Clopidogrel/Aspirin alternative

I have asked this question before but just wondered if anyone might have had similar problems, both of them give me side effects which are starting to become increasingly problematic. Clopidogrel gives me a dull ache in the back of my throat and windpipe (almost like angina symptoms), and Aspirin irritates my stomach/intestinal tract even when taken along with a PPI. The GP 's surgery are telling me that there is no real alternative other then Warfarin which they say is not suitable for me and would not prescribe it (wouldn't really want it to be honest). has anyone else had similar or been prescribed a different blood thinner other than warfarin?

[Milkfairy Heart Star]

There is an alternative to Warfarin, Novel oral anticoagulants, NOAC are prescribed for atrial fibrillation.

Rivaroxaban, dabigatran, apixaban and edoxaban are NOACs

They can in some cases be used to treat blood clots such as deep vein thrombosis, DVT.

I am not sure if they will be suitable for you however no harm asking your GP's advice

bhf.org.uk/informationsuppo...

[Hidden in reply to Milkfairy]

Thanks for that, no harm at all! I do sometimes wonder if carrying on with these drugs is really necessary. I understand that the plaque can sometimes break off but if that happens then it is going to cause a blockage anyway? Or maybe it is because the arteries are likely to be narrowed generally and therefore more prone to causing clots?? I have never felt comfortable with the problems of bleeding they can cause, or if they are really needed in otherwise fit people. Ah well.

[Milkfairy Heart Star in reply to Hidden]

This is a conversation we have in our house. My husband had his stent inserted 10 years ago in his 40's, so on aspirin for life.

He now has Atrial fibrillation so is taking a NOAC.

A clot can end up in your brain causing a stroke. That happened to my dad.

I take clopidogrel to help prevent any possible clots forming as my vasospasms effect the smooth flow of blood through my blood vessels.

🤷‍♀️

[Hidden in reply to Milkfairy]

I understand that any interruption to the smooth flow of blood, such a pooling in AF or any other problem where the normal rhythm is interrupted, can cause the blood to clot, with obvious dangers. I also know that in the first few months after a stent insertion there is a possibility that clots may form in the stent, hence the dual approach, however there seems to be some conflicting opinions as to how long the dual approach is maintained for. In a person like me, where the heart was undamaged, and the narrowed arteries have been opened up and held open, and who is otherwise fit and healthy and able to exercise to fairly intense levels, and who does not have any problems with their heart rhythm or high blood pressure, just what the risk of clotting is versus any other person? The stents are obviously stable some 3 years down the line. during the Angiogram the cardiologist did comment that "there is a general narrowing but nothing to worry about" and my RCA was not stented as it was only 50% blocked. So is it that any arteries that are narrowed present a risk of clotting? If so there will be probably millions of people walking around who are as yet not diagnosed, or is it that if any bits of plaque break off they will cause a clot? I would have thought that any bit of plaque no matter how small will cause problems anyway if it reached the tiny vessels in the brain? And some plaque is stable and won't break off, or the Statin will hopefully stabalise the plaque? I would love to chat to a cardiologist!

[Milkfairy Heart Star in reply to Hidden]

Ah a Cardiologist a very rare beast at the moment 😊

It would be great to truly have an opportunity to discuss our treatment options in depth!

The inner lining of the blood vessels the endothelium is involved in how the blood clots.

Here's some bedside reading.

ncbi.nlm.nih.gov/pmc/articl....

[Hidden in reply to Milkfairy]

Blimey, looks like heavy stuff, but thanks I will read it. I suppose I could ring a BHF nurse but I don't think they would be likely to suggest asking to come off them, understandably, as it is obviously almost set in stone that we all take them. They still worry me though, as well as the side effects.

[Milkfairy Heart Star in reply to Hidden]

Sometimes these articles just make my brain hurt too and I decide to keep taking the tablets!

[Hidden]

Useful, thank you.

[Chappychap]

It's a difficult call. But if you discount side effects then I believe the benefits of aspirin outweigh the risks. This is particularly true once the patient gets to late middle age or older.

Age is by some margin the biggest heart attack and stroke risk factor that we face, bigger than smoking, obesity, or lack of exercise. So no matter how superficially fit and healthy we might be, every passing year counts against us. And aspirin isn't just a preventative medication, it also significantly reduces stroke and heart attack severity should the worst occur. Which is why one of the first thing paramedics often try is giving the patient an aspirin. But it's obviously far better if your bloodstream is, so to speak, pre-loaded! However, you might explore the middle ground of a "pill in the pocket" strategy and carry aspirin with you and also brief family members why it's there?

However, I recognise that we put the hard yards in, not just for more years, but more more good years, so we can't ignore the quality of life element that side effects represent. Which is why these type of medication choices are so deeply personal.

Good luck!

[Hidden in reply to Chappychap]

Thanks for the luck, we all need it. Your reply is just about along the lines of my thinking to be honest. I always carry couple of full size Aspirins with me, if not for myself then anyone else who might need one should the worst happen. The side effects are not too bad, it would just be better if they were not there. Unfortunately the Clopidogrel almost gives a feeling similar to the Angina I felt just much less, a bit of a tight feeling in the throat and windpipe, but obviously there all the time and not brought on by exertion or anything else, I had it right from the off. I have been given a different PPI (Pantoprazol), so I might see if I can swop back onto the Asprin and see if it relieves some of the digestive tract problems.

[Hidden in reply to Chappychap]

Just read through your comments again. As you say age is a big factor, and there was a bit of a phase where once a certain age had been reached it was thought that taking a "precautionary" aspirin every day was a good idea. However I think the general feeling now is that the risks outweigh the benefits, which in some cases, could maybe be said of some people who have had stents fitted but are otherwise fit and healthy? It can't be just dismissed that these drugs do increase the chances of internal bleeding quite substantially. As you say it's a big call.

[firstlight40]

So ticagrelor is an alternative to clopidogrel. It's what I'm on (with aspirin) and the only side effect I have is an increased tendency to bruise which shows it's working. You could ask to be tried on ticagrelor (also called Brilique or Brilinta)

[Hidden in reply to firstlight40]

Thanks for the suggestion, I have looked into this and interestingly shortness of breath (which is what I feel really, although I am not actually short of breath, if you see what I mean) is a side effect of Clopidogrel. unfortunately Ticagrelor is actually very similar to Clopidogrel and is actually more likely to cause it. I think this is why the GP has said there are no real alternatives, for me. You can't win can you!