heparin
plavix
aspirin
lovenox
coumadin
Why would a patient be put on a combination of coumadin lovenox, aspirin, plavix, heparin?
Question posted by SarahJ86 on 19 July 2009
Last updated on 1 November 2010 by CABarron
5 Answers
CABarron
1 Nov 2010
Working in the cardiovascular ICU, we treat patients that have just had open heart surgery such as bypass grafting and valve replacement surgery. Patients with new heart valves are placed on coumadin (warfarin). They are also given Lovenox [a type of low molecular weight heparin (LMWH)] injections x 5 days or longer until their INR is therapeutic on coumadin x 2 days. It typically takes about 4 or 5 days for patients' coumadin levels to become therapeutic and during this time they are at risk for blood clots. The Lovenox injections protect patients from blood clots during this window. Patients do not typically receive heparin and Lovenox simultaneously, it's one or the other. Patients with new bypass grafts are also prescribed plavix and aspirin to help keep the bypass grafts open. So if someone has valve replacement surgery along with bypass grafting, he or she will most be taking these meds, at least for a short time.
yanni
8 March 2010
i am on coumadin 2 mg plavix 75 mg and aspirin 81 mg after a drug eluting stent in feb 2010 LAD... it was my second stent in the LAD. the first was bare metal and placed in 1999. I have been on coumadin for 10 years since a 2000 MI. Plavix and aspirin now added to coumadin ..concern I have is for bleeding but my doctor says this is the right combo for at least 1 year. I also take lipitor 20 mg toprol xl 25 mg and protonix, 40 mg. i am 62 male .
jfrost0220
13 Oct 2009
For every individual case, the Dr has to balance the risk of clotting with the risk of bleeding. If you're worried about being on combination therapy, please seek a second opinion! Perhaps my story can shed some light. I am a healthy 5'6", 125 lb, active, non-smoker. I am 41 and had a large DVT this summer (from right calf to inferior vena cava in abdomen!) following a 12 hour car ride during which I did not stop often enough. I am currently on plavix, aspirin, and coumadin (and took Lovenox for 16 days in the hospital). The cardiologist explained to me that, as someone else mentioned, each medication acts on different components of coagulation. That said, it's not typical to be on combination therapy after a single event or if you do not test positive for genetic thrombolytic factors (due to increased risk of internal bleeding), so I should mention that this is my second event. I had a PE in '01 after starting on BCP.
After that event I was coumadin for 6 mos (and Lovenox for 7 days in the hospital). Because I've had 2 events, I will be on the combination therapy for 3 - 6 mos and coumadin for life (coumadin for life is "standard of care" for anyone who has has more than one thrombolytic event). I should mention that I did NOT test positive for any genetic thrombolytic factors. The cardiologist explained that additional genetic factors likely exist but are currently unknown - and I probably have one of them because I've had 2 events and am otherwise healthy. Nevertheless, I am concerned about the increased risk for bleeding and have an appointment scheduled with a hematologist for a second opinion. Better safe than sorry. Hope this helps.
marjorie zych
1 May 2010
I have been on Coumadin for years and Lovenox(off and on) for years. Sometimes in combination. I have a blood disorder known as Factor 5 Leyden. I will be on blood thinners for life, I have even got clots while on the meds. I am deadly allergic to aspirin or I would probably be on that too. A Hematologist is always a sure bet if you are getting clots for some reason. Have they tested you for Factor 5 before I know you said you had some tests I think you should find out if tha was one of them. You definately need to move around if your traveling even if you just pump your feet it helps. I only found out about this disease because my mom died from a clot and during the autopsy this condition was diagnosed and is hereditary as well, all us girls have it and the lucky boys got spared. I have given myself the Lovenox shots many times it's no fun, all the bruising. I was trained by the Visiting Nurses when I got out of the hospital. It's not bad I guess if it saves your life.
Well I got off track for a bit there talking about me. You should definately see that Hematologist it will be safer for you. Yes I have obviously heard of being on more than one blood thinner they do work differently but I never have heard of quite so many maybe three but not all that, I think that may be to much but I am not the doctor. Keep an eye on the bleeding situation you don't want blood to thin either, that can be just as dangerous, BE CAREFUL!! Hope I helped I don't know
alii
20 Sep 2009
All of these medications are dissimilar in physical, chemical, and biological properties, thus affecting different pathways of action. In many situations combination therapy has an overall better therapeutic effect and have been shown to have less side effects because the dose is a lot smaller in polypharmacy.
Robert_325
20 July 2009
It would most likely be for the prevention of blood clots. It could be following a stroke, heart attack, there are all kinds of potential scenarios where blood thinning medications would be used. Those are all blood thinners or meds to dissolve a clot (as with heparin). Hope that helps.
Sijai
25 Aug 2010
The two times I had blood clots, they first started me on Lovenex, shots in the belly. They also put me on a hephrin drip. This is to get the blood thinned down quickly. When I reached the pro time INR, between 2 & 3, they started me on oral coumadin.
First thing, was to thin the blood quickly, next to maintain. Sijai
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