Doctor insights on:
Stent For Widow Maker
Consultant thai hospital says clopidogrel Aspirin Warafin are all indicted for 89yr Afib who had Mycardial Infarction after stroke and 50% risk True?
AFib + MI: The 50% number sounds high, but Coumadin would be for reducing stroke risk of atrial fibrillation, and the aspirin/Plavix are for stent placement after MI. So, triple therapy is likely indicated. This should be for the shortest period as possible then reduce to 2 agents, most commonly Plavix and Coumadin. Triple therapy of aspirin/plavix/Coumadin has a high bleeding risk, so avoid risky things. ...Read more
For young (<60), asymptomatic, paroxysmal atrial fibrillation patients on NOACs with LVH, should the patient seek out catheter ablation for treatment?
Depends: on left atrial size and function, frequency. Ablation is a big deal and frequently unsuccessful. I would try to suppress with a beta blocker like Bystolic, get magnesium level to 2.1-2.4, potassium to 4.1-4.5, stay off stimulants/alcohol, use hawthorne berry, avoid many other supplements, get general labs checked. Why the LVH? HRS, MD, FACC. www.thepmc.org ...Read more
If someone got a drug eluting metal stent in their heart, could it be replaced later with a dissolving stent so they become stent-free ultimately?
No such thing: As a practicing cardiologist in the nyc area, i can answer from personal experience. At each major hospital, there are both extremely talented interventional cardiologists (those who implant stents), as well as plenty who leave much to be desired. You should not look for a specific "heart hospital", but rather a doc who others tell you can be trusted to treat each patient like his own family. ...Read moreSee 1 more doctor answer
Stent: When treating an obstructed coronary artery with a stent is the appropriate treatment, the stent if properly placed and without complications is usually 90-95% effective at relieving the symptoms associated with the obstructed artery. Stenting is not necessarily appropriate for all patients and treatment needs to be individualized. Discuss with your cardiologist. ...Read more
After 1 year on plavix (clopidogrel) and aspirin for 2 stents for LAD will a patient usuaaly discontinue the plavix (clopidogrel).(diabetic also)?
Why would i be given Clopidogrel (Plavix (clopidogrel) ) for TIA when Warafin is reversible? Is Warafin Not indicated in in TIA
for Carotid Artery Disease ?
Differences: Clopidigrel has been carefully studied for prevention of stroke and heart attack, and seems to work well for local obstruction of blood vessels, but warfarin is an anti-coagulant designed to prevent blood clots at a distance from entering the brain circulation. Warfarin does not seem to be risk advantageous for local TIA, and likely your doctor has made a reasonable choice. ...Read more
For a patient who never had bypass, no stent, but had asd closure, a-fib and chf, clopidogrel+warfarin really required?
To clot or bleed?: For a patient in their 30's with history of ASD s/p closure, a-fib and chf, but no cad, dual therapy may be required. Facts such as CHF severity, prior thromoembolic events from a-fib or asd, ventricular clots, and personal & family history of blood clots can help influence the decision to stop or continue dual therapy. Decision is best made by collaboration between cardiology & the ct surgery. ...Read more
61 yr old hypertensive male has total occlusion of right coronary andom.Stenting of om1 done. Ejection fraction is 45-50%. Is CABG indicated for rca?
Likely no: The damage that could have been done from the occluded rca has already happened, and the vessel can't get worse than totally occluded, so, provided that anginalsymptoms symptoms are controlled there is no need to do anything. Overtime, compensation typically occurs for an occluded vessel in the form of progressive collateral circulation. ...Read more
Clopidogrel for a TIA Consultant found an ordinary diseased Vein in neckand NOT Carotid Artery from the Tests.take Fibrazate any ideas of treatment?
Not usually reported: In 35 years of medical practice, I don't think I've ever heard of incidentally finding a diseased VEIN in the neck when an ultrasound/CT/MR angiogram for carotid artery diagnosis. The most important thing to prevent if you have vein disease is a clot; you are already taking clopidogrel for this purpose. Vascular disease risk lowering (lipids, BP, non-smoking, weight, blood sugar) targets arteries. ...Read more
Can : Form restenosis at about 9 months so need to be checked. After that they can last several years. Need follow up. Make sure to take your blood thinner. ...Read more
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