Halting clopidogrel worries reader
Dear Dr. Roach: I have been taking Plavix (clopidogrel) for 15 years because of a mild heart attack that resulted in three stents. Next month, I am having a prostate MRI and biopsy. The urologist told me to stop taking clopidogrel seven days prior and substitute 81 mg of aspirin in its place. I am very concerned about a possible blood clot during this period.
Two of the stents are in my left anterior descending artery placed backto-back, which is one reason why my cardiologist advised me to stay on clopidogrel all these years. All three stents were placed in 2009. My question is, what are the risks associated with stopping clopidogrel for seven days, even though I will be taking aspirin?
R.W.
Answer: Stents are flexible, metal-wire mesh devices that are placed into an artery after a blockage in the artery is opened, usually by a balloon procedure called angioplasty. The stent helps the artery stay open while the artery heals itself from the trauma.
In the first two weeks after a stent is placed, the risk of stent closure without medication (usually both clopidogrel and aspirin immediately after the stent placement) is high, so elective surgeries are deferred until it is safer (about six months later).
After 10 years, the risks involved with stopping clopidogrel in exchange for aspirin for a week are very small.
The rate of adverse events (such as a heart attack or the need for another stent) were the same in people with a long-term stent as those who never had one in the first place.
That being said, as an internist, I still touch base with my patient’s cardiologist before making a recommendation about this medication, so I hope that the urologist has done so as well.
Communication among specialists is necessary for a patient to get optimal care, and a quick call to your own cardiologist to confirm this is prudent.
Dear Dr. Roach: Iam a 75-year-old female in good health. An incidental finding in a recent CT scan were “multiple stable bilobar hepatic cysts, the largest within the right lobe measuring on the order of 9.3 cm.” My primary care doctor says not to pay any attention to this, but 9.3 cm seems awfully large to me.
I checked my liver measures on my most recent metabolic panel, and they were all normal.
Should I be concerned about this large cyst?
M.C.
Answer: Liver cysts are common, found as an incidental finding within 15% to 18% of the general population. I’m going to assume your cysts meet the criteria for “simple” cysts, since complex cysts are more concerning and call for further evaluation.
Large cysts like yours are found more commonly in the right lobe. They are almost always benign, even at this large size. With an absence of symptoms, they do not need further evaluation. The fact that there are multiple cysts does not make it more likely that these are worrisome.