-100% blockages and 2 stents. All hereditary, my mom died at 40 of heart disease. I am experiencing terrible pain from DDDisease and osteoarthritis. I was told yesterday by a neurosurgeon some very ugly and harsh statements including “I am screwed because of my medical history and my family medical history”. Also, “That I have a messed up heart”!!! (Excuse the language but was his EXACT words). Also that there was nothing he could do to help me!

      I was in shock and devastated, and that I can’t take any NSAIDS cause of Plavix. I was considering making an appointment with my cardiologist about getting off plavix? He always told me I should stay on it as long as I could afford it. Reading your post just made up my mind. My heart over my pain! Thank you so much for your post. Blessings to you!

  2. Elsa
    Oregon
    Reply

    My husband is 82, physically active, has occasional atrial fibulation, and takes Sotalol and Atorvastin , which controls it well. Very suddenly this week he lost perifrial vision in his right eye. We immediately saw Drs. (Internist, Opthomoligist) who ruled out stroke, heart problems, eye problems (optical nerve, macular degeneration, detatched retina, etc.) Also had a cat scan, who showed normal brain. He has been prescribed 1 Plavix per day, for 1 month. Dr. says, it may work to restore the lost vision. Has anyone else with vision loss, been treated with Plavix, or should we be searching for 2nd opinions? Any suggestions would be appreciated.

  3. Delores
    Florida
    Reply

    I am at a rock and a hard place. Dr. (Cardiologist) wants to put stent/stents in. When I was a patient in another hospital a cardiac cath was done, with one artery 95% blocked. The three others were 45% – 65%. At that time the Cardiologist there wanted me to have a bypass, Heart surgeon said no, I was not anatomically adaptable, etc. #1 Cardiologist still wants to do do the stents., tells me it is up to me. I know nothing about all of this, I should have more information which is not forthcoming. The thought of taking Plavix for X number of years frightens me. I tried it for two weeks and bled out of most of my pores so stopped. I see my Internist who I trust in one month. What questions should I ask him. I am age 83 1/2. Scare stiff in Florida. I had one heart attack at age 60, have been on Aspirin and Nitroglycerin since with no problems until now, with no pain, just chest discomfort.

  4. Carl M.
    Duncan Oklahoma
    Reply

    I had a massive heart attack in oct./12/15. I’m on Plavix 75, 81 aspirin, and also a med for cholest.. Plavix for a year at most doc said, had hernia surgery on feb 2/ 16 and took my Plavix so every thing went well..

    I smoked from age 10 and sept 9/15 I turned 41 then heart attack came, before hernia surgery they checked my pulse and told me it was a very strong pulse.. I thought after a heart attack heart pulse would be weak?? Also bypass two stent, the bypass was just one.. Don’t smoke any more, more energy and just want to go and go..

    Don’t understand that after what I went through, all I know God is taking Care of things for me…

    • Bill
      Reply

      So glad your doing well. You feel good because you stopped smoking and your heart is now reconfigured and restrengthened so keep moving, eat well and enjoy every day. Blessings. Bill

  5. Marshall
    Reply

    I am a 46 year old male who suffered a MI in 2013. I used to smoke and have not since admitted to the hospital at the time of the MI. During my stay they placed a Promethius DES into the Circumflex artery. Like others here on this board I was prescribed multiple medications. One to control High blood pressure, cholesterol, and one for the stent. In addition to the prescribed medications I was placed on a daily regimen of taking aspirin.

    During my first follow-up here is what the Cardiologist performed:
    Listened to breathing, (nurse checked bp), listened to heart and took resting pulse rate. Height and weight were also checked. My second visit went the same, with the same checks. No blood or stress tests were performed.

    I was told that I could take myself off of the Cholesterol and blood pressure meds but would have to remain on Plavix (clopidogrel). So, now the three year mark, still taking Plavix. Still bruise easily, I have a very sensitive abdomen area, but other than that no other major issues.

    I am currently starting to wean myself off of Plavix, but will remain on aspirin. I am just concerned that I will have another MI. From what I have read there seems to be no good information regarding the use or non-use of Plavix, or the duration of which how long patients should take the medication.

    It seems a win-win for the pharmaceutical companies and for the Mfg. companies that make stents if an individual has to remain on an RX med.
    Thoughts?

  6. Mahesh
    Nagpur
    Reply

    I had chest pain while walking a distance , when I consulted with cardiologist initially he did ECG which was normal , then I failed test for TMT, cardiologist diagnosed a clot in Left coronary artery after angiography , then I had undergone angioplasty in the month March 2015 , dr had inserted a stent.I am on Plavix 75, Asprin 75 mg and rosuvaststin 20mg. I wish to do hair transplant and surgeons has asked me stop blood thinner for a week kindly advice what I should do?

  7. Rishard
    Wisconsin
    Reply

    I am as confused as much as can be. I have much pain from joints , and muscle’s. Cramps I was told co q 10 would make these go away or lessen it. I had 3 stents inserted 1 year ago. The more I read about stents they sound scary, not very good. Can I take coq10 safely with copidgrel? So some pain might go away. I also take stations. I also take a bad y aspirin every night. Confused !

