Fao Sqad

[retrocop]

Good morning Sqad. Have been hositalised about a month due to side effects of routine aortic stent insertion ie AKI High BP Pulmonary
Odaema High BNPs and cardio enzymes. Two heart echograms( last 3 weeks) show no heart damage. Some cardio registrar has convinced himself I have had a heart attack as BNP was 117 ( and falling) and Cardio enzymes ( Tropanines ? Were 1200 and falling. Creatinines were 85 pre op to 227 immediate
Post op and falling now to about 135. I am in cardio ward awaiting ambulance transfer to St Georges for a angiogram on Mon/ Tues to confirm coronary or not.
My concern is that since admitted to cardio ward Friday eve I have been prescribed Clopidogrel and aspirin daily. This is on top of Rivaroxaban that I have taken for last year. Isn't 3 anti-coagulents too much as I have now developed nose bleeds at night and is there a danger of brain bleeds or other haemorrhaging? Of course no weekend doctors here to make known my concerns though I am aware I can refuse the Clopidogrel by the ward S/N
TIA for your deliberations Sqad.

[Sqad]

retro....first of all, this is not my area of expertise but, slaney who is a retired consultant Hematologist would be a better opinion and i am she that she will see your post.

Firstly, the combination of Clopidogrel and Aspirin is routinely used in many such situations, routinely and safely. I have been watching your posts with interest and i would certainly suggest that the combination id the MINIMAL anti coagulant cover that you would need.But as for adding a third anticoagulant, i cannot see the advantage........although as i said i am not an expert in this field.

The raised cardiac enzymes would suggest to me that there is added heart damage despite the "normal " echocardiograms.
Your angiogram booked for early next week will give your the answer, one way or another.
BNP results would indicate a degree of heart failure and that would fit in well with further heart muscle damage.

Nose bleeds are a worrying sign, BUT so is the development of heart failure and the risk of further blood clot formation.

Swings and roundabouts here retro, but slaney may put a little more meat onto my answer.

You have had a rough ride.

[retrocop]

Many thanks for a full and informative summary Sqad. I much appreciate your time afforded me and advise. I will discuss at tomorrows Doctors rounds and let you know what they say. Seems the angigram will provide a better picture.

[Peter Pedant]

Hi retro
having a good time in hospital I hear

Slaney who dwells mainly in crosswords hopefully will give a definite answer.
Altho it sounded like pharmocological overkill, the two are given together

http://www.mdpi.com/1424-8247/5/3/279/htm

whether or not it is appropriate for you is a decisiion for your doctors tomorrow and it is unlikely you will bleed to death in between

sounded from your post op course that it was pretty obvious that you had had a cardiac event ( went into heart failure post op and you were nt in heart failure previously ) so I would go with the flow quite honestly - you are in good hands at st G's

[ladybirder]

Let's keep bumping this post up into Latest Posts for Retro in the hope Slaney will see it. She was on line yesterday (18th).

[ladybirder]

Bump.

[retrocop]

Thanks PP and Ladybirder for advice and suggestions.

[dannyk13]

Retro, do stop skiving, I miss your wit (?) here.:-)

[ladybirder]

One last Bump.

[MargoTester]

Afternoon Retro - have you had your angiogram yet?

[slaney]

Just seen this - doubtless by now retrocop will have discussed the risks/benefits of triple anticoagulation with his own doctors who will be in a much better position to inform him than me.
There is support in fairly recent NICE guidelines to prevent damage after a heart attack....

"rivaroxaban, in combination with aspirin plus clopidogrel or with aspirin alone, was more effective than aspirin plus clopidogrel or aspirin alone"

https://www.nice.org.uk/news/press-and-media/nice-draft-guidance-recommends-rivaroxaban-xarelto-to-prevent-blood-clots-in-people-who-have-had-a-heart-attack

I hope the angiogram goes well for you with no further complications retrocop...

[murraymints]

ah..retro...big hugs xx hope you get things sorted and home soon...

[Patsy33]

Thinking of you Retro.x

[retrocop]

Slaney,
Please forgive my belated thanks for your time and informative advice. The
N.I C.E link was interesting but ended up ,as usual, bean counting the costs of the medications in the Coronary treatment protocol.
Been fighting a failing NHS for last 10 days hence my late gratitude. Battle over now I discharged myself yesterday :-( Many thanks for your time and advice.
L

[Peter Pedant]

Hi Slaney !
thx for the nice advice !

clopidogrel is one of the few drugs that makes anaesthetists sit up and think (" aaa rgh!" ) so I just wonder what clotting is like with all three.

as you know also the final chapter ( ish ) was that retro dx'd himself against advice .....and back to the GP.