Anti-coagulation

[PeterJemmett]

During a recent visit to my Cardiologist I asked about my cardiac history as I have always been confused and I never fully understood all that happened.

It would seem back in Apr 2013 that I had 2 stents (right coronary artery and left anterior descending artery) when I was diagnosed with unstable angina, following this I wasn’t started on the anti-coagulant until it was picked up at my 6 month check-up, this worried me and short while later my cardiologist reassured me as I was taking aspirin at the time.

Fast forward to Dec 2016 and I suffered a heart attack, it now seems that one of the original stents ‘failed’ (right coronary artery), my understanding is this was probably a build of plaque around the stent (the very thing anti-coagulation is supposed to prevent) rather than the stent collapsing, so I was re-stented.

My question is, would it be normal practice to start anti-coagulation after any stent or is relying on aspirin accepted?

I don’t like to think the worse but it’s crossed my mind that there might be a case of negligence or malpractice for failing to start my anti-coagulation and could this have contributed to my heart attack? – (I realise it is also partly down to poor diet and lack of exercise but what %?).

[PeterJemmett]

This is my understanding as well. At the time I was naive to any of this and I remember the cardiologist being surprised I wasn't on any anti-coag and started me on clopidogrel immediately.

[Dolphin14]

Someone dropped the ball here.

[fergusthegreat]

Hi Peter, just another layman's opinion but yes you should have been started on dual anti platelet therapy after your stenting.

However, this therapy is to stop stent thrombosis whilst the stent heals not to prevent re blocking with plaque.

The therapy is also typically stopped after 6 or 12 months so it's unlikely it would have prevented a heart attack 3 1/2 years later.

[PeterJemmett in reply to fergusthegreat]

That does seem to make sense but doesn't really make me feel any better as when looking it up the first line is - Stent thrombosis is an uncommon but serious complication that almost always presents as death or a large non-fatal myocardial infarction, was my life put at risk?

[Handel in reply to PeterJemmett]

Hi PeterJemmett.

Like others posting on this forum, my husband was put on Clopidogrel plus aspirin.

Good luck to you xxx

[fergusthegreat in reply to PeterJemmett]

Hi Peter, stent thrombosis I believe is basically a blood clot within a stent which is basically another term for a heart attack so yes they are very serious.

Anticoagulants are given to reduce this risk after stenting but I believe that while you're in hospital your blood clotting factor is checked.

Maybe there is a medical reason you were not given clopidogril.

I needed a stent for a severely narrowed artery but was almost discharged without treatment and would probably be dead now without it. You could have had a heart attack because you weren't prescribed clopidogril but you didn't.

Unfortunately, like everyone doctors made mistakes but we are both still here so let's enjoy it.

Like I said before, I'm a layman and in my opinion if you should have been given clopidogril and you weren't then yes that would have increased your risk of stent thrombosis but it didn't happen and you're next heart attack has nothing to do with this because you would have stopped the clopidogril by then anyway.

[Milkfairy Heart Star in reply to fergusthegreat]

A Heart attack is a myocardial infarction. Permanent death of the heart muscle.

The most common due to a prolonged lack of blood supply ischaemia.

A coronary artery can be blocked by a blood clot , plaque or narrowed temporarily by a severe vasospasm but this does not necessarily lead to a heart attack. It can lead to unstable angina and Acute coronary syndrome.

I spend at least a week in CCU every year with unstable angina and possible acute coronary syndrome. So far so good I have always over the past 7 years got to hospital in time to receive the treatment I need to prevent a heart attack.

The BHF has this information about heart attacks and the usual treatment

bhf.org.uk/informationsuppo...

For those who want a more formal definition there is the 4th Univetsal definition of Myocardial infarction published last year which the medics use.

escardio.org/Guidelines/Cli...

[Milkfairy Heart Star]

I acknowledge the what 'ifs' are impacting on your well being.

Are you able to discuss what happened with your GP or Cardiologist?

Then how we quantify risk is important. We and our Healthcare professionals all have our own view on risk and what risk we are comfortable with.

I live with a poorly recognised and understood condition. I have experienced care that has been at times poor and decisions have been made that increased my risks of a serious cardiac event.

I had to stay in hospital for 10 days once until I had a Cardiac MRI to check I hadn't had a heart attack because of the mistake of one of the medical staff.

They apologised and I now have an Admission plan to help the staff care for me appropriately.

I hope you are able resolve this issue soon.