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What is the risk of taking Clopidogrel or Aspirin If I do have endocarditis?

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Posted on Tue, 2 Jul 2019
Question: Please read attached documents thoroughly to get an idea of the cardiac history which I'm under investigation for.

Last night i had an incident. I was playing with my dog when suddenly i felt extremely dizzy. My vision in my right eye gone very blurred, black looking and everything was warped looking out of the right eye. In my sight in that eye everything was just jumping and erratic. At one point i could barely see out of my right eye. A few minutes later numbness down the left side of my face and arm began. An ambulance arrived and taken me to A&E.

On arrival of the ambulance my blood pressure was 158/96? On the way to A&E pain started in the left side of my neck and radiating up to the top of my head.

After getting to the hospital my vision began to return and my blood pressure quickly dropped back to normal.

The doctor done bloods and all came back normal so they put me through a CT scan of my brain. The CT scan came back normal but the doctor still wasn't satisfied as apparently the CT scan can not rule out a TIA? The doctor then told me to take a Clopidogrel tablet (or aspirin) and wait for a call back from the TIA clinic for a appointment.

In regards to the cardiac problems that i have been experiencing for a few months I've been told that although unlikely they can't rule out endocarditis until after my echocardiogram is completed.

Does this sound like a TIA to you?
Do you think it could be related to the cardiac problems?
If i do have endocarditis what is the risk of taking clopidogrel or aspirin with it?

Just as a side note, i did not take the clopidogrel tablet that the doctor told me to take before leaving the emergency room as i have heard blood thinners can be dangerous with endocarditis.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would recommend as follows:

Detailed Answer:

Hello,

I would agree with the ER doctor on the fact that your symptoms are very likely to be related to a stroke.

I would not agree with endocarditis, because you have a normal white blood count and normal PCR, excluding the presence of inflammation.

In my opinion your tests are not suggestive for endocarditis.

Anyway, a carotid artery narrowing due to atherosclerosis is less likely considering your age, but a carotid artery dissection can not be excluded.

For this reason, I would recommend performing some tests:

- A cardiac ultrasound, in order to examine your heart function and structure and exclude a congenital heart disorder or endocarditis
- An ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends for a prolonged time and exclude possible cardiac arrhythmia
- A Doppler ultrasound of the carotid artery to exclude dissection
- Other blood lab tests (thyroid hormone levels, blood lipid profile, anti-thrombine III plasma levels, anti-cardiolipine antibodies, anti-phospholipidic antibodies, homocystein levels).

A trans-esophageal cardiac ultrasound may be needed.

You should discuss with your doctor on the above tests.

Meanwhile, I would recommend taking daily baby aspirin in order to prevent any possible stroke. It does not make any harm even in endocarditis.

Hope you will find this answer helpful! Let me know if I can assist you further.

Regards,
Dr. Ilir Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thank you doctor you have been most helpful. I did have a high speed motorcycle accident about 6 months ago. Had to have surgery on my right foot, do you think that could have caused a carotid artery dissection? or would it have surfaced before now? They did do a ct scan after the accident which was clear.

So in your opinion is this two separate problems? The cardiac and the stroke, or possibly linked?

One thing I'm very worried about is that i am a smoker. Could continuing to smoke now cause any significant further risk in regards to a stroke? I've found my smoking has increased recently due to the worry of my cardiac problems over the last few months.

I'm a little concerned about the baby aspirin. Due to having relatively uncontrolled asthma right now, I've never taken aspirin before and I'm concerned if i have the worsening of asthma symptoms. Do you think i could take a high dosage of cod liver oil instead of the aspirin? Say 7-8g daily? Is it a good enough blood thinner or is the Antiplatelet properties not good enough compared to aspirin?

Finally do you think the stroke and cardiac issues could be related to anabolic steroids? I have run testosterone and dianabol many times since i was about 16. Not taken any anabolic steroids for about 6 months though, since my road accident.

Sorry for all the questions and thank you!

doctor
Answered by Dr. Ilir Sharka (13 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello,

Considering your allergy reaction and asthma, I would recommend taking Clopidogrel daily, as suggested by your doctor, until performing the above mentioned tests.

It can not be substituted by cod liver oil, because it does not have the same effects, even in high doses (its main action is is cholesterol levels and does not help blood thinning for the prevention of stroke).

Regarding the differential diagnosis between dissection and a cardiac issue, we can not judge only based on your medical history.

Of course an accident would lead to a high risk for dissection, but you would also experience headache or neck pain too.

