Dale Matson
In December of 2016 I had two Drug Eluting Stents (DES)
placed in a coronary artery.
The standard protocol after DES is dual antiplatelet
therapy. In my case this meant Plavix and aspirin. The reason for this is to
prevent a clot from forming in the stents. The preferred standard of care in
the United States is one year on DES and longer if there is no bleeding. How
much longer is still being evaluated.
The problem for me was I had three ulcers that I was unaware
of and on January 1st I began to notice black stools, which is an
indication of a GI bleed. I was hospitalized and the following day an endoscopy
was performed and the ulcers were cauterized. Thankfully this stopped the
bleeding but not before my hemoglobin dropped to 7 because I lost half my blood
volume.
The GI doctor prescribed daily doses of a liquid antacid and
protein pump inhibitor to control the acid in my stomach and reduce the chance
of a future bleed. The decision was made at the hospital not to give me an
infusion of blood even though my hemoglobin level warranted it. The current
thinking is that it is safer to let the patient build back their blood numbers
without the possible problems that can accompany a transfusion.
I was sent home under this circumstance and had previously
been prescribed Lipitor, a statin drug. Lipitor is prescribed for lowering
cholesterol and reducing inflammation but the side effects for me were
unacceptable with insomnia and loss of libido. Additionally statin drugs also
are blood thinners.
I am 72 years old and don’t even want to talk about the
possible other side effects of statin drugs for older people.
I had a prior bout with anemia because of prolonged bleeding
from a surgical procedure a few years ago and learned how to raise my iron
levels with iron rich foods and iron supplements. I also used a private testing
lab to regularly check the progress of my anemia.
I began the same regimen but this time I was making very
little progress. My hemoglobin, hematocrit and iron saturation were very low
and climbing only slowly. I began to wonder about this and talked with my primary
care physician. His comment was that the blood thinners and antacids were reducing
the iron uptake in my system. He suggested an iron infusion but I am concerned
about this because there is essentially no literature out there saying that
iron infusions are safe for patients with stents.
I have read considerable literature about optimum duration
of dual antiplatelet therapy for DES. In Europe, the standard is 6 months. As I
understand the research on this, it claims there is not a significant
difference in stent thrombosis with patients who stop dual platelet therapy
after 6 months and those who stop after one year.
My GI doctor told me I could bleed again and this weighs
heavily on my mind. It is the double-edged sword of the risk of bleeding verses
the risk of a clot in my stents. It is not easy to live with and I wonder if
some of the heart attacks in the stent research were stress related. It would
simply be devastating to bleed again and lose what little progress I have made
with my anemia that is a daily burden and an increased risk factor.
I know that my cardiologist, because of the U.S. standard of
practice, would not be allowed to tell me to stop the dual antiplatelet therapy
at 6 months even though I am at risk for another severe bleed. However, I will
do what is necessary to maintain my quality of life. I have seen more than one
piece of research from Europe that states that current generation DES are much safer than the first generation.
The fact is that when there is a high bleeding risk the duration of the dual
antiplatelet therapy should strongly evaluated. In some studies after one year
the risk of bleeding increases as the risk of a stent thrombosis decreases.
I have not included
citations of the research I have discussed, which can easily be found on an
Internet search. Additionally, I am a layperson not making recommendations
to anyone else. I am merely stating the difficulties I face and the
decisions I have to consider. I know this however. It is important to be an
informed consumer of medical services and that it is the individual patient who
can and must be their own advocate and final decider.
I think there are a great number of folks out there who are
in the same situation and I hope this article provides some clarity. What are
your thoughts?
