Stopping blood thinners after having a stent

[Maisieandjess]

Hi everyone, The Doctor has advised my dad to come off his blood thinners which he was put on after having a stent due to a blockage in his artery, he has said to stop them because his stomach is too delicate to handle the blood thinners and it's causing ulcers, my dad's worry is now that he is off them will his stent clog up he isn't taking any stations either as these don't agree with him, just wondering if anyone else is going through the same thing? Wondering if anyone has been off the meds a long time after the stent and been fine?Thanks in advance for any advice x

[Maisie2014]

Hi. I had a stent four years ago and take two blood thinners; Ticagrelor and Aspirin. It sounds like the Aspirin is upsetting his stomach. I take Nexium to protect my stomach from both these meds.

[AlfredV]

I had a stent in April 2020. Took all the meds for 2 weeks. Then stopped all except clopidogrel and aspirin. Stopped the clopidogrel after 6 months and I stopped the aspirin 18 months ago. I've made many lifestyle changes at the same time. This was a personal choice as the medication was making me very ill.

[Jack2019]

Mine was in 2018, 2 stents. I took the blood thinner for the prescribed year, I stopped the aspirin after 6 months into the prescribed lifetime advice, and I never took the statin. Taking no drugs since the end of the first year. I always carry aspirin and angina spray, which I have never needed. However, each person is different and will be influenced by so many other variables.

[Hidden]

Yep. After my last (sixth) stent I was left to my own devices. Couldn’t see a doctor for six months so I did my own research.

It’s a toss-up between blockage and bleeding, I’m afraid. Research clearly shows that the longer you are on antiplatelets (aspirin; clopidogrel; rivaroxaban) the greater the risk of a dangerous, disabling, or even fatal, bleed of brain or stomach. On the other hand, the risk of a stent re-blocking, although small, is not zero.

I chose to find alternatives to prescribed antiplatelets and take thrombolytics instead. This is information and not advice, as each of us must make the decision for ourselves. I chose nattokinase and serrapeptase, as enough research has been done on them to establish a therapeutic dose (I.e. how much to take).

I urge you to research it for yourself. The Journal of the American College of Cardiology, Circulation, are two journals to look at. The PubMed website will point you to more research papers.

[Milkfairy Heart Star in reply to Hidden]

"Research clearly shows that the longer you are on antiplatelets (aspirin; clopidogrel; rivaroxaban) the greater the risk of a dangerous, disabling, or even fatal, bleed of brain or stomach."

Would you please be able to post the links to the relevant research articles that support your statement?

PS.

Are you a former Registered Nurse?

Sadly the title nurse is not protected in law like

Doctor, Midwife, Pharmacist or Dentist.

[Hidden in reply to Milkfairy]

Actually, the title “nurse” is protected by Act of Parliament and it is an offence to pass yourself off as one when you have not qualified (Nurses and Midwives Act 2011). When I retired from the register a few years ago I was reminded of this in a very strong letter from the Nursing and Midwifery Council (NMC).

I qualified as a registered nurse and practised for nearly forty years. I am returning to practice in the New Year as I think there is still a lot of work to be done.

I might struggle to find the exact references as I did not save all the papers I read, and I was just following my nose, making notes as I went. It was just for personal information, after all. I’m also away from my desk at the moment so don’t exactly know what I actually did save..

As I said in my other post, the NIH site PubMed is a good place to start a search. You will find links to published , peer reviewed papers on the subject. There is a lot of information on antiplatelet therapy. The straight line relationship between duration of therapy and risk of major bleed is clear, but stopping or changing medication is a decision each of us must make for ourselves. I made my own risk assessment because I have spent a career doing just that for other people, and felt I could weigh the pros and cons. If you do not have clinical experience I would suggest you at least try and discuss it with a doctor or nurse. Whatever you decide, it’s not straightforward so I urge you to be cautious.

[Milkfairy Heart Star in reply to Hidden]

Actually, the title Registered Nurse is protected sadly not the title 'Nurse' alone in the UK.

A leading Professor of Nursing has been leading a campaign to change the law.

unison.org.uk/health-news/2...

guyshospitalnursesleague.or....

I signed Alison Leary's petition. MPs voted against the amendment.

There is a Nurses and Midwives Act 2011 which relates to Ireland.

irishstatutebook.ie/eli/201...

The term Registered Nurse is protected under the 1997 Nurses Midwives and Health Visiting Act which applies in the UK.

legislation.gov.uk/ukpga/19...

