Stopping clopidogrel safely—abruptly or gradual cessation?

[CarolingTeacher]

I’ve been on clopidogrel (Plavix) for one year after a drug eluting stent was placed in my significantly blocked LAD (aka widow maker artery) 2/23. I’m wondering if the following is true or not, and what your experience has been with stopping clopidogrel safely—abruptly or gradual cessation?

Because I’m going to have some minor surgery very soon and I need to be off of both blood thinners for a week before that, some mixed messages have come to my attention about the serious danger of just abruptly stopping clopidogrel after a year, as well as additional dangers of stopping after having been on it for 2 years or longer—suggesting that both can cause death in 60% of people within 3 months because of how it changes blood cells, and how clotting can rebound, and how that can cause clots or cardiac arrest until those blood cells can renew (regenerate?).

Then I read about hopeful suggestions to avoid clots by instead stopping clopidogrel by tapering it gradually over a period of time (adding in low dose aspirin). But some studies dispute that.

All of this disparity has really concerned me, so I called my cardiologist, pulmonologist, and talked to my pharmacist about it, and all said just stop taking it. That worried me even more because I have atherosclerosis and “thick blood”—I’m on blood thinner Xarelto for that (I’ve already had 3 blood clots).

I decided that if there is any truth to this occurrence, I really want to live. So I began to research more about it. Most of the studies I found were a quite a bit older and they were mixed in their recommendations. There was even an old BHF Health Unlocked post from that time period that said a relative stopped taking it abruptly and died 3 months later!

Have any of you had experience with discontinuation of clopidogrel/plavix? Do you have any helpful suggestions for me about what to do? Thank you so much for your help!

[BeKind28-]

Hello

I was on Ticagrelor both do the same job you either get put on one or the other

When the year was up which they usually keep you on them unless there are other reasons for you to stay on them longer they just told me to stop them no weaning of them just you do not have to take them now

I did not get any side effects just stopping them in fact I felt better

Maybe ask your Doctor or you could phone the BHF Nurses if you are a little bit unsure

I hope your op goes well x

[CarolingTeacher in reply to BeKind28-]

Hello, dear BeKind!☀️

Thank you so much for sharing your story, your advice and encouragement, and for caring about me. It meant so much to me because I’ve been so, so afraid. What you advised makes so much sense—and I’m feeling more and more brave about just stopping the clopidogrel. I loved hearing that you actually felt better off of your Ticagrelor. (I am curious and interested in looking up that one up now.) I wish you the best. Hugs🫶

[BeKind28- in reply to CarolingTeacher]

Hello

I am glad you feel so much better I am an anxious person but when the professionals tell me to do something and I will be alright I have learnt they know what they are doing so I will trust them

I hope you will update us and I am sure you will be fine x

[CarolingTeacher in reply to BeKind28-]

That’s very sound advice. Thank you so much!☀️

[Weetabixie]

Hi Caroline Teacher, I've been on clopidogrel since 2003 as I have lupus anticoagulant and was getting nose bleeds from aspirin so was changed to clopidogrel. I've stopped many times before for things like extractions and a uterine ablation and had no ill effects thankfully.

[CarolingTeacher in reply to Weetabixie]

Hello, Weetabixie. You are just the person many of us needed to hear from. It’s wonderful to hear that you have successfully stopped and started up again many times without issues. What great news! As for me, you’ve provided firsthand hope—and I appreciate that very much. I wish you continued health and success.🎉

Thank you!

[Weetabixie in reply to CarolingTeacher]

Take care and best of luck moving forward

[CarolingTeacher in reply to Weetabixie]

Thank you🫶!

[Instructor57]

I will be coming off them at the end of February and have been told I can just stop taking them.

However, I actually have a GP appointment next Friday where my intention will be to confirm this .

[APC65 in reply to Instructor57]

I too am due to come off the mid February and have been told to just stop. I was going to do my own thing and gradually reduce - I be keen to know if there is any wisdom to doing that though.

[CarolingTeacher in reply to APC65]

Hello APC65. That’s what I’ve been wanting to try. I even found a tapering chart with days on and days off gradually changing! It got me excited. I’ve also seen the suggestion of adding in baby aspirin instead of the clopidogrel as a person weans off of it.

I’ve begun to change my mind away from that because the doctors who would comment on these ideas liked adding the enteric coated baby aspirin, but not the tapering.

The reason for that the doctors said that was clopidogrel does a number on our platelets—and they are changed. When we stop the clopidogrel, the platelets begin to regenerate and new ones are created—and the old clopidogrel ones begin to go away.

The doctors also said that if one is weaning off of it instead of stopping it altogether, the platelets keep getting doused with clopidogrel and it’s a setback for them and they don’t get a chance to regenerate new ones.

I would love to hear more about this idea if anyone has better information than I have received about it (because I still kind of like the idea of tapering if it is a better, safer, and a valid procedure).

