The "Plavix Rebound" Phenomenon
Plavix reduces the function of blood platelets, and thus reduces the chance that a blood clot will form in the diseased coronary artery after treatment. Therapy with Plavix is currently recommended for one year after treatment for ACS, and is often continued for longer than one year if a drug-eluting stent has been used as part of that treatment.
In monitoring 3137 patients who received Plavix after being treated for ACS, the authors of this new study say that the patients' chance of having a heart attack or dying was nearly twice as high during the 90 days after Plavix was stopped, than it was after this 90-day interval. They speculate that perhaps tapering Plavix instead of stopping it abruptly, or perhaps increasing the dose of aspirin during the first 90 days after stopping Plavix, may help to reduce this rebound effect - but of course, more studies will need to be done to see whether either of these strategies are effective.
DrRich Comments:
This study is the first to document an apparent increase in risk immediately after Plavix therapy is stopped. However, any regular visitor to our forum will be familiar with the phenomenon, since we've heard plenty of stories there that fit with the notion of a "Plavix rebound." Also, one suspects that many (if not most) cardiologists have their own experiences in this regard, considering their otherwise inexplicable vehemence in refusing to allow their patients to stop Plavix long enough to have needed surgical procedures.
So, we owe thanks to the authors of this new article for bringing this problem, at last, out into the light of day.
Patients with ACS need aggressive therapy in any case, in order to optimize their odds of long-term survival. And with any aggressive therapy there will be inherent risks. It is therefore useful to have those risks fully defined. The only good way to get around the risks of treatment, unfortunately, is to do everything possible to avoid needing treatment in the first place, by aggressively managing cardiac risk factors.
Where this new information really ought to make a difference is in patients whose doctors are recommending stent placement (as opposed to medical therapy) for stable coronary artery disease. Doctors are obligated to fully inform those patients of the risks of stent placement, and now, for the first time, one of the risks that they're obligated to describe is the possibility of a Plavix rebound.
Sources:
Ho PM, Peterson ED, Wang L, et al. Incidence of death and acute myocardial infarction associated with stopping clopidogrel after acute coronary syndrome. JAMA 2008; 299:532-539.
Comments
I was taking Plavix for a year after my stent was installed. My doctor said that I can stop taking it which I did. Its been about three months that I stopped it with no bad effects. Maybe because I also take Coumadin and baby aspirin because of my Atrial Fibrillation.
I have been on plavix for three years following non coated stent replacement. I got the stents because they put two holes in my aorts during angioplasty. No one has ever suggested taking me off of plavix. Indeed, i was told it was a lifetime drug for me.
I was put on Amodiarone when I had no arrythmias and stopped that after 3 months. No problem. I now ask why I was put on Clopidogrel when all I had was an angiogram with no stents fitted? Is there a problem in the UK with consultants putting people on drugs just for the sake of it? Having read this blog, I now intend to phase out the Clopidogrel as well.
Please do not stop Plavix/Clavix even after a year after stent placement.Along with Plavix take baby aspirin,BP tablets and good cardio exercise for atleast three years.Also note that the tendency for clot formation in the blood varies with each individual and there is no test or criteria to identify this.Hence safer to take Plavix or a cheaper alternative.
I had 3 drug-eluting stents inserted almost a year and a half ago. I have been on Plavix since and was told I would be taking it for the rest of my life. Despite Plavix and Asprin therapy, within 1 year, one of my stents has completely occluded. I NEVER miss taking my meds. Wished there was a cheaper alternative or a generic Plavix. Despite my medical insurance–it’s still quite expensive.
Some safe anti-platelet-aggregation nutraceuticals as substitutes for Plavix:
Mixed Tocopherols (NATURAL Vitamin E)
Kyolic Aged Garlic Extract (non-odorous)
Cocoa
EPA (an omega-3 fatty acid)
Olive oil
Ginger
Green tea
Magnesium
Curcumin (in Turmeric)
Bromelain
Pomegranate juice
The anti-platelet-aggregation action of these nutraceuticals have all been documented in Medline.
I had 1 drug-eluting stent and was on Clopidogrel for 1 year then it stopped. im now back on it because last week I had a small heart attack.
My husband had medicated stents put in. Took plavix for 2 years three months when the doctors stopped it. One month later he experienced an acute or severe heart attack and is still hospitalized.
I had emergency stent placement four and one-half years ago. I’ve got four Cordis® drug-eluting stents….two in each of the two compromised artieries which were the RCA and the LAD. Both arteries shut down 100% on the same day. I just now experienced some “angina-like” symptoms two weeks ago. I was on Plavix for over a year and then just quit due to a move and the expense of the drug. I was only told recently that I “should get back on Plavix ASAP” by a cardiologist. So far, after receiving BP med, Xanax, and continuing with the good heart-healthy diet and exercise plan….I’ve lost 10 lbs and haven’t had another chest pain in 6 days straight. (knocking on wood) ~G.
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Had 1 stent put in two years ago and have been on Plavix ever since. Every time I try move off Plavix I encounter the following symptoms:
1. Day 1 – no problem
2. Day 2 – loose appetite
3. Day 3 – slight nausea
4. Day 4 – Nausea + slight chest pain
I end up double dosing the Plavix for a few days which brings me back to normal. I’ve seen two cardiologists on this one and neither has heard of this problem before. They’ve both stated that if an event occurs, its a major event, not a gradual event as I’ve described. Have also tried to gradually tranistion off Plavix, but somehow, that doesn’t seem to work either.
hAVE BEEN ON PLAVIX FOR 4 YEARS SINCE MY TRIPLE BY-PASS AS WELL AS AMIODARONE (5 DAYS A WEEK) AND FEEL GREAT. hOWEVER, i HAVE MICROSCOPIC BLOOD IN MY URINE AND AM GOING FOR A CYSTOSCOPY OF MY BLADDER, ETC. BUT WAS WONDERING IF PLAVIX COULD CAUSE HEMATURIA (TRACE AMOUNT OF BLOOD INURINE). HAS ANYONE ELSE HAD THIS SITUATION?
Hi,
My husband take Plavix now for almost a year. Our insurance does not cover any brand names. I was having a friend send it from India for half price, but customs have said if it is available in the USA we can’t bring it in the country. Is generic just as good as the brand name “Plavix”. There is a website super saver meds com that offers it as a generic.
thanks
Faye,
To the best of my knowledge it is illegal to sell generic Plavix in the US.
DrRich
First, Of course it’s illegal to sell a generic here because the drug company hasn’t made enough money yet raping us by overcharging for it.
But more to the point of this. I have been on Plavix for 5 years 6 months. I was only off once for 10 days before a medical procedure. My initial stent was non medicated within 3 months the artery scare tissue blocked it.
I was scheduled for radiation therapy (Brakey SP?) but they couldn’t get the beads to the stent so they put in two medicated stents.
Now I’m on Plavix for life.
Big problem I have is that I’ve lost my job and because it was a contract job I can not collect unemployment and now have no health insurance.
All the programs for free Plavix are based on last year’s income. Not the temporary or immediate need of now work now and no income today or until I find a job.
So I’m screwed. My doctor gave me a month of samples but after that I’m SOL
And I’m scared to death if I can get this and my Crestor.
Ernie
The unfortunate thing about Plavix is that doctors were lied to about the drug! There are class action suits everywhere right now.
There is ABSOLUTELY no proof that plavix prevents restenosis of the stents and the
dangers far outweigh the benefits, sorry.
DOES ANYONE KNOW WHAT VITAMINS AND MINERALS CAN BE SAFELY TAKEN WITH PLAVIX.