From the other hand anabolizants can help increase your cardiovascular risk by causing changes in coagulation tests. But you have stopped them now. So, we can not make a true connection.

Smoking can increase your cardio-vascular risk. For this reason, I would strongly encourage you to stop smoking.

You should discuss with your doctor on the above tests.

Hope you will find this answer helpful. Let me know if I can assist you further.

Wishing all the best.

Regards,
Dr. Ilir Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (3 hours later)
Thank you once again doctor, you have been a great help.

I'm just a little nervous to take the single 75mg clopidogrel tablet, i know it sounds silly as the hospital only wants me to take one pill before my stroke clinic appointment. But from the studies of this drug i have researched show a clear high risk of internal bleeding and hemorrhagic events. One study showed over a double death rate when patients was prescribed clopidogrel and aspirin after a stroke or heart attack.

Do you think my concern is warranted?

Would it be possible to swap the clopidogrel for anything else? Preferably over the counter. Maybe i should just take aspirin? I've never actually tried aspirin so i don't know if i have an allergy to it. But my asthma is not very well controlled.

Do you think high doses of Pycnogenol could work?

I'm just very worried as i haven't taken any blood thinners currently. I have the stroke clinic appointment tomorrow at 3pm but I'm scared i could have a stroke between now and then if i don't take anything.

About the smoking, am i okay to use nicotine patches and other replacement products? Or could that warrant an equally increased cardiovascular or stroke risk?

Thank you again.



"In a previous article titled, "The Powerful Aspirin Alternative That Grows on Trees," we featured a 1999 clinical study published in Thrombotic Research that found that when habitual smokers were given either 500 mg of aspirin or anywhere between 100-200 mg of pycnogenol, the pycnogenol group experienced equivalent platelet aggregation inhibiting effects but with much lower bleeding times:"

Maybe a good alternative? Not sure though.
doctor
Answered by Dr. Ilir Sharka (3 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:

Hello,

Clopidogrel is a possible treatment option in patient which are allergic to aspirin, like you.

Regarding Pycnogenol, there is not enough clinical data evidence to support its effects in the prevention of stroke. Some articles from some small centers are not enough.

So, I would encourage to take Clopidogrel in order to be a little more safe.

Regarding its possible complications, they are usually seen in older patients, which have high blood pressure, chronic stomach problems or fragile arteries (due to diabetes, hypertension, etc).

Hope you will find this answer helpful. Let me know if I can assist you further.

Wishing you good health.

Regards,
Dr. Ilir Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (52 minutes later)
You make a very good point, thank you.

Do you think it would be very foolish to wait until my stroke clinic appointment at 3pm tomorrow before taking the clopidogrel?

Thanks


Also if i do take the clopidogrel tablet is it okay to chew them? It just says 75 on the tablet. I have issues swallowing tablets.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
My opinion as follows:

Detailed Answer:

Hello,

I don't think that it would be foolish not to take Clopidogrel until tomorrow, but taking it would make you safer.

However, the decision is up to you.

It is better to be swallowed with water. You can cut it into two pieces, it is too large to take at once.

Hope to have been helpful. Wishing you all the best.

Regards,
Dr. Ilir Sharka
Cardiologist
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 8056 Questions

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What is the risk of taking Clopidogrel or Aspirin If I do have endocarditis?

Brief Answer: I would recommend as follows: Detailed Answer: Hello, I would agree with the ER doctor on the fact that your symptoms are very likely to be related to a stroke. I would not agree with endocarditis, because you have a normal white blood count and normal PCR, excluding the presence of inflammation. In my opinion your tests are not suggestive for endocarditis. Anyway, a carotid artery narrowing due to atherosclerosis is less likely considering your age, but a carotid artery dissection can not be excluded. For this reason, I would recommend performing some tests: - A cardiac ultrasound, in order to examine your heart function and structure and exclude a congenital heart disorder or endocarditis - An ambulatory 24-48 hours ECG monitoring to examine your heart rhythm trends for a prolonged time and exclude possible cardiac arrhythmia - A Doppler ultrasound of the carotid artery to exclude dissection - Other blood lab tests (thyroid hormone levels, blood lipid profile, anti-thrombine III plasma levels, anti-cardiolipine antibodies, anti-phospholipidic antibodies, homocystein levels). A trans-esophageal cardiac ultrasound may be needed. You should discuss with your doctor on the above tests. Meanwhile, I would recommend taking daily baby aspirin in order to prevent any possible stroke. It does not make any harm even in endocarditis. Hope you will find this answer helpful! Let me know if I can assist you further. Regards, Dr. Ilir Sharka Cardiologist