I wish you well and I’ll be thinking of you, APC65, as you weigh your options and make a final decision.

[CarolingTeacher in reply to Instructor57]

That sounds great. Will you let us know what you find out at your GP appointment? Thank you, Instructor57!

[Instructor57 in reply to CarolingTeacher]

Yes, I saw my GP and he told me to just stop taking them there is no need to reduce or come off slowly

[CarolingTeacher in reply to Instructor57]

That is so fantastic to hear, Instructor57! You must be relieved. Thank you very, very much for letting us know!☀️

[Lowerfield_no_more]

I just stopped taking Clopidogrel completely and abruptly at the end of my year post HA. Made no difference whatsoever to me, or at least none that I noticed. Thankfully just one less tablet to take 👍.

[CarolingTeacher in reply to Lowerfield_no_more]

That is outstanding news, Lowerfield! I’m so happy for you—and you’ve given me hope! Thank you! I wish you the best.

[Sb1171]

Not sure if your research has come across this review which suggests "Fear of a ‘rebound’ of prothrombotic platelet activity on stopping the drug has provoked much discussion and many studies. However, review of the available literature reveals no evidence for production of hyper-reactive platelets after cessation of clopidogrel in patients who are stable."

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

[CarolingTeacher in reply to Sb1171]

Thank you for talking about that, Sb1171. Excellent news! Yes, like you I did come across that in my research. The earlier articles were so alarming at first with the 60% dying 3 months later of those who abruptly stopped taking it. Then it became more reassuring when they seemed to feel living longer depended on being fully healed before stopping clopidogrel cold turkey. But it hasn’t been a balm for my fevered soul yet because I don’t know how to know for absolute positive sure if I’m healed (stable) yet.

Thank you for the hope!!

[Sb1171 in reply to CarolingTeacher]

I understand completely. I was prescribed 90mg Ticagrelor (alternative to Clopidogrel) for one year post MI. I read research that suggested that 90mg, followed by 2 more years at 60mg had better outcomes in those at high risk. I asked the GP about this and he didn't think I was at particular high risk, but did let me stay on 60mg for two more years on the basis that I felt safer on it. I am still in that two years, but will then be stopping as the prescribing guidelines don't recommend it past 3 years post MI. It is not that I worry about rebound clotting, rather that I think the drug makes another MI less likely while I am on it (at the expense of regular bruises!)

[CarolingTeacher in reply to Sb1171]

Yes…exactly! That’s my bottom line too…even if I do worry about rebound clots. You were so fortunate. I wish my doctors would honor my concern and understanding of my own body and allow me to continue on it a little longer.

Thank you for your excellent article! It was very helpful.

Unfortunately, I couldn’t leave well enough alone and tonight I went in and researched the most current articles I could find on “stopping clopidogrel”, and some of them had me worried all over again.

My doctor recommended that I stop clopidogrel now cold turkey and add baby aspirin to the Xarelto I take. Hopefully he’s correct.

Thank you for your note back, Sb. I wish you well as you also search for answers to this.🫶

[Sb1171 in reply to CarolingTeacher]

My GP is an actually a stickler for doing things by the book. Luckily this was by the book (BNF) which specifically provides for Ticagrelor 60mg for another 2 years directly after the initial 1 year at 90mg post MI. It also provides for 60mg to be commenced within 2 years of MI or 1 year of taking another ADP medication. There is no such provision in the clopidogrel page. It is not clear from your initial post whether you have had an MI. If you have, then you might be in scope for Ticagrelor 60mg instead, which might give you some reassurance. If you have not, you might have more luck trying to convince a GP to “bend” the Ticagrelor guidelines (your LAD was blocked and you had a stent, what difference does it make to future risk if you actually had an MI first) than trying to convince them to “break” the Clopidogrel guidelines. See here: bnf.nice.org.uk/drugs/ticag...

Finally, I would just add that I am 99% convinced that the only benefit Ticagrelor is now providing me is psychological, so if you do have to stop (which is what most patients do) I am sure you will be absolutely fine.

[CarolingTeacher in reply to Sb1171]

You have been such an encouragement to me. Thank you for this note. You spelled your situation out so well for me—it was very helpful and I understand now about your extra time on T. I will look into this, but I am realizing that I probably need to set aside my terrors about stopping the C., take courage from you and the other lovely people who posted their experiences here, and just pull the plug (just writing that is scary). Your last encouraging thoughts really helped. Thank you!💕

[FakeNews]

My LAD was 95% blocked when I had my heart attack. Had a stent put in and took Clopidogrel for one year then stopped taking them. No weaning off and I didn’t have any side effects.

As an aside I did have unrelated surgery last year and had to stop Apaxiban before that. Again, no side effects.

[CarolingTeacher in reply to FakeNews]

FakeNews…you are my new hero. Your LAD beat mine by a lot and yet stopping the Clopidogrel (and then the Apaxiban for surgery) was not an issue for you! Thank you, thank you, thank you! You’ve given me real hope! Stay well!

