Thank you for this helpful review on a drug that I never prescribe but is always a bane in my practice. And "mud in your eye" to all those who think surgeons are not "thinking physicians". I had one cardiologist telling me that I should have patients stop plavix 2 weeks prior to elective surgery and another telling me 1 week. I've used 2 weeks to be safe, but I guess I was too conservative. I've had patients requiring emergency surgery who were on coumadin, aspirin, and plavix (and not had a hypercoagulable syndrome) - someone really wanted to make sure there would never be a clot forming in that patient!
My husband has finally stopped asking me if he should ask his physician about Plavix. I keep telling him that, unless his doc suggests it, he doesn't need it.
I hate those ads.
I also have a nagging concern that he might react to Plavix like he reacted to Aggrastat - by destroying all his platelets. Scary reaction, that one, especially considering he was awating bypass surgery at the time.
I just got home from ACC. I did not attend the session that discussed this trial. My physician collaborator heard about this in the news. We both are alarmed as we suspect that some patients who NEED to be on ASA and Plavix will stop their medication. If patients have drug eluting stents that are less than 6 mos old, they need antiplatelet therapy to prevent stent thrombosis. I hope the media hype does not lead to patients stopping Plavix and a rash of sudden MIs in patients having stents clot off.
I did hear one of the presenters say that Plavix only needed to be held for 3 days prior to surgery. Not sure where he got that info. (He was referring to pts going to CABG after PCI).
What also concerns me is the Asteroid trial results with Crestor -they used 40 mg, a high dose. Without close follow up these patients could have adverse events.
Direct to consumer advertising is misleading and inappropriate in my opinion, but the media hype of medical reporting can be just as bad.
You've distorted the information a bit. The implication of saying that "Plavix is not indicated for TIA" is to suggest that it is contraindicated.
I suppose in an intellectual sense, one could say that if you had a patient who has had a TIA, but never a stroke, never a coronary syndrome, never peripheral vascular disease, yes there has not been a study showing that Plavix given just for that indication was effective. The problem is, these studies aren't done.
Where do you find enough patients for "pure" TIA studies? The problem is, all these things go together to a very large extent.
I also searched the PDR information on Plavix for this statement about TIA or something to that effect, and it's not there.
Plavix will continue to be used in patients with TIAs, and legitimately so. The business about the risks of Plavix and aspirin is actually old news, it was already reported some time ago in a study of secondary stroke prevention. The real world problem we face is what to do with patients who continue to have events while on one drug. It's important to explain the risk to patients, but it may be a risk one has to consider taking.
I see your point; however, my preference would be for there to be a much better aspirin vs. Plavix trial in patients with TIAs and no evidence of carotid disease before offering it as a first line drug. Given what I have seen of the literature, my personal preference in that setting would be to take aspirin alone.
I understand your point-of-view, but in the February issue of Stroke, it was explicitly stated in a large collection of Guidelines (this particular one on p. 594), that "aspirin (50 to 325mg/d), the combination of aspirin and extended-release dipyridamole (Aggrenox), and clopidogrel (Plavix) are all acceptable options for initial therapy" after stroke or TIA of nonembolic etiology.
Lets not also forget that FDA and Their stent makin buddies also once began saying Take it(plavix) for 90 days,6months later a year and then for Life. The now say double it if thata dont work. And in my case( 3 stents clotted) pretty much convinced me long before that B.S Boston Scientific as well as folks at Plavix were lying again. Did they tell you as many as 1/3 rd of folks on plavix /aspirin are resistant and clot anyway. I m learning the hard way, I am making docs test even after tellling them this a year ago before my last month heartattack/clot by and in , another stent also while on both
I have had a single stent installed about 2 years ago. Upon my Cardiologist's recommendation, I have been on 325mg of Aspirin and on Plavix daily. My brother who has had a stent about 3 years ago was recently told by his Cardiologist to stay on Aspirin but get off of Plavix. So that really confused me whether I should do the same. So I got off of Plavix also, but continue to take 325 mg of aspirin, but not sure if I should get off of plavix, or just reduce it to every other day. My research on the internet seems to support getting off of Plavix, simply very expensive for fixed income, which is the primary reason to get off of it. What would you do if you were in my place. Thank you.
I am on plavix for A.F. is this ok?????
I HAVE NO HEART PROBLEMS, I HAD TWO TIA,S NO STROKES, SHOULD I TAKE ASPRIN, SHOULD I TAKE PLAVAX? ALSO?
What recommendations would you have for a patient taking 75mg plavix and 325mg ASA who needs and abscessed tooth extracted? Two prior MIs, CABG x 5, smoker. How long should the plavix and/or ASA be held? Should they be held (low risk that he'll bleed out vs. potential risk of stopping the meds)? PCP did not offer any protocol, "looking into it".
Commenting by HaloScan
