tomorrow morning I am having a angiography done of my carotid arteries.

[Strumin210]

My question is has anyone developed atherosclerosis due to an MPN. None of this started till this year. My platelets were one million fifty seven thousand the other day when doing a blood test prior to my procedure Monday. I take hydroxurea and low dose aspirin for the platelet issue. Does not seem to be lowering them. The surgeon wanted me to take Plavix and my oncologist said for me to not take it( I agree 💯 percent) . I am not starting a drug that can give you a heart attack or stroke when you stop it. Any advice on the atherosclerosis???? What can clear my veins out?

[Rem31]

I have ET and take aspirin and HU. I can’t answer your questions but can share my experience of my two angiograms and clopidogrel/Plavix.

The angiograms were done at different cardiology centres three years apart and on both occasions I was required to take 8 clopidogrel/Plavix tablets prior to the procedure. At the time I didn’t question it and I have a strong feeling the procedures would not have gone ahead had I refused to take it.

Before the first angiogram it was thought I had blocked arteries and it was anticipated I would need stenting and, with stenting, the aspirin would be replaced with a daily clopidogrel/Plavix tablet. The cardiology team were very clear about the need for daily clopidogrel with stenting.

In my case it turned out I didn’t need stents so still taking aspirin but I’m not aware my Mpn team would have advised against taking clopidogrel/Plavix. However in view of my cardiac condition they are keen to keep my platelet level around the 400 level (uk measure).

[Strumin210 in reply to Rem31]

Thanks

[hunter5582]

Plavix (clopidogrel) is an antiplatelet medication that some with MPNs do use. It is more powerful than aspirin and comes with a risk of hemorrhage. While the rebound effect would be a concern if you suddenly discontinued the Plavix, I would be more concerned about the bleeding risk since your platelet levels are so high, which increases your risk of bleeding events. There is a Black Box Warning with Plavix, that I would assume was already addressed.

Black Box Warning - Diminished Antiplatelet Effect in CYP2C19 Poor Metabolizers

clopidogrel antiplatelet effect is dependent on conversion to active metabolite by CYP450 enzymes, principally CYP2C19; in pts homozygous for nonfunctional alleles of CYP2C19 gene (CYP2C19 poor metabolizers), clopidogrel forms less active metabolite and has reduced anti-platelet activity at recommended doses; CYP2C19 genotype tests are avail. to identify CYP2C19 poor metabolizers; consider using other platelet P2Y12 inhibitor tx in CYP2C19 poor metabolizers

Treating the arteriosclerosis will be essential in the context of a MPN where there can be an abnormal interaction between platelets and the vascular endothelium. I would not want to speculate on the appropriate interventions in your situation other than the obvious lifestyle choices that you would need to make for the MPN anyway. I would definitely consult with a MPN Specialist and have that doc work collaboratively with your care team.

Good luck with the procedure. Please do let us know how things turn out.