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    How to wean off Plavix?

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Posted on Tue, 18 Jul 2017 in Hypertension and Heart Disease
Question: I need a 2nd opinion. I had a mild heart attack 2 1/2 years ago at the age of 48. I had low blood pressure, low cholesterol (142 - ldl was 69) and no family history of heart disease. The doctors said I had a soft plaque that ruptured in my LAD. They called this a fluke. A stent was placed in the artery although no calcification was found. I have been on Plavix 75 mg. and asprin 81mg. since. I am currently weaning off the Plavix. Is it safe to take it every other day during this weaning process. I remain on aspirin daily.
doctor
Answered by Dr. Rishu Saxena 1 hour later
Brief Answer:
Attach details of stent.

Detailed Answer:
Hi,
Thanks for posting your query on HCM.

No weaning should not be done on your own.
There are varities of stents available these days some of them require life long dual antiplatelet therapy while in some we can switch over to single antiplatelet after an year.

Please mention the details of stent (attach your angioplasty notes).
However as you are on dual antiplatelets from two years i think you have a drug eluting stent and dual antiplatelets should be taken life long.
Stopping or taking plavix alternate day on your own can lead to stent thrombosis and can cause another heart attack.

Thanks.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Rishu Saxena 42 minutes later
What I have is a card that was given to me that states I have the XXXXXXX Scientific Promos Premier - Everolimus -Eluting Platinum Chromium Coronary Stent System.
Initially, my cardiologist said I would be taking Plavix 75mg for 1 year. Then, he explained that recent studies showed for a patient of my age and history it would be better to take it for 3 years. I am now at the 2 1/2 year mark. But, at no time did he say it would be life-long. In fact, when I asked initially I was told that it would not be for life. The only medication he has said will be life-long is the aspirin 81mg. this is why I am seeking a 2nd opinion.

Please advise.
Thank you

How long do i wait to get a response for my followup question?
doctor
Answered by Dr. Rishu Saxena 10 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
Have gone through your details yes plavix could be stopped now.
Take only ecosprin 81 mg once daily.
As per the standard protocol second antiplatelet can be withdrawn after a year.You have already taken it for almost 2 year plus so you can switch over to aspirin 81 mg once daily.
However a statin in low dose like rosuvastatin 5 mg should also be taken regularly.
Are you on betablockers or ace inhibitors?

Betablocker's should be taken in optimal doses life long after stenting.
Please mention your ejection fraction.Is there any regional motion wall abnormality in 2d echo?

Please mention the doses of statins and other medicines you are on?Or is aspirin and plavix only drug you are on?
Waiting.


Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Rishu Saxena 6 hours later
Hello,
I was taking metropolol 25mg until 2 months ago. He discontinued it in April. I don't know about any abnormality in 2d echo. Should I request an echocardiogram?
Plavix and aspirin 81 are the only drugs I take. Aside from that i take tumeric as. Daily supplement now for about a month.
doctor
Answered by Dr. Rishu Saxena 6 hours later
Brief Answer:
Follow up.

Detailed Answer:
metoprolol reduces the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA) .
A cardioselective betablocker,A statin( If lipids are in control) then in low dose and single antiplatelet should be continued life long.
As you had a heart attack we should know your ejection fraction.If ejection fraction is less then 55% then an ace inhibiotor like Ramipril should be also given in doses of 5 mg daily to prevent cardiac remodelling.

Standard treatment should be -
Tab aspirin 81 mg once daily (9pm)
Tab Metoprolol 25 mg once to twice daily (depends on blood pressure).-Metoprolol prevents cardiac remodelling and improves ejection fraction.
Tab Rosuvastatin 5 mg once at 9 pm- Apart from lipid lowering feature it has a pleotrophic effect in which it reduces the size of infarct minimises chances of fibrosis in infarcted zone.
Tab Ramipril 5 mg once daily(if ejection fraction is less then 55%).

This should be the standard therapy post PTCA and there is no sense to stop betablocker and statins.

Please discuss this with your cardiologist and see what explaination he gives you.

Thanks!

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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