Common Drug Q&A » Blood Thinner » Plavix


A: That would be a question best asked of her doctor. There are so many factors that would go into a decision about whether to get a hysterectomy, take hormones, or take a drug like Plavix.

My personal recommendation would be for her to talk to her doctor about either lowering her dose or switching to something that’s not as harsh if her blood is too thin and it’s affecting her period… that’s not right and it’s likely not healthy. I’m not sure if that has anything to do with her choice of getting a hysterectomy, but that would definitely be a concern that would be best directed to her doctor. Good luck to the both of you!

Q: how long before a thiroid byopsy does a person need to be off plavix and coumadin?
How long does a person need to be off coumadin and plavix before a byopsy on the left side thyroid . This person has severe heart and lung problems also. Any have a clue?

A: That is a decision that needs to be made by the physician performing the biopsy in conjunction with the patient’s cardiologist. It depends on the risk of stopping the anticoagulants vs. the risk of bleeding.

If you are concerned, call the physician who is planning on doing the biopsy and ask.

Q: Does anyone have tips on how to prevent inflammation of stomach lining due to bloodthinner Plavix?
My mom is 79 and has only one third of her stomach left. After a heart attack in 94 she first took an aspirin based bloodthinner, which caused ulcers. She has been on clodidogrel (Plavix) for years now and we thought it was relatively safe, but instead it’s causing stomach inflammation with some bleeding. As she has to take a bloodthinner (so her doctor says), it’s a real dilemma. I am truly concerned.

A: Actually, the answer is pretty easy.

She should be on a medication such as Nexium, Protonix, or Aciphex.
These help reduce the acid in the stomach and should lessen the inflammation.

Q: Im on plavix and wanting to get back into Mixed Martial Arts. Is this a bad idea?

Just a year and a half ago, I had 3 stents placed in my heart. Before the surgery, I was into kickboxing. I’ve heard that a sideaffect of Plavix is internal bleeding. With that said, is returning to kickboxing a bad idea? Would other sports which involve less contact make more sense ie brazilian jujitsu? Thanks for the help.

A: I would call you doctor. Many times people are just on Plavix for a couple months following stents being placed. Since there is a natural coating that forms on the stent and the danger is when that layer is forming. See the problem with Plavix is that it will inhibit clotting within blood cells and any trauma from all but tai chi and chi gong could cause a major bleed. I would see if it is right for you to get off of Plavix and be on a aspirin regimen.
But as for martial arts those really are your 2 choices.

Q: plavix medication– Is it safe to drink green tea if you are taking this medication?
I take plavix and have heard that people taking coumadin, a blood thinner is not supposed to drink green tea. I know that plavix is also a blood thinner.

A: You have answered yourself friend.
I wouldn’t , for if you are on Plavix I’d bet you are on at least 1 or 2 other meds.
Why risk it?
Call your Dr. tomorrow and ask; he’ll know more from your history.

Q: Does protonix lessen the effectivity of plavix if taken together?
My mom had a stent put in her mesenteric artery which had become blocked due to her arterosclerosis. She is taking plavix to avoid blockage and protonix for acidity, bloating and other discomforts. She has read about the medical controversy that protonix can inhibit the effectiveness of plavix, but her doctors have not heard of this. She is very concerned.

A: A report warns that taking the drug clopidogrel (brand name: Plavix), the second most popular drug in the world, with proton pump inhibitors (PPIs) can increase the risk for major cardiovascular problems by 50% and of having a heart attack by 74 %.

The study reports that PPIs inhibit the effectiveness of clopidogrel, the number two prescription drug in the world, thus increasing the risk of a major cardiac event, such as heart attacks and strokes by 50 percent. Since PPIs mimic the effect of a variant gene, which also renders clopidogrel ineffective, this study further suggests a potential role for genetic testing.

Your mother should talk to her cardiologist if she is taking plavix to avoid blockage and protonix for acidity, bloating and other discomforts.

