Side effects of stopping plavix
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Side Effects of Stopping Plavix (Clopidogrel)
Introduction to Plavix (Clopidogrel)
Plavix, also known as clopidogrel, is a widely used anti-platelet medication that inhibits the ADP-dependent pathway for platelet activation. 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.
Allergic Reactions and Desensitization
One of the common reasons for stopping Plavix is allergic reactions, such as rashes. These reactions are classified as Type I (Gell and Coombs classification) allergic reactions. A case series has shown that patients experiencing such allergic reactions can be desensitized to clopidogrel using a specific protocol. This involves administering 15 doubling doses of clopidogrel over an 8-hour period to achieve a maintenance dose of 75 mg per day. This method allows for the safe and prolonged use of the drug despite initial allergic reactions.
Perioperative Management and Bleeding Risks
Stopping Plavix is often necessary before elective surgeries due to its irreversible inhibition of platelets, which lasts up to 7 days. This is particularly crucial in trauma patients, such as those with hip fractures, where delaying surgery for more than 4 days can increase postoperative mortality. A survey of orthopaedic departments in the UK revealed varied practices regarding the perioperative management of patients on clopidogrel. Some units stop the medication and operate immediately, while others delay surgery for up to 10 days. The lack of formal guidelines in most units highlights the need for further research to establish best practices.
Conclusion
Discontinuing Plavix can lead to significant side effects, including allergic reactions and increased bleeding risks during surgery. Desensitization protocols can help manage allergic reactions, allowing continued use of the medication. However, the perioperative management of patients on clopidogrel remains inconsistent, underscoring the need for standardized guidelines to minimize complications and improve patient outcomes.
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