The colonoscopy dilemma: To Plavix or not to Plavix?

Dangerous Overkill

Two days in the intensive care unit.

That unexpected and frightening result was apparently prompted by the use of aspirin combined with a best selling drug during a very common medical procedure.

Tell your friends, tell your family – this could easily happen to anyone.

You’re being followed

A friend of mine named Helen believes she nearly lost her brother Mel in the hours following a colonoscopy.

Mel is retired police officer, in his 60’s, and in pretty good health. But a couple of years ago Mel underwent angioplasty and a stent was inserted into an artery. His doctor recommended a daily low dose of aspirin, and prescribed the drug that’s almost always taken by patients with stents: Plavix.

I’m sure you’ve seen the television ads for Plavix. They seem to run nonstop on the major networks most evenings. I’m especially unnerved by the one where a hospital gurney ominously follows a man around wherever he goes. Very creepy.

Plavix is a blood thinner, so Mel was concerned about how the drug’s effect might impact a scheduled colonoscopy. His doctor told him to stay on the Plavix – otherwise he’d be at risk of a heart attack or stroke.

During the colonoscopy, the bariatric surgeon found several polyps in Mel’s colon and removed them. And then the bleeding started. And wouldn’t stop. And instead of heading home after the “routine” procedure, Mel found himself in ICU, listed as critical.

Helen tells me that Mel is home now and doing better, although he’s still quite fatigued. He lost so much blood that he was nearly given a transfusion.

Rock and a hard place

Mel’s experience illustrates a dilemma that’s played out in hospitals every day: How do you perform surgery on someone whose blood will clot poorly because it’s purposely thinned?

Any doctor faced with this dilemma will find conflicting advice.

The Plavix prescribing information is very clear: “PLAVIX prolongs the bleeding time and therefore should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or other pathological conditions (particularly gastrointestinal and intraocular). If a patient is to undergo elective surgery and an antiplatelet effect is not desired, PLAVIX should be discontinued 5 days prior to surgery.”

Simple enough. But based on a “consensus guideline” issued in 2007 by the American Heart Association, the American College of Cardiology, and others, many doctors will advise patients to NOT discontinue Plavix use. Here’s how the website for a Minnesota gastroenterology clinic states their policy: “We are currently recommending that patients continue on their usual Plavix dosing before and after a colonoscopy…”

Obviously, every patient is different and risks have to be evaluated case by case. But one obvious way for colonoscopy patients to avoid an experience like Mel’s is to make sure that Plavix is taken only when absolutely necessary and not just because you’ve been scared half to death by the sight of a hospital gurney that stalks middle-aged men.

In addition, taking aspirin with Plavix is dangerous overkill. As the Plavix prescribing information states: “…the combination has been shown to increase major bleeding.”

You can read about other risks linked to Plavix use in the e-Alert “Does Your Doctor Know All the Potential Side Effects of Your New Prescription?” (1/2/02).