Take care always

Q: What is the mechanism that allows patents with coronary stents to eventually stop taking Plavix?
While the appropriate duration of anti-platlet or anti-coagulant therepy is currently being investicated (believed to be 6 months, a year or longer), it appears that the general theory is that it can eventually be stopped. Currently, it appears that it can be stopped sooner with bare metal stents than it can with drug eluding stents. What I would like to better understand is, why can it ever be stopped with either stent type. What happens to reduce the chance of clot formation after a year say, that allows Plavix to be discontinued? Is it that tissue grows over the stent? If so, then why go through the trouble of making drug eluding stents, which attempt to fight said tissue growth? Also, if tissue growth is bad, because it causes the vessel to close, then what happens when the drugs on the drug coated stents are used up? Do the drugs just delay the inevitable? If so, how long is the delay?
Thanks for the detailed reply. However, Taxus Express2 DES elude a drug specifically for slowing epitilialization! While I appreciate that there may be a need to minimize this process, so as not to allow too much growth into the vessel, it seems reckless to prevent such growth all together, thereby preventing full bio-compatibility.

If the plaque is soft enough that it can be pressed, like play-doh up against the artery wall, Why can’t it simply be scrapped back into the catheter and removed.

A: -You got it right…let me explain. When the angioplasty is performed – essentially what happens is that a balloon simply crushes the flow limiting lesions (plaques – at least 70% blockage) out of the way. A stent is deployed and “sprung” into place, propping the vessel open. Now after you crush the plaque, this is very thrombogenic as a thrombus is part of the typical healing process (but definitely not too good in the middle of a large artery supplying your heart muscle with blood). The drug eluting stents (DES) are coated with medication that is anti-thrombotic and the Plavix assists the process.

At this point lets compare the bare metal stents – the Plavix of course prevents the thrombus here too. But why do you only need it for three months…because the healing occurs faster (because the healing process was not being inhibited at the site of the stent by the stent) After three months, all healed. The stents have been epithelialized and are now seamlessly part of the artery.

So I hear you asking – why did we ever use the DES in the first place? Because once the angioplasty is performed there is a very high risk period where a thrombus could form shortly after the procedure is performed – thus precipitating an acute event (a heart attack!). The DES have a substantially reduced episodes (roughly 30% for bare metal verses less than 10% for DES). Here’s the rub – the DES stents often never epithelialize. That means that there’s a rough, mesh, straw-like structure inside the artery forever. Anything that causes swirling or eddies in the blood stream can also be thrombogenic too – hence the recommendation for continued use of Plavix indefinitely in some cases.

We risk stratify based on a few things -
*the length of the stent or stents deployed consecutively
*the location of the stent (high risk verses moderate or low risk)
*the baseline risk for a patient being hypercoagulable in the first place – e.g. smoker, hypertensive, cancer, etc.
*Pateint preference.

Our understanding of this is a best guess at this point. We hope to have some clinical trials to guide us more definitively on all of this some time in the future.

The original flow-limiting lesions are plaques are not the simple intimal lining found in healthy arteries – so having the “skin” that grows over the stents is not at risk for over growth and causing blockage again. The enemy is the plaque.

With our current understanding, these plaques grow through having excess cholesterol and triglycerides in our system. There are some great studies that show with agressive control (always through use of high dose medications, like statins) of cholesterol the plaques can be stablized and in fact reduced. (see the HATS and ARBITOR2 studies)

Not all patients follow our advice, however. They continue to smoke, have poorly controlled hypertension, diabetes, and high cholesterol – which, you guessed it, can result in “in-stent restenosis.” This has nothing to do with the thrombogenesis or Plavix we discussed above.

I hope this has answered your questions and helps.
Good luck.

Addendum – I am not sure how you invent a stent that attempts to prevent a biological response entirely – clotting – but then does not affect epithelialization. When first introduced it was thought that once the drug stopped being eluting – about six to nine months, that epithelialization would occur then…and it may in some people. But in others, the show is over and no additional healing occurs…the stent remains pressed in the arterial wall. Really this idea that the intimal lining over-grows and is responsible for stenosis is just not the case.

I understand that there is work being done on a magnesium stent that will actually might dissolve over time – interesting. Also, I am sure, full of potential unforeseen consequences.

The pressures used to clear stenosis is 3 atmospheres; which is significant – it is a misnomer to think of the plaques like Play-dough. It is called angioplasty, afterall – material is moved – 70% or greater blockage (often near totally occluded) to usually to 0%.

“Digging” the material out would in no way change everything we just discussed and we would be back to the days of – no stents – which resulted in frequent thrombosis and restenosis at the same spot. (aka the Halcyon Days for interventionalist cardiologists)

There are “cutting balloons” that are sometimes used to clear severely calcified plaques (have their own risk of embolization – even though a screen is deployed downstream from the procedure).