People with atrial fibrillation or mechanical valves are prescribed anticoagulants for life to help prevent strokes.

[Hidden in reply to Milkfairy]

Whatever. I was a registered nurse for nearly 40 years. Are you trying to say I wasn't? What point are you trying to make here? Or are you just naturally combative?

I know what I'm talking about. I know about antithrombotics, antiplatelets, anticoagulants, and thrombolytics, and the difference between them. Don't be so condescending as to instruct me on AF and antiplatelets or anticoagulants as if I was new to the idea. Been there; done that. Looked after people with AF and managed the haemorrhages that result when antiplatelet therapy goes wrong. How much of that have you done?

Just go and do your own research. You are being tiresome.

[Sb1171 in reply to Milkfairy]

Here is a link to research about extending dual anti platelet therapy. (Specifically Ticagrelor 90mg or 60mg beyond the initial 1 year at 90mg)

nejm.org/doi/full/10.1056/n...

It does indeed indicate that there is an increased risk of major bleeding, but this is small and it also indicates that there is a significant reduction in cardiovascular death.

[Milkfairy Heart Star in reply to Sb1171]

Thank you for the link.As patients we need to be able to have the information to make an informed choice about which treatment risks and benefits are acceptable to us as individuals.

[bridgeit]

Hello Maisie. Having read AncientNurse's informative post I should like to suggest another product for your research purposes.

Have you had a look at pycnogenol? This is also an antithrombotic that has attracted interest from scientific quarters. I've inserted a couple of reading references, here's the first:

pubmed.ncbi.nlm.nih.gov/237...

Note that research results refer to the French pine bark extract pycnogenol, not 'pine bark' extract which is cheaper. They are not the same product and do not have the same antithrombotic effect.

Here's a reference to a dialogue I found interesting:

chriskresser.com/4-natural-...

It is a transcript from a radio programme. They discuss several alternative (to usual meds) antithrombotic options including pycnogenol and natto/nattokinase. Be cautious regarding policosanol research results. The research was I think commissioned within Cuba, which has huge economic interests in manufacturing the product. The research findings may be biased.

Incidentally, natto is fermented soya in its food state rather than a supplement. It might be possible to purchase actual natto from an Asian foodstore to be eaten as part of a balanced diet. The Japanese swear by it. My understanding is that eating it takes some getting used to (dodgy smell!). Here's a reference with more info about natto:

drjohnday.com/is-nattokinas...

Best of luck to your dad and I hope you're able to sort out something reassuring that will not upset his dodgy tum.

PS. It goes without saying really that it is always wise to check with a GP or pharmacist before taking any over-the-counter supplement to ensure that there are no contra-indications with existing meds. A really supportive GP might even offer your dad a blood clotting test in due course to measure how effective any alternative product is working out, compared with historical results when he was on prescribed meds.

[Maisieandjess]

Thank you everyone for the amazing advice x

[Suzyh]

I took blood thinners for 6 months now just take asprin /statin/isosobide mononitrate and no problems

[Moriela in reply to Suzyh]

How much statins are you taking ?

[Pitt12345]

Because my husband had another heart attack 6 months after stopping his blood thinner Consultant put him back in it (eventually for three years as he had the 2nd ha 20 months after first and then six months later git a blockage of stent which then needed bigger stent). He is due to come off it next April . Consultant says they will discuss things in March. Everybody is different - if he is concerned perhaps raise them with Consultants secretary and ask secretary to forward his concerns to consultants. All good wishes

[peterjones105]

If I was in your Dad's situation (and admittedly I am not) I would research natural anti-coagulants such as Turmeric, Ginger and the like.Very good luck.

[kkatz]

It is 15 years since I had my stents.I was on Clobidogral for a year and this was stopped.I have been taking Edoxaban for 6 years since AF diagnosis.I have took statins for years before stents but I have been reduced to very low dose for quite a few years due to muscle aches.

[MountainGoat52]

Hi Maisieandjess,

I'm rather surprised your father's GP isn't prescribing and alternative to the medication that is causing his ulcers. There are many alternatives to the standard medication. For a start Aspirin can be supplied as a coated tablet that doesn't dissolve until it is past the stomach.

Since being prescribed blood thinners and various other medications I have adopted an approach which, for me, works well. I take all my main medication and vitamins with my breakfast cereal. I follow this up with the 70mg Aspirin in a good amount of water, at least 1/4 pint. Then on top of that lot goes a cup of tea, further diluting the Aspirin. One of my medications requires further doses during the day and I always take these at meal times. If I forget one, I don't try and fit it in with a snack otherwise it does give me stomach ache. Fortunately it is a secondary medication for my Raynauds, so it only becomes essential in cold weather.