[Plastow48]

After my first AF episode my clopidrol was stopped immediately and I was put on Apixaban instead. This was over 3 months ago and I have had no problems. Sure you will be fine too. Good luck. Jenny

[CarolingTeacher in reply to Plastow48]

Oh Jenny! That’s really wonderful news that the Apixaban has made a difference with the AF!

Thank you!Take care!🫶

[Sljp0000]

HiAfter failed bypass surgery followed by a saddle PE I had 4 stents in 3 arteries last February. I had instructions from the doctor who did the stents to stop Clopidogrel after 1 year which is obviously very soon. However, the consultant surgeon at the hospital who did my surgery said I should take them for life. I'm also on Apixaban. Like you, I don't know who to listen to or what to do. It's sad that the NHS isn't singing on one hymn sheet on this. Don't really know who to ask now. Let me know what you decide please?

Thank you

Susie

[Sususulio in reply to Sljp0000]

A little off topic but I’m also on apixaban and clopidogrel, 30 second conversation after stent and told for life. It’s a bit of a worry and causes issues, at the moment trying to sort out a dental extraction no one seems willing to agree a protocol round it.

keep on keeping on x

[CarolingTeacher in reply to Sususulio]

Oh my goodness, Sususulio! You’re in a tough situation too. I hope some of the answers here help you too—and I wish you the best as you make that tough decision!🫶

[CarolingTeacher in reply to Sljp0000]

Hello, Sljp. I’m so sorry that you’re singing from the same songbook (hymn sheet😉) as I am with what to do about this drug that is so widely prescribed. I agree that it is just baffling that these different doctors and specialists worldwide are forced to wander around in the dark on this issue. What a huge help it would be to millions of us to have some solid consensus with best practice guidance on all things clopidogrel! (Is anyone out there listening who is able to spearhead that effort?)

Also, I also had a “significant” PE in 2019 (the hematologist today validated the huge size)…though I didn’t have the saddle one you survived—wow!

The doctor who found my PE told me then that I had “thick blood” and that would be a threat my whole life—and to stay on the blood thinner. That’s why I’m so scared to be told to stop.

In the days since I first posted this, I was sent to appointments with (new to me) doctors of internal medicine, cardiology, and hematology/oncology. No agreement on the clopidogrel from any of them—all 3 claimed it was not in their area of practice to make decisions about clopidogrel and to go see a different specialist about it—then they told me to stop cold turkey—one doctor included stopping my Xarelto or cutting it in half. I couldn’t believe it! After each appointment, I drove home so disheartened!

I’m so hoping you and I can find our answer very soon, dear Sljp. Yes, I will let you know if I find anything else out. Take good care!🫶

[Hidden]

Hi Teacher, I had 2 DES in 2020 July I stopped clopidogrel after 6 months. I have been on Aspirin 75 mg ever since. I am still alive 😊. USA guidelines specify minimum 6 months of dual anti plat therapy in absence of any other complications & Stable coronary heart disease. Hope it will help you make decision. Stents Abbot Xience Prime

[CarolingTeacher in reply to Hidden]

Hi, Axeman121. Yes! Very helpful info! I’m so happy you’re doing well with this plan…it sounds like it would work for me too. Thank you so much for sharing your story and for caring about me.☀️

[FrankWillbe]

Stopped taking Clopidogrel one year after my stents, I was given a card to carry around with me and it gave a planned duration. I checked with the heart failure team and also the hospital team where I had the stents and an ICD.They confirmed it could just be stopped and I am on other medication to help look after my heart. I have not experienced any issues.

[CarolingTeacher in reply to FrankWillbe]

Wow! You were so fortunate to have such a great teams to see you safely through it. I’m so happy to hear you’re doing so well. This is very cool!

Thanks for sharing it, Frank!

[Jack2019]

I Just stopped after the year was up because that what it said to do on my discharge notes when it was prescribed after the stents were put in. That was 2018 for me.

[CarolingTeacher in reply to Jack2019]

Thank you! That’s very reassuring to hear, Jack!

[Musicl]

I have been on Clopidogrel for four years and have had three lots of surgery in the past two years. Each time, I was told by The surgeon to stop the medication 5 to 7 days prior to surgery. Straight after surgery, on to Xarelto for five weeks, then back onto Clolidogrel. Hope this answers your question.

[CarolingTeacher in reply to Musicl]

So glad to hear that worked for you. What a relief it was to hear it. Thanks so much, ChristineK!

[Qualipop]

I took it for 6 months after a hear attack then simply stopped. IT should have been 12 m onths but it upset my stomach badly. NO problems at all. I'm sure s topping for a week or two won't cause problems.

[CarolingTeacher in reply to Qualipop]

I’m so sorry you went through that…and I’m happy to hear that stopping really helped you. Thank you so much, Qualipop…your experience was helpful to me!