Length of dual anti-platelet therapy depends on risk factors
DEAR DR. ROACH: I had a surprise heart attack two months ago. (I have no family history of heart attack, and my blood pressure and cholesterol numbers were good.) My right coronary artery was 100% blocked, and a drug-eluting stent was inserted. Thankfully, there was no heart damage, and other arteries are fine. I am currently on 81 mg of aspirin, 75 mg of clopidogrel, and 10 mg rosuvastatin. Can you tell me the current recommendations for the length of dual anti-platelet therapy (DAPT)? I had to switch from Brilinta to clopidogrel due to the significant bruising. (A mosquito bite even caused bruising.) The bruising is somewhat better, but more than I'm comfortable having. The thought of having to use DAPT more than a year is depressing me. -- S.S.
ANSWER: Because the types of stents are always changing (a drug-eluting stent slowly releases tiny amounts of medication designed to prevent the stent from closing), the optimum duration of time to use medications to prevent clotting of the stent (which could lead to a heart attack) is not known. Using two medicines to prevent clotting (such as aspirin plus clopidogrel, or Plavix) reduces the function of the blood-clotting cells. The platelet further decreases risk of stent failure, but does increase the risk of bleeding.
Bruising, however unsightly and sometimes painful, is not a major concern that would get a cardiologist to stop using dual anti-platelet therapy. Bleeding requiring hospitalization and medical conditions that increase bleeding risks are the major reasons to cut DAPT short.
For someone like you, with no more than an average risk for bleeding, most experts would use aspirin, plus clopidogrel for six to 12 months. In people with a newer drug-eluting stent, of the type you likely have, treatment with DAPT for 30 months showed a reduced rate of stent clotting (0.3% versus 0.7%) and heart attack (2.1% versus 3.2%), while the rate of moderate/severe bleeding increased (2.5% versus 1.3% percent) compared with people using DAPT for 12 months. Since the rates of bleeding are about the same as the benefit in reducing clotting of the stent and heart attack, most experts do not use DAPT for more than one year except in people at the highest risk for heart attack.
DEAR DR. ROACH: My 20-year-old daughter will be moving soon to finish her final year of college. She will be living off campus and will need to use a public laundromat. Given that most of her clothing labels recommend "cold water and low heat drying," there is concern about her contracting monkeypox from another laundromat customer. We have read about monkeypox being primarily contracted through close personal engagement with someone who is infected. However, every article also states that it can be passed through items such as sheets and clothing. Should we be worried? -- C.P.C.
ANSWER: While I can't say it's impossible, I can say it's very unlikely to get transmission of monkeypox (or other viral diseases) through clothes at a laundromat. Even cold water with detergent will render viruses non-contagious. It's far more important that she be careful about her close contacts, and for her (and everybody) to seek prompt medical attention if they have a new and painful rash that might be monkeypox.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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