Clopidogrel vs warfarin
Common Questions and Answers about Clopidogrel vs warfarin
plavix
After six years post MI and ef varying between 25-35%, my cardiologist now feels that I should shift from aspirin(150)+clopidogrel (75) to warfarin. Two years back he did tell me that he is double minded on whether to put me on warfarin. But this time he appears to be very sure and has insisted me to go for warfarin.
His justification is "that is what literature says".
I have no AF or valve problem.
To date there have been no reports of an important interaction in humans between warfarin and clopidogrel. Nonetheless, because warfarin increases the risk of bleeding, blood tests to measure the degree to which the blood is anti-coagulated or thinned (prothrombin time; INR) may be ordered to assess the degree of blood-thinning when warfarin and clopidogrel are used together.
s like if I want some Clopidogrel (another form of anti platelet med) I could ask for either Clopidogrel or Plavix, Plavix is the brand name the drug company trades the medication under.
Warfarin (coumadin): Because of the increased risk of bleeding, the concomitant administration of Warfarin with Plavix should be undertaken with caution. (See PRECAUTIONS - General.)
At high concentrations in vitro, clopidogrel inhibits P450 (C).
I am a 71y male, active , working medical professional, with Hx of Htn & carbamatic mechanical aortic valve in 2000 for AI. Non Eluding Stent in Nov. 2009. Although published INR range is b/w 2-3 for patients on triple anti-thrombotic therapy of 75mg clopidogrel, 80mg asprin & warfarin,I've also heard that INR of 1.5 - 2 is also acceptable. Kindly verify, confirm, advise, forward relevant studies/trials PDFs.Thank you for your timely response and effort.
Based on the level of risk, most patients are either started on aspirin or Warfarin (Coumadin). Clopidogrel (Plavix) is an anti-platelet agent and acts via a different mechanism than coumadin does (coagulation pathway). Adding Clopidogrel to aspirin is a guideline that holds a Class 2b (see below) recommendation, and usually considered in those in which Warfarin is unsuitable due to patient preference or physician's assessment on a patient's ability to safely sustain anticoagulation.
At 18-month follow-up, there was no difference between patients with a drug-eluting or bare-metal stent in cumulative rates of death or myocardial infarction (MI). However, after clopidogrel discontinuation patients receiving drug-eluting vs bare-metal stents experienced higher rates of death and MI (4.9% vs 1.3%, respectively). These results have created uncertainty regarding the minimal necessary duration of antiplatelet therapy after drug-eluting stent implantation.
I don't know about "normal," but if the regimen of warfarin and Plavix is working for you, then great. Your goal is to find something that works. Have you been tested for clotting disorders? Your story makes me wonder about that, especially if the stroke happened to be due to a clot.
I have been told that the INR safe range is b/w 2-3 for patients on triple anti-thrombotic therapy of 75mg clopidogrel, 80mg asprin , and warfarin - 10 years after aortic valve replacement.
However, it has also been mentioned that an INR of 1.5 - 2 is also acceptable. Please verify and confirm.
Patient is 71y active , still working medical professional, with Hx of Htn and aortic valve replaced in 2000 to manage Aortic Insufficiency.
Your prompt response will be greatly appreciated.
Combining plavix and aspirin increases the risk of bleeding vs. aspirin alone in patients treated for more than a brief period of time. That is the regimen followed for my DES implant.
f you are in this category a prior MI and unstable angina:" In the CAPRIE trial, clopidogrel (plavix) was equivalent to aspirin for patients with a recent (but not acute) MI.
t answer your question but I had a PVI ablation for afib in February and have been on Warfarin for the past 2 months. When I went to get my initial IRN check, the nurse explained to me that there were different classes of drugs (I think 8) that worked on coagulation. Heparin was one, aspirin was another, then Coumadin/Warfarin, Plavix, etc. She explained that I had to be on the Warfarin and aspirin while healing because these were the drugs best suited to my condition.
Given that yesterday he said to not take the warfarin he was changing me from the genertic warfarin and putting me on the brand name of the med coumadin. Said some folks do not tolerate warfarin well but do well on coumadin and i am to start the coumadin today. I would be lying if i didn't say i am a bit gunshy at this point. This med has made me absolutely miserable and today is my 43rd bday...
continue warfarin therapy, withhold warfarin therapy for a period of time before and after the procedure, or temporarily withhold warfarin therapy and also provide a "heparin bridge" during the perioperative period. Which management option to follow is primarily determined by the characteristics of the patient and by the nature of the procedure.
This is really a question only your doctor/s can answer - they know your complete medical history, other meds and know the risks/benefits of either med. So please contact your doctor for their advice.
Best of luck!
heparin is used because it acts immediately. Warfarin might be given, but it takes a day or two to begin working.
But heparin is given by injection or instead usually by IV, so it's not practical except when the patient is in the hospital. Warfarin is oral.
IV is better because the dose that is delivered to the bloodstream is more sure. Injecting heparin into the body can results in variable dosing, depending on the nature of where the heparin is injected (e.g.
If you are bruising that easily with warfarin, clopidogrel(plavix) and aspirin, then I think your cardiologist is probably suggesting a wise change in your medication. Warfarin is a powerful anticoagulant and I think your stents should be fine with withdrawal of the plavix. The main concern here is obviously an internal bleed which can be life threatening. My opinion is that the balance for your safety has to be right, and the cardiologist has done that.
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