After dual antiplatelet therapy with aspirin and clopidogrel; what & #039;s the best single antiplatelet agent?
(Source: BMJ Comments)
Source: BMJ Comments - December 20, 2018 Category: General Medicine Source Type: forums
Room 4: patient decides to stop plavix without permission
what do you guys do with patients who decide to stop plavix (or other blood thinner) on their own?
Say you saw a patient and explained at the consult that you were going to check with cardiologist to make sure they were okay with holding plavix.
Then you hear from the patient that they want the injection because they decided that it was okay to stop plavix without permission.
Do you do the injection since they have been holding it?
Do you say no since you don’t have permission?
Do you...
Room 4: patient decides to stop plavix without permission (Source: Student Doctor Network)
Source: Student Doctor Network - January 24, 2018 Category: Universities & Medical Training Authors: geauxg8rs Source Type: forums
MI management, basic question
Hey all, intern here trying to get all this jazz straight. I know there's a bazillion mnemonics out there, but I'm just trying to make sure my management of STEMI and NSTEMI is correct for what we do in the emergency department. In addition to oxygen, monitor, and IV access:
STEMI --> Aspirin, clopidogrel, nitro (if no contraindications), heparin (ufh vs lmwh depending on institution, I guess), beta blocker (f no contraindications), PCI (and if going to PCI, give IIb/IIIa drug like...
MI management, basic question (Source: Student Doctor Network)
Source: Student Doctor Network - November 30, 2016 Category: Universities & Medical Training Authors: Fungi121 Source Type: forums
Knee Injection on Coumadin AND Plavix
What are your thoughts on doing an intra articular knee injection on a patient on Coumadin and plavix concurrently. The patient's INR is on the low therapeutic range. I've found a lot of evidence that says its safe to do joint injections on coumadin, if the patient's INR is therapeutic, but couldn't find anything specifically about coumadin and plavix together. Any sources/references/practical advice would be appreciated. Thanks. (Source: Student Doctor Network)
Source: Student Doctor Network - September 24, 2016 Category: Universities & Medical Training Authors: theanswer03 Source Type: forums
Carotid endarterectomy after DES
Hate to bring up this topic again..
Reviewing a chart today I came across a 67 year old lady, that is about 90 days out from a DES after an NSTEMI, scheduled for upcoming CEA due to critical ICA stenosis >90% occlusion that was found out routine screening. Been asymptomatic neurologically. Cardiologist has "cleared" patient provided ASA/plavix is not interrupted and vascular is fine with that.
Copied from a previous post, from ACC/AHA
5.2. Timing of Elective Noncardiac Surgery in Patients...
Carotid endarterectomy after DES (Source: Student Doctor Network)
Source: Student Doctor Network - September 13, 2016 Category: Universities & Medical Training Authors: Colba55o Source Type: forums
Intraop Seizure
Long time lurker here. Enjoyed reading clinical discussions. I'm quite fresh out of training and would appreciate any feedback or wisdom about a recent case:
50 yo F for elective lumbar laminectomy. PMH of lupus anticoagulant with previous right central retinal vein thrombosis on plavix + coumadin, off both for 5 days for surgery. She's on Plaquenil, CellCept, Prednisone for SLE. No h/o HTN, DM, stroke, heart/lung/renal/hepatic issues. 100kg BMI 35. NKDA. No previous GA anesthetic...
Intraop Seizure (Source: Student Doctor Network)
Source: Student Doctor Network - June 8, 2016 Category: Universities & Medical Training Authors: eggscal99 Source Type: forums
Why is CoPlavix not enteric coated?
Hi, I have a question. Co-Plavix is the brand name for the aspirin clopidogrel combination marketed by Sanofi. Now this product is only film coated and not enteric coated. My question is: Isn't it wrong to administer aspirin/clopidogrel as a formulation which is not enteric coated on accounts of the GI ulcers it can cause.
Secondly, in Pakistan, there are other kinds of products for the same combination. Some of them are bilayered tablets. Some are pellet containing enteric coated tablets...
Why is CoPlavix not enteric coated? (Source: Student Doctor Network)
Source: Student Doctor Network - March 29, 2016 Category: Universities & Medical Training Authors: Natasha123456789... Source Type: forums
Dual anti-platelet therapy after DES, how long should it be?
The benefit of aditional antiplatelet therapy (clopidogrel, prasugrel or ticagrelor) of DES is well documented. However, due to the increased bleeding, controvesy remains on the ideal duration of therapy. I have mostly recommended one year dual antiplatelet therapy.
4 trials presented at AHA yesterday have conflicting results. While DAPT suggests 30 months is better than 12, two european studies ISAR-SAFE and ITALIC support that 6 months is not different than longer treatments.
What do you usually do? 6, 12 or even more? Individualize? How? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 18, 2014 Category: Cardiology Authors: MBittencourt Source Type: forums
What is the future of "Triple Therapy" after coronary stenting?
Identifying the optimal regimen for antiplatelet therapy in patients requiring long-term anticoagulation following coronary stenting is an area that has traditionally been understudied. Although all major guidelines recommend (limited) triple therapy in this situation, these recommendations are either result of expert consensus or are largely based on observational data.
The WOEST trial was an open-labelled randomised trial and compared dual therapy (a combination of clopidogrel and vitamin K antagonist) with triple therapy (Aspirin, clopidogrel and vitamin K antagonist) in patients undergoing coronary stent...
Source: Doc2Doc BMJ Cardiology - November 17, 2014 Category: Cardiology Authors: Heart Matters Source Type: forums
ssri + varfarin
Hello to everyone!
It is known from recent researche that ssri antidepressants increase bleeding tendency.
Taking this fact in consideration how do you manage in your daily practice pacients who are concomitantly on ssri + clopidogrel or varfarin regiment ?
Do you think that we should lower the inr target in pacents who are taking varfarin and ssri ? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - October 8, 2013 Category: Cardiology Authors: ikaros Source Type: forums
Do you consider smoking status when prescribing clopidogrel?
Clopidogrel was a massive earner for its manufacturer while its patent lasted, but like so many drugs which have cost health systems billions in long-term treatment, it may not actually do that much for most people who take it. A meta-analysis of nine trials in patients with established cardiovascular disease, the effect of clopidogrel was highly dependent on smoking status. Those who smoked showed a 25% reduction in a composite outcome of cardiovascular death, myocardial infarction or stroke, compared with a reduction of 8% in non-smokers. This may also apply to the newer agents ticagrelor and prasugrel, though ...
Source: Doc2Doc BMJ Cardiology - October 7, 2013 Category: Cardiology Authors: Richard Lehman Source Type: forums
What's the best antiplatelet regime for patients on wafarin?
I often struggle with this for patients in AF who end up having a stent and often find that aspirin plus clopdiogrel plus warfarin can be a very difficult combination particularly when a drug eluting stent has been implanted! I'm pleased to see a trial that supports what I think many cardiologists do in practice which is warfarin and clopidogrel only (plus a PPI!)http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62177-1/abstractWhat's your antiplatelet regime of choice in this situation?sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - February 23, 2013 Category: Cardiology Authors: sadian Source Type: forums
