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What Are The Advantages Of Having Plavix Therapy For Coronary Artery Disease?
My husband had an inferior wall MI on 12/19 with two stents placed in the RCA. At that time the circumflex was noted to be 70%blocked. He returned to the cath lab two days later having been placed on Plavix and aspirin therapy. During the cath an ultrasound of the LCA was done and showed significant obstruction. The stent placement was aborted and the plan was to have open heart bypass urgently. We are now facing differing opinions on the Plavix therapy. The interventionalist is adamant about keeping the plavix on board right up until the bypass surgery. The cardiac surgeons are very nervous about this approach and want a bridge with lovenox. I would like to hear from you re. the pros and cons re. Plavix/fresh stents and MI etc. What is the current standard? Is there evidenced-based practice that you could reference in your response? Thank you. Colleen
Fri, 20 Feb 2015
Hello! Thank you for using HCM! Regarding your husband's medical history I couldn't understand if besides RCA stenosis (already treated sucessfully by two stents implantation) and the stenotic LCX (70% or greater whichever it be); was there any other lession in another coronary artery (I mean LAD or Left min artery). Because it would not be a wise option to send the patient to the urgent cardiac surgery for only a LCX stenosis without trying first PCI with stent implantation (whichever the grade of stenosis) especially when the risk in greater in the settings of an acute myocardial infarction. Plavix is an important and necessary antiagregant drug that coupled with aspirin helps in mantaining stent patency in the most vulnerable period after stent implantation.
Nevertheless, regarding Plavix and cardiac surgery: it is recommended by current guidelines that it should be interrupted 4-7 days prior to the procedure to minimise the risk of bleeding. When talking about URGENT or EMERGENT surgery the opinion is more flexible; there is no time for therapy switching so the patient is transferred to surgery with the present effect of antiagregants.
Hope to have responded your concerns.
Greetings from Dr. Iliri
Nevertheless, regarding Plavix and cardiac surgery: it is recommended by current guidelines that it should be interrupted 4-7 days prior to the procedure to minimise the risk of bleeding. When talking about URGENT or EMERGENT surgery the opinion is more flexible; there is no time for therapy switching so the patient is transferred to surgery with the present effect of antiagregants.
Hope to have responded your concerns.
Greetings from Dr. Iliri
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