[HSF] Re: Follow up to the New York Times article Stents vs. CABG

Thu Mar 1 09:31:06 EST 2007

Group:
I just met with all the cards in our hospital and asked them the  
question:"After DES placement, should plavix be stopped  
preoperatively before doing other types of surgery?"
All agreed that plavix should be continued for at least 1 year (if  
not longer) after DES. I have given more platelets and seen more post  
op hematomas (in the neck, for example, after Carotid Endart), but I  
have not yet seen MI's in these pt's.

By the way, the reason the DES occlude is that the drug coating  
prevents tight apposition of the stent to the arterial wall. This  
leads to "undersizing" of the stent vs the artery. In the small space  
between stent and artery, thrombus may form.

John Schor, MD
PO Box 4445
Cottonwood, AZ 86326

On Feb 28, 2007, at 7:35 PM, hgrmd at aol.com wrote:

> Ed,
>   I can't wait to use your term "Plavix junkies" the next time I'm  
> talking to an interventionalist.  In certain aspects, it's probably  
> worse than having a mechanical valve.  Using heparin or Lovenox  
> overlap, the unprotected window for a procedure is only about 24  
> hours.  In contrast, the Plavix junkie must stop at least 5 days in  
> order to get the procedure done.  I'm thinking about selling my J&J  
> stock in anticipation of it being "Mercked".
> Hal
>
> -----Original Message-----
> From: ebender001 at charter.net
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wed, 28 Feb 2007 6:55 PM
> Subject: Re: [HSF] Re: Follow up to the New York Times article  
> Stents vs. CABG
>
>
> Let me also add a case. 75 year old male with previous CABG and  
> subsequent DES to RCA vein graft feeding a hyperdominant RCA. He  
> has a small skin cancer from his arm that needs to be removed.  
> Plavix stopped for 5 days, gets a skin cancer about the size of a  
> dime removed, and has a huge infarct immediately after surgery. He  
> required redo CABG, but did well after prolonged hospital stay. We  
> have hundreds of thousands of Plavix "junkies" out there. I smell  
> multiple class action lawsuits in the making.
>
> Ed Bender, MD
>
> On Feb 28, 2007, at 5:26 PM, hgrmd at aol.com wrote:
>
>> Cary,
>> Thanks for sharing this unfortunate case. I've heard and seen >  
>> similar. It's slowly dawning on the interventionalists that they >  
>> really screwed up, and that these DES patients are analogous to >  
>> those with mechanical valves. The lawyers will soon be in another  
>> > feeding frenzy.
>> Hal
>>
>> -----Original Message-----
>> From: CSPassik at aol.com
>> To: OpenHeart-L at lists.hsforum.com
>> Sent: Wed, 28 Feb 2007 5:26 PM
>> Subject: [HSF] Re: Follow up to the New York Times article Stents  
>> > vs. CABG
>>
>>
>> HSF'ers,
>>
>> I would like to share for your mutual interest an unfortunate case  
>> > I saw
>> yesterday. 51 yo man, active, skinny in good shape. He presented >  
>> with an MI
>> 7/05 and underwent multiple drug-eluting stents to his LAD and CX  
>> > for 2-v CAD.
>>
>> Big vessels, good angiographic result and good residual LV >  
>> function. Newly
>> diagnosed with early stage prostate CA and was scheduled for a >  
>> robotic
>> Davinci prostatectomy. His Plavix and ASA was thus stopped two >  
>> weeks ago.
>> Cardiology workup included stress testing which was somewhat >  
>> equivocal so he
>> was
>> cathed last Friday. Stents all looked widely patent. Cardiologist  
>> > thus said
>> "low risk for heart problems"-start his antiplatelet meds ASAP >  
>> post-op. He was
>>
>> about 2/3 of the way through his port access prostate yesterday >  
>> when he had
>> ST segment changes and therafter coded/CPR. Operation aborted-with  
>> > an open
>> bladder leaking into the belly and a cath lab visit-- occluded >  
>> stents in both
>> vessels-successfully opened but poor reflow and expired.
>> In summary, these drug coated stents are, IMHO, going to turn out  
>> > to be a
>> disaster for the patients who ever need anything done at any time  
>> > in the
>> future that will require stopping their Plavix. They have created  
>> a > new
>> disease! I
>> suspect we will all be seeing and hearing more of these cases, >  
>> and I also
>> suspect the stent manufacturer's will try to tell us that this is  
>> > just one
>> case,not reaching statistical significance, blah, blah blah. Too >  
>> bad this poor
>> man didn't have a nice 2V CABG in 05.
>> Cary Passik
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