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What Causes Hiccups After Stent Placement In Coronary Artery?
Question: I notice the occasional hiccup in my husband after his stent was put in. He had a non medicated stent put in his artery. He has been prescribed 4 blood thinners one of which is plavix and I just read a LOT of patient reviews of that drug that were NOT good. What can we do? He is on Lovanox (which I find odd that it comes in a form that sticks the patient) coumadin, aspirin and plavix. Should I be concerned about the hiccups and is the plavix necessary to my husband's health? Or is it a big pharma crime, as suggested bu the patients comments?
Brief Answer:
Pl. see below & discuss with treating cardiologist
Detailed Answer:
Dear Madam
1. Whenever a stent is put in a coronary artery (artery of heart) combination of aspirin and plavix (dual antiplatelet therapy or DAPT) is mandatory for variable period of time depending upon the type of stent and clinical indication. This may be as long as 1 year. Lovanox is usually added to these two drugs in initial first week, when patient has suffered from a heart attack or unstable angina. Why have they added coumadin to these drugs is not clear as yet. It is combined for very specific conditions only because these four drugs together have a strong risk of bleeding in patient. Usually we add fourth drug in very high risk cases with atrial fibrillation or prosthetic heart valve.
2. You must discuss this with your cardiologist and ask him about the indication of the fourth agent. I hope he will be able to explain you. It is not prudent to change or stop a drug without consulting your treating doctor.
Feel free to discuss further.
Sincerely
Sukhvinder
Pl. see below & discuss with treating cardiologist
Detailed Answer:
Dear Madam
1. Whenever a stent is put in a coronary artery (artery of heart) combination of aspirin and plavix (dual antiplatelet therapy or DAPT) is mandatory for variable period of time depending upon the type of stent and clinical indication. This may be as long as 1 year. Lovanox is usually added to these two drugs in initial first week, when patient has suffered from a heart attack or unstable angina. Why have they added coumadin to these drugs is not clear as yet. It is combined for very specific conditions only because these four drugs together have a strong risk of bleeding in patient. Usually we add fourth drug in very high risk cases with atrial fibrillation or prosthetic heart valve.
2. You must discuss this with your cardiologist and ask him about the indication of the fourth agent. I hope he will be able to explain you. It is not prudent to change or stop a drug without consulting your treating doctor.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes he does have afib, that is why the coumadin. I do not doubt the decisions of his doctor, I am just curious as to if there is a reason for hiccups, which in my husbands case are few and far between, I just noticed that once in awhile he does a little hiccup and on a separate note, if plavix has been a bad choice for many patients as the comments I read suggest. I thought I would ask a doctor about that. I also would like to know if the stent can move accidentally.
Brief Answer:
please see details.
Detailed Answer:
Dear Madam
1. Hiccup, per say, is not a well reported side of of any of these four drugs. However hiccup occurs due to irritation of diaphragm (the muscular membrane between lungs and abdomen) and may result from pathology of any organ underlying diaphragm like stomach, liver etc. Mostly it is the gastric irritation responsible for this symptoms and most of the medicines in English system of medicine can cause gastric irritation. Gastric irritation by aspirin and clopidogrel (plavix) is well known. Hence these drugs may be indirectly responsible for his symptoms. Beside this hiccups occuring only on exertion can be sign of anginal heart disease, if associated with other symptoms. Since a number of medications may cause gastric irritation, it is really difficult to pinpoint the exact drug. However if it only occurring on exertion, you need to discuss it out. Most of the time in our practice when patient's hiccups are not suggestive of angina, we add medicine which reduce gastric acid release.
2. As I explained you earlier that it is a mandatory drug for those with stents for a duration depending upon the type of stent and its indication. Why do you feel it is a bad drug or it is not a good drug? Please explain the same. We do use this drug in all our patients with stents and those who had heart attack in last one year. We find its acceptability very good.
3. Stents do not move accidentally except when they are being deployed in the XXXXXXX lab. This happens usually if we chose a small length of stent and the plaque is hard. Except for this, once deployed successfully, they do not move.
Hope this explains your query. If there are any more questions Do write to me. (With details of when and for what reason his stenting was done)
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Madam
1. Hiccup, per say, is not a well reported side of of any of these four drugs. However hiccup occurs due to irritation of diaphragm (the muscular membrane between lungs and abdomen) and may result from pathology of any organ underlying diaphragm like stomach, liver etc. Mostly it is the gastric irritation responsible for this symptoms and most of the medicines in English system of medicine can cause gastric irritation. Gastric irritation by aspirin and clopidogrel (plavix) is well known. Hence these drugs may be indirectly responsible for his symptoms. Beside this hiccups occuring only on exertion can be sign of anginal heart disease, if associated with other symptoms. Since a number of medications may cause gastric irritation, it is really difficult to pinpoint the exact drug. However if it only occurring on exertion, you need to discuss it out. Most of the time in our practice when patient's hiccups are not suggestive of angina, we add medicine which reduce gastric acid release.
2. As I explained you earlier that it is a mandatory drug for those with stents for a duration depending upon the type of stent and its indication. Why do you feel it is a bad drug or it is not a good drug? Please explain the same. We do use this drug in all our patients with stents and those who had heart attack in last one year. We find its acceptability very good.
3. Stents do not move accidentally except when they are being deployed in the XXXXXXX lab. This happens usually if we chose a small length of stent and the plaque is hard. Except for this, once deployed successfully, they do not move.
Hope this explains your query. If there are any more questions Do write to me. (With details of when and for what reason his stenting was done)
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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