  8. Ralph J.
    California
    Reply

    I am 80 years old man. Had a heart attack in 2013 obviously because I had a 98% and a 65% blockages. The 98% was cleared, a stent was placed in the artery while the 65% was left alone by the surgeon theorizing that the Plavix that I would be prescribed would open it up. I have been taking Plavix since. I suffer of severe osteoarthritis with so much pain that I take morphine along with other pain killers. I had surgery in the lower back in 2005 but I have been told I should have another surgery or at least get epidurals to relieve the pain.

    The back doctors refuse to do surgery or even do the epidurals unless I stop the Plavix while the heart surgeon refuses to allow me stop Plavix because he think it would be very dangerous. I read several articles and many read that it would be possible stop the Plavix for a while others say differently and I am very confused. Do you or any one has a different approach to solve this problem?

  9. CharlieS
    OK
    Reply

    Had a major heart attack in 2004. No stent or bypass because of complications. Placed on Plavix at that time and have been taking it since. 5 years ago had Rouen-y and doctor said no NSAIDs. 24 months ago was diagnosed with clogging at the same site as the previous heart attack.

    Doctor said that I had to agree to full strength aspirin for the rest of my life or he wouldn’t insert a stent, and increased my Metoprolol while waiting to schedule the stent. A few days later, developed a major lower GI bleed resulting in several days in the hospital and two units of blood as will as multiple bags of saline solution in both arms. Untreated stent was later implanted with no complications. I also have an ICD which was originally implanted soon after the first heart attack.

    Now, 2 years later, I had an upper GI bleed resulting in saline solution and 4 units of blood. 2 EGDs indicated bleeding ulcers at the anastomia for the Rouen-y. I am off all blood thinners while waiting to see the cardiologist. Beginning to feel like I have a choice of knowing I will bleed to death with a gastric bleed or have a fatal heart attack in short order. Surely I’m not the only person in the world in this situation, though I feel like it now.

  10. padma
    kerala,india
    Reply

    I am a 45 year old man. I underwent angioplasty and put one stent on in April this year due to unstable angina. My ecg and echo were normal. On TMT test I failed and my cardiologist suggested angiogram. There was 80% block. Now I am on aspirin 75, clop 75, atorvo 40mg, and metoprolol 50mg.
    I am taking 80mg telmisartan in the morning. I am not diabetic. My problem is in some days even in there is a feeling of difficulty in extreme left side and left hand. Please explain what will be the reason?

  11. Randy
    Pearl City,IL.
    Reply

    I had my first heart attack in 2004,100% blockage of the RCA they removed clot and put in a stent,they found two more weak spot in artery and put two more stents in 2-weeks later.They put me on Plavix and asprin regiment and 2010 had a second heart attack,one of the previous stents plugged up and had another stent put inside the one that plugged.I have continued on Plavix and asprin regiment and was told must likely it will be for life.I have must arteries at 50%,in time it will come down to bypass surgery.The chance of still being here yet without the Plavix and asprin are slim.So if you have no other complications from the medicine,stay on the Plavix.I have had no complications at all,no bleeding problems and blood still clots fine in bleeding test.I would also recommend you drink more water because it helps dilate arteries and veins.I am 55 now and still going,even with diabetes,high cholestrol,and disabled.Good luck to all.

  12. Floyd
    Maryland
    Reply

    I had three stints in 2004. Two other blocks were found but the doctors felt medications would take care of them. I took Plavix for over a year and was put on a full size Asperin and other meds. In 2011 I took a stress test and was rushed to the hospital to get two additional stints for the other two blocks. I was put on Plavix and baby Asperin. After one year the doctor felt I should stay on the Plavix and Asprin. At two years I asked to be removed from the Plavix because of the extended bleeding when I cut myself shaving or any other minor cuts. The heart doctor insisted that I remain on the Plavix and Asprin. He suggested that I may have to stay on both for life. I have a check up next month and will discuss this issue with him again.

    I noticed that a rash was a side affect of Plavix. I developed this rash about two years ago that stays about two to three weeks, clears up for about two weeks and returns. My family doctor has been treating it with a topical steriod cream. It gives some relief but not much. I am going to see a Dermatologist to see if he can help. does anyone have any suggestions?

  13. 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.

  14. 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.

  15. 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

  16. 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

    • Marshall
      Charlotte, NC
      Reply

      I would like a follow-up. What occurred after the three month period passed? Are you currently taking a prescribed blood-thinner such as Plavix and/or Clopidogrel?
      Thank you. I hope you are well.

  17. 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.

    • unni
      India
      Reply

      Did you check for ulcers in your GI track? Aspirin causes ulcer which leads to bleeding.

  18. 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).

  19. 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.

  20. 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.

  21. 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

      • Raj
        Reply

        Its better to experiment ourselves rather than letting doctors experiment on us.. After all its our body. Experiment and get tests get done regularly that’s the best way…

  22. 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…

  23. 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.

  24. 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

  25. 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..

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