I hope that answered your questions – and I hope at this point that I have earned my 10 points (uncramping my typing fingers-whew) have a good day, my friend.

Q: dose olive oil have any reaction to durgs such as plavix or bencar?
I was eating a salad with olive oil and my blood pressure went up. I take Plavix and Benicar. Just wondering if caused a reations.

A: never heard of it before but I would ask your doctor…would like to know myself?

Q: how is it safe to take plavix and a colesterol medication at the same time?
my sister in-law had been prescribed so many medicines and we had to take her off many of them. But there are one more question should she be taking plavix and a cholesterol medicine or should she just take none and do a natural one. she had open heart surgery 4 yrs ago her over all level is 200 what should we do.

A: This is a question that your sister-in-law needs to discuss with HER physician.

I’m a doctor, but not HER doctor, so there is no way I would venture to guess what medications might be appropriate for her.

I do not know of any contraindications to taking those two medications together.

I certainly hope that medications were discontinued in conjunction with her physician. Sometimes, stopping a medication inappropriately can lead to major problems.

Q: what else is there to take to help offset a reaction to niaspan when my mother is already taking plavix?
i have already asked it but i forgot to mention that my mother is taking plavix and a baby aspirin with the niaspan to help offset it, and then she takes a benadryl during the reaction. what else can she do or not do?

A: I’m on Plavix because I can’t tolerate aspirin. Aspirin causes my reflux and gastric pain worse. The doc said only given Plavix for the patient who can’t tolerate aspirin. It is very expensive. I’m surprised that the doctor is a liar. Your mum can have Plavix even she can tolerate aspirin.

Q: Is it okay to take tylenol while taking Plavix?
my grandmas had a stroke a few days ago and the doctor put her on plavix, but she wants to take tylenol for some aches. does anyone know if thats safe?

A: Yes, your grandmother can take Tylenol with Plavix. Unlike aspirin, Tylenol does not “thin the blood” and therefore is safe to us with Plavix.

Q: When administering plavix what would you assess for in a patient?
This is a question on phamacology. If you know what you look for before administering this drug that would be great. Thank you!

A: You want to make sure that the patient’s bleeding times are not to high before you give the med as this helps with thinning blood. After giving and with any patient on any blood thinners you want to asses v/s (high heart rate and low BP can cause concern), you also want to assess for any signs of bleeding, check gums, make sure patient doesn’t have bloody stools, etc. Also monitor for bruising. Teach patient to be careful and avoid accidents (bumping into something, etc)

Q: Does anyone know when it is safe to start back on Plavix, after a GI scope?
I had a upper GI scope done 11 days ago. I have been off of Plavix since a week before.The DR who did the scope said to stay off for two weeks but my regular DR said to get back on it now. Im confused and don’t know what to do.He said I bleed alot during the scope. Has anyone else had this problem ? I feel so tired all the time so I would like to go back on it.

A: If there has been no more bleeding since your scope and your Hb levels are normal, you can start taking it again now. New guidelines actually advise against the discontinuation of Plavix prior to such procedures if you have had recent stenting. The risk of hemorrhage is minuscule. A diagnostic endoscopic procedure (with or without biopsy) is low risk. There only time Plavix absolutely has to be stopped prior to the procedure if you were having polyps removed, etc. The risk needs to be balanced with the importance of maintaining full antiplatelet therapy. If you have had stents put in less than 12 months ago, the benefits outweigh the rare risks. You did have a bleed, so it’s a good thing Plavix was stopped prior to the procedure.

You don’t have to be a Doctor to keep up to date with current research. Thats ignorant nonsense. My answer was based on current medical advice that suggests the benefits outweigh the rare risks in most cases.

Perhaps you’d like to familiarise yourself with the new policies and research before criticising others. If you don’t have the correct medical knowledge to answer these questions then avoid answering in this category.. Answer FAIL

Q: Are there any risks to discontinuing Plavix one year after having a stent implanted?
Would one be more susceptible to a stroke?

A: Yes and you risk developing a blood clot blocking off your stent and having a heart attack. Speak with your cardiologist first.

Q: Is it true Plavix can wash chlamydia out of a persons system?
This guy told me Plavix washed chlamydia out of his system..

but to me it sounds like he is lieing…

A: Plavix is ot the treatment of chlamydia

Doxycycline & Azithromycin are

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