Plavix | Coronary Artery Stent | Bleeding Complications

Patients who have coronary artery stent are usually prescribed to take aspirin and Plavix. Most patients tolerate these two drugs quite well. The most common complication seen in my patients is bleeding.

I have two patients who had coronary stents and were put on these two drugs by the same cardiologist. The first patient developed massive lower gastro-intestinal bleeding requiring several units of blood transfusion. The aspirin and Plavix were stopped during this hospital ization. The bleeding stopped . The patient was discharged but was told by the cardiologist who put in the stent to continue to take Plavix and aspirin to prevent the stent from clotting.

The patient was confused. When she came to see me in my office, I told her that this was a dilemma. It's a tug-of-war between keeping the stent open and the risk of bleeding. After explaining to her the pros and cons, she decided to continue to take aspirin and Plavix.

For the next 6 to 8 months after the massive lower GI bleeding mentioned above, she had at least 4 or 5 episodes of lower GI bleedings requiring hospitalizations with blood transfusions once or twice. Of course each time the bleeding stopped after stopping aspirin and Plavix. Finally the patient told me that she was fed up with repeated bleeding. She decided to stop these two drugs permanently and accepting the risk of losing the patency of the stent. I agreed with her completely because she had made an informed decision.

After that decision, she did not have another bleeding episode for the next two years which is the present time. With her age of above 75 and the underlying colonic diverticulosis, she may still have lower GI bleeding in the future even without taking aspirin and Plavix. Her cardiac status has been stable.

The second patient had coronary stents and was prescribed aspirin and Plavix for a while without any bleeding complication.

One day he presented with upper abdominal pain in the office. Rectal exam showed black tarry stool and positive occult blood. A gastroscopy was done and and a mild bleeding of the gastric mucosa was found. He was told to stop aspirin and Plavix.

Not long after that he was back on aspirin and Plavix by the order of the cardiologist. Informed decision was made by him and his wife to continue these two drugs. So far so good; he does not have any more bleeding from the stomach. Of course he will be taking a medication in the family of Proton Pump Inhibitor(PPI) indefinitely.

In conclusion, informed decision by the patient is the best solution for the dilemmas described above, in my opinion.