Side effects of plavix when stopped
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Summary
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Some studies suggest that stopping clopidogrel can be managed safely in patients with drug allergies through rapid desensitization, while other studies indicate concerns about increased bleeding during surgery in patients who have been taking clopidogrel.
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Side Effects of Stopping Plavix (Clopidogrel)
Introduction to Plavix (Clopidogrel)
Plavix, also known by its generic name clopidogrel, is a widely used antiplatelet medication. It is particularly effective for patients with cardiovascular diseases, especially those who have undergone coronary stent implantation or present with acute coronary syndromes. However, discontinuation of Plavix can lead to several side effects and complications, which are important to understand for effective patient management.
Allergic Reactions and Desensitization
One of the common reasons for discontinuing Plavix is allergic reactions, such as rashes. These reactions are classified as Type I (Gell and Coombs classification) allergic reactions. In some cases, patients can be desensitized to clopidogrel, allowing them to continue using the medication safely. A case series has demonstrated a protocol for rapid desensitization over an 8-hour period using 15 doubling doses of clopidogrel to achieve a maintenance dose of 75 mg per day. This approach suggests that desensitization can be a viable option for patients with allergic reactions, although further studies are needed to confirm its safety and efficacy.
Perioperative Management and Bleeding Risks
Stopping Plavix before surgery is a common practice due to its irreversible inhibition of platelets, which lasts up to 7 days. This is particularly relevant for patients undergoing elective surgeries, such as those with hip fractures. A survey of orthopedic departments in the UK revealed a wide variety of practices regarding the perioperative management of patients on clopidogrel. Some units stop clopidogrel and operate immediately, while others delay surgery for 5 to 10 days or continue the medication and operate immediately. The lack of formal guidelines in most units (85%) highlights the need for standardized protocols to manage the increased risk of intraoperative bleeding associated with clopidogrel.
Conclusion
Discontinuing Plavix can lead to significant side effects, including allergic reactions and increased bleeding risks during surgery. Desensitization protocols may offer a solution for patients with allergic reactions, while standardized perioperative management guidelines are essential to mitigate bleeding risks. Further research is needed to establish best practices for the safe discontinuation and resumption of clopidogrel in various clinical scenarios.
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