Sorry that I can't answer your question, but I feel there is a solution to your father's situation... it is just a matter of finding it.

Regards,

Gerald

[Gibson01]

It’s standard practice to be prescribed low dose aspirin ( for life) and an antiplatelet such as Ticagrelor for 12 to 18 months after stents. Has the GP prescribed Lansaprazole or similar to protect the stomach?

I would have thought stopping the antiplatelet should be the last resort.

[Qualipop]

I was put on ticagrelor and aspirin after a heart attack and 2 stents. Ticagrelor had to be changed to clopidogrel because of breathing difficulties. The tocag or clopi is usually stopped a year after the stents. Mine was stopped after 6 months for exactly the same reason as your dad. My stomach couldn't take it. I couldn't take the usual protective drugs like omeprazole as I'm allergic to them so I could only take famotidine. Even after stopping the clopidogrel and only taking aspirin I still had horrific stomach pain so my aspirin was changed to a coated version that doesn't dissolve until it reaches the intestines. No more problems but I do st ill take famotidine to protect my stomach from other meds. Maybe a coated aspirin would be better for him.

Has he tried different statins? I couldn't take atorvastatin at all but simvastatin is fine for me. Rosuvastatin is supposed to be even better for lack of side effects.

[Maisieandjess in reply to Qualipop]

Thank you for the great info I will pass it all on sorry you have had troubles too, glad you are finding something that helps

[Qualipop in reply to Maisieandjess]

I've had stomach ulcers in the past so have to be extremely careful what I take

[Grassmower]

I tried two statins and developed hot numb feet with both, symtpoms of peripheral nueropathy. The cardica nurse is recomending a referal to the lipid clinic.

[Qualipop in reply to Grassmower]

I wondered if statins had caused my peripheral neuropathy but when we checked it started before the statins. Feet and ankles.

[Maisieandjess in reply to Qualipop]

My dad gets that too in his feet and ankles he says he can't feel them very well and it's like walking on balloons, is that what it's like for you

[Qualipop in reply to Maisieandjess]

Underneath the balls of my feet yes it's a bit like walking on balloons or foam but round my ankles and half way up my shins it feels as if I have hundreds of elastic bands squeezing tight and prickling. I do have slight swelling in one ankle but have had that for years since a lymph gland was removed so that leg doesn't drain as well as it should. That started long before the neuropathy. The prickling isn't at all like when my hand goes to sleep because I've slept funny. It's just there all the time, tight and prickly

[Morningasker]

I had a silent myocardial infarction, I don't know when, but I didn't feel anything.

2 years ago, routine control, I got 1 stent placed.

My doctor wanted me absolutely on statins and Aspirin Cardio. I stopped Aspirin Cardio after 2 years and replaced it with OPC. ( oligometric proathocyanidis).

With Aspirin, I was bleeding very fast and long time. I don't want to imagine what would happen, when bleeding is internal, doctors "forget" to tell that to theyr's patients

I never took statins, terrible side effects for almost no benefit. Friends around me, taking statins for years are getting demented. One of them stopped the statins a year ago, he is back and reading newspapers again.

Keto since 1 1/2 years, lost a lot of weight, blood pressure OK, without medication.

My cardiologist did not want to send me for a calcium score, useless, he said. Next step, changing the doctor.

I have a BMI of 21,5, no alcohol, don't smoke, move a lot, eat healthy, age 74.

[RailRover]

I have a similar situation. I was prescribed Apixaban after HA aged 62, and continued after triple bypass, nearly 4 years all tolled. I became concerned at the possibility of a bleed because my mother died of a brain haemorrhage, albeit at 81. On the other hand, my father died after several heart attacks aged 47, and I'd already proved I was disposed to suffering blocked arteries just like him.

I raised my fears with a cardiologist at a routine clinic and she agreed with my worries about the bleed. She arranged a 48 hour holster ecg test checking for afib, and then took me off the Apixaban. Some months later, at my next clinic, a different cardiologist called the decision of his colleague "brave", and told me that if I was his relative I would most certainly be on the therapy. That convinced me, so I went back on them.

I understand it's a balancing act, a fine judgment, and I have no criticism of either cardiologist. Every case is different, and there is no right answer to the quandary. Well, I suppose there is, but not this side of the post-mortem which I am keen to postpone for as long as possible.