Monday, November 8, 2010

The risk of stopping antiplatelet therapy

Antiplatelets , especially Aspirin and Clopidogrel have established their importance in management of coronary artery diseases. But they also pose a bleeding risk. This risk is high if a procedure needing tissue sample is done. We had a 66 yo male ..4 months after a STEMI for which he received a drug eluting stent , and was started on Aspirin and clopidogrel. This clinic visit he is complaining of 6 month h/o early satiety, loss of apetite..and our records show a weight loss of 15lb in last 3 months.He needed a upper GI endoscopy ..with a possible biopsy. What do we do with his antiplatelets? ....Lets look at some facts from AHA
· Cessation of all antiplatelet therapies after PCI, at any time, for any stent, is associated with an increased risk of thrombotic events, including late stent thrombosis. These events are likely to occur within 7 to 30 days of drug discontinuation. 

·Cessation of clopidogrel (alone) during the early period after PCI (within 30 days of either DES or BMS placement) is associated with an increased risk of events. 

·Cessation of clopidogrel (alone) beyond 30 days from the time of BMS placement is common in clinical practice and does not confer increased risk of thrombosis over a brief period of time. 
·Cessation of clopidogrel (alone) upon completion of 6 months of treatment after DES placement is controversial (in terms of long-term risk) but does not seem to confer a significant short-term risk(within the subsequent 30 days) in a majority of patients if aspirin is continued. 

 The importance of continuing aspirin in the above scenarios was shown by a review in JACC 2005, where the median duration of stent thrombosis when both drugs were stopped, was 7 days...compared to 122 days when only clopidogrel was stopped and aspirin was continued.In addition, many retrospective studies have shown safety of continuing aspirin during GI procedures. The GI prcedures have been classified into high & low risk based on the risk of bleeding.
Considering the urgent need for endoscopy, the fact that UGI endoscopy is a low risk for bleeding, and the STEMI 4 months ago....we had our patient continue Aspirin, but stop Clopidogrel 5 days before procedure. He will continue his dual antiplatelet therapy the day after his procedure. As always.....the befits & risks were, and have to be discussed with the patient!

26 comments:

  1. Hi there, I enjoy reading through your post. I wanted to write a
    little comment to support you.

    my homepage: calories burned calculator
    Also see my web page :: calories walking calculator

    ReplyDelete
  2. Hi, everything is going fine here and ofcourse every one is sharing information, that's in fact excellent, keep up writing.

    Also visit my blog post ... http://endurosmale.net

    ReplyDelete
  3. First off I would like to say superb blog! I had a quick question that I'd like to ask if you do not mind. I was curious to know how you center yourself and clear your mind before writing. I have had a tough time clearing my mind in getting my ideas out. I do enjoy writing but it just seems like the first 10 to 15 minutes are lost simply just trying to figure out how to begin. Any suggestions or hints? Kudos!

    my blog post; Cambogia Trim Diet

    ReplyDelete
  4. I feel this is among the most vital information for
    me. And i am glad studying your article. However wanna remark on few normal things, The web
    site style is great, the articles is in point
    of fact nice : D. Excellent activity, cheers

    my webpage - Xength X1 Reviews

    ReplyDelete
  5. Generally I don't read post on blogs, however I would like to say that this write-up very forced me to try and do it! Your writing style has been amazed me. Thanks, very great post.

    Also visit my website: Ultra Celeb Diet Reviews

    ReplyDelete
  6. Why visitors still make use of to read news papers when in this
    technological world everything is accessible on web?

    Look at my blog post - garcinia cambogia where to but

    ReplyDelete
  7. This is the right web site for anybody who really wants to
    understand this topic. You understand a whole lot
    its almost tough to argue with you (not that I personally would want to…HaHa).
    You definitely put a fresh spin on a topic which has been discussed for
    many years. Excellent stuff, just excellent!

    Also visit my blog - Green Coffee Cleanse Diets

    ReplyDelete
  8. Good post. I learn something new and challenging on websites I stumbleupon
    every day. It will always be useful to read through articles from other authors and practice something
    from their websites.

    Green coffee

    ReplyDelete
  9. Thanks for sharing your thoughts on male enhancement commercial.
    Regards

    Here is my weblog: pearl x reviews

    ReplyDelete
  10. Thank you for the good writeup. It in truth was a enjoyment account it.

    Look advanced to far delivered agreeable from you! By the way, how
    could we be in contact?

    my web-site - Lipo Slim

    ReplyDelete
  11. I blog quite often and I really thank you for your
    content. Your article has really peaked my interest.
    I am going to take a note of your blog and
    keep checking for new information about once a week. I subscribed to your Feed as well.



    Feel free to surf to my site :: Buy no2 maximus

    ReplyDelete
  12. Hi to every single one, it's truly a pleasant for me to pay a visit this web page, it consists of priceless Information.

    Also visit my website ... Green coffee reviews

    ReplyDelete
  13. a week and also transform your physique very quickly.

    If you only lift ten pounds routinely, your muscles will grow to meet that need
    and no more. A great way to always maintain the proper form is to
    leave your feet firmly planted on the ground, and always grip
    the bar no more than shoulder width apart.

    My web site; Power Pump XL

    ReplyDelete
  14. Hello There. I found your blog using msn. This is an extremely well written article.
    I will make sure to bookmark it and come back to read more
    of your useful information. Thanks for the post. I will
    certainly comeback.

    my blog post; Lift and glow pro reviews

    ReplyDelete
  15. If you are going for finest contents like myself,
    only pay a visit this web site every day since it presents feature contents, thanks

    Look into my web blog Traditional Lutheran Liturgy southwest Omaha

    ReplyDelete
  16. What's Going down i'm new to this, I stumbled upon this I have found It absolutely useful and it
    has helped me out loads. I hope to contribute & aid different users
    like its aided me. Good job.

    my weblog: new york diamond wholesalers

    ReplyDelete
  17. Definitely Ƅelieve thɑt that you said. Your favourite reason seemed to be on the
    internet the easiest thing to bear in mind of.
    I say to you, I certainly get irkeԀ at thе same time as fߋlks consider worries that
    they jսѕt do not realize aboսt. You controlled to hіt the nail upon the toρ as smartly as defіned out
    the whole thing withoսt having side-effеcts , folks can take a signal.

    Will probably bе again to get more. Thanks

    my web-site ... Toni Slavin

    ReplyDelete
  18. The Vintage Wholesale Company The Vintage Wholesale Company.Walson Rockabilly are a vintage wholesale company who focus on vintage fashion wholesale. WalsonRockabilly Vintage Clothing wholesalers are the UK's leading,Shop wholesale vintage dress, xxxx silk dress, vintage jewelry products from reliable vintage dress wholesalers on walsonrockabilly and get worldwide,We know wholesale vintage clothing. We're the only vintage clothing wholesaler that knows what it's like to be in your shoes,because we run stores ourselves.Always Vintage is a Wholesale Vintage Clothing Distributor. We offer more than ninety different categories of vintage clothing for you to choose from.Waist Cincher
    Latex waist trainer
    latex waist cincher

    ReplyDelete