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Medication News & Update

  A recent article appeared in JAMA (Journal of American Medical Association) which reported a higher risk of heart attack and death in patients  within 90 days after stopping clopidogrel(Plavix). It is believed that the platelets for a temporary time period become more active once the clopidogrel is stopped. This same effect with paltelet activity has been seen on patients who take aspirin, and other non-steroidal antiinflammatory agents or Coumadin. The increase in acute coronary syndrome or heart attack has also been seen when aspirin or heparin were stopped. This is called a rebound effect. In the case of clopidogrel they are calling it "clopidogrel rebound". The researchers believe that may be what's happening when the clopidogrel is stopped. The study does not prove that stopping clopidogrel increases or causes the problem but it does raise some concerns and warrants further study. Continuing clopidogrel long term does carry risk of bleeding and increased cost.

      There has been some thought that by tapering the clopidogrel slowly by decreasing it to one 75mg tablet every other day for two-three weeks then discontinuing it may prevent this rebound platelet activity. There is no proof yet that this is necessary. There are still many questions that need to be answered by further studies. The majority of patients in the recent study were male average age 66yrs old. Until further study can be done to confirm the risk or dispell it the recommendations for use of clopidogrel( Plavix) remain:

For medically treated patients or patient with placement of a bare metal stent:

clopidogrel for at least one month up to 12months.

For those with drug eluting stent placement:

clopidogrel for at least 12 months or indefinitely

If the patient is also on aspirin the aspirin should be continued indefinitely.