* It’s being Prescribed because I’m continuing to have damage to optic nerves, migraines, and leg and arm vessel clotting. ( but for the true purposes of this topic, it’s the small brain vessels that would be best served by plavix as warfarin addresses these on a different matrix all together.)
* it’s waiting for me at the pharmacy, I’ve not yet picked it up. My husband is out of state so I don’t want to be here with our teenager alone...
* I’m getting mixed ( and strongly polarized optinions on the matter from hematology and neurology.)
*My APS specialty hematologist said he would give it a cautious nod of approval but the final say should be from neurology because the vasculature of the brain is what would be most affected by plavix
My consulting APS neurologist ( part of University if Texas San Antonio Research System ) who I have NOT found to be knowledgeable in application, though it very unwise when asked if adding plavix should be considered. She was certain I would ,” bleed out “ because I would ,” not be able to form a plug”. She said the addition of plavix would “ cut off two or three arms of the clotting cascade. The said it would increase the chance of a catastrophic bleed by two to three fold. She said she had watched with her own eyes, “ patients bleed out and die in front of her.” I asked if they were APS patients. She just looked blankly at me and said ,” ummm.” ( a little evasive? ) . That very flat monotone ,” ummmmm” was extremely hard to read. I do appreciate her caution. Her perspective as the physician watching a patient bleed out before her eyes must forever alter her perspective on these drugs. But what is the patient story? An automobile accident? Traumatic injury? True APS? Was it truest APS? This did not seem like comprehensive data.
( This is the same woman who refused to heed dr Hughes clinic letter he wrote for me stating I needed an INR of ,” at least 3.5”
She would not recommend anything over 3.0
( now she has changed her mind and agrees to 4.0 but that’s after I did my own thing with my hematologist.) Very brilliant woman, no doubt, but I have no use for her. I don’t think I plan to return unless something really unusual changes my mind. )
*so - that was two weeks ago. This past week I saw my treating neurologist- he’s been with me from the “ beginning “ of brain stuff- 2012. He diagnosed my seizures. He knows the neurologist I spoke of above from San Antonio- university of Texas health science system. He feels she is wrong. Since he’s my treating neurologist, he’s putting me on plavix right away. He said it should be perfect for my brain dysfunction. ( and continued vascular degeneration. ) He has many patients on both who have vascular disease and a heart valve issue ( A- fib) and they do fine. They are usually elderly. They do not have aggressive pro thrombotic disease like APS patients do, so he feels the risks of dual therapy are not as risky in APS patients as in the general population.
*He said there is only one strength. ( I asked for the lowest dose...)
* you can’t cut it in half ( I asked that, too... it’s all or nothing...)
Here are my specific questions to those of you on the forum ( and Admin) who have been on both warfarin and Plavix concurrently:
1. Can you take plavix every third day or so? ( I know plavix binds to platelet membrane, and stays there for as long as platelet is active, viable. ) There is no antedote for Plavix.
2. Did you reduce your INR a tiny bit with Plavix? I asked my neurologist and he quickly said no. I told him he answered to quickly... to think again... I understood they were acting on different cascades- the warfarin extending the TIME it takes to clot and the plavix the aggregation , But none the less, with the combination now at play, should the INR be adjusted down just a tad? He said.... “ maybe? “
I called my treating hematologist Thursday morning ( left voice mail message with his nurse) to let him know that my neurologist had added plavix, and should I adjust my INR, and could I please get a Work in ... I still have not heard! ( I keep having this issue...)
( please realize we are not NHS. It’s not under one system. Often my docs do send each other clinic notes- but not always. Often I’m surprised what they have, or Have not , received from one another.)
Thanks for help-