PLAVIX TX and Transplant

[huldafolk]

Hi all;  Just got through a tough spot.  I had to go for a routine MIBI heart test recently.  The results came back that I had a REVERSIBLE DEFECT in heart perfusion.  I was then immediately taken off the transplant list until this could be further investigated and treated as required. Just this week,( 5 weeks after the MIBI results) I got in to see the Cardiologist for a ANGIOGRAM. during the procedure it was determined that I had a 90% blockage of the RCA and 40-50% blockage on two other heart arteries.  All were balloon plastied and the RCA got a bare metal stent.  After the procedure ,the access site bleed profusely and I was taken to the CICU for control of the bleed. I have a bruise half way across my groin and half way down my thigh. Hb dropped from 120 prior to 107 now.
I have been placed on 81mg ASA for the rest of my life as well as 75 mg PLAVIX /1per day for 2 months. I have been advised that I will not be able to get back on the transplant list until I am off the Plavix in 2 months,.I have been on FRAGMIN for bridging during the procedure and was taken off my regular Warfarin (inr 2-3) for the procedure and am now going back on it to get an INR of 2-3,  Alot of anticogulants???  Any other like experiences??   Can the CALCIUM BINDERS cause heart blockages?? My cholesterol numbers have always been normal.

[VintageVera]

It strikes me how all here on IHD have become medical experts. I don't have answers to your questions but am believing that you will get back on the transplant list. LOVE, VERA

[Nephrologista]

Your anticoagulants each address different ways the blood can clot.  The Plavix is to prevent the platelets (little cell fragments that circulate in your bloodstream) from clumping together in response to the bare metal of the stent.  In about six to eight weeks, that bare metal will be covered over by the tissue of your blood vessel, so you won't need Plavix after that.  The aspirin is probably overkill while you're taking the Plavix, but afterwards, it will help protect you from forming platelet clots if a plaque in your heart blood vessel ruptures - that's what causes a heart attack, the platelet repsonse to a plaque rupture.

From what you mention, I can't tell why you're taking coumadin.  If you needed bridging with Fragmin for a procedure, it might be something like an artificial heart valve or a history to form blood clots.  Coumadin works on a different system of blood clotting, so aspirin and Plavix won't address those needs.

Dialysis patients have a very elevated risk of heart blockages, for reasons that aren't entirely clear.  There's a lot of inflammation in the body of a kidney patient, and inflammation is the hot topic these days in understanding heart disease.  Calcium-containing phosphorus binders seem to cause more calcification in the arteries, but the link to actual heart blockages hasn't been proven.

My only question is why you have to be off Plavix for two months before you can get back on the transplant list.  Platelets are irreversibly posioned by Plavix, so there's a risk of bleeding from surgery.  But the lifespan of a platelet is only seven days, so by one week you should have all new platelets and be ready to go.  They do open heart surgery after people have been off Plavix for seven days.  Two months seems excessively cautious, and you might want to ask your transplant coordinator for clarification.

[Stoday]

I found that information useful, Nephrologista. Ta!