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Will Stopping Intake Of Prasita Prior To Surgery Cause Complication?
Question: Hi Doctor. I underwent stent in April 2013 for unstable angina. Now planning to under go spinal surgery L3-L4, L4-L5 ( Robo guided minimal invasive spinal fusion). I need to stop Prasita 10mg 7 days prior to my surgery. Iam also using Ecosprin 75mg.
Can I stop Prasita 10mg 7 days prior to my spine surgery and if yes what is the risk of having any medical complications. Please elaborate your reply
Thanks
XXXXXXX
Can I stop Prasita 10mg 7 days prior to my spine surgery and if yes what is the risk of having any medical complications. Please elaborate your reply
Thanks
XXXXXXX
Brief Answer:
please see below.
Detailed Answer:
Dear sir
The prasugrel or prasita is given to prevent clot formation on stent. The risk of clot formation is highest in first month and goes on decreasing with time. Most of recommendations suggest that aspirin and prasugrel Like drugs should be given for 12months after stenting. Some authors suggest this period to be 15 months. Although cases of stent thrombosis or clot formation have been reported after one year too. Period around surgery itself increases propensity of clot formation. Decision to stop the drug also depends upon your symptoms, site and size of your stent and if you are a diabetic. The surgeon and treating cardiologist discuss risk and benefit if surgery.
In nutshell, clot formation may occur on a stent however the incidence is low at this juncture. If it occurs complications may be serious. Best decision is taken by your treating cardiologist. Feel free to discuss further.
Sincerely
Sukhvinder
please see below.
Detailed Answer:
Dear sir
The prasugrel or prasita is given to prevent clot formation on stent. The risk of clot formation is highest in first month and goes on decreasing with time. Most of recommendations suggest that aspirin and prasugrel Like drugs should be given for 12months after stenting. Some authors suggest this period to be 15 months. Although cases of stent thrombosis or clot formation have been reported after one year too. Period around surgery itself increases propensity of clot formation. Decision to stop the drug also depends upon your symptoms, site and size of your stent and if you are a diabetic. The surgeon and treating cardiologist discuss risk and benefit if surgery.
In nutshell, clot formation may occur on a stent however the incidence is low at this juncture. If it occurs complications may be serious. Best decision is taken by your treating cardiologist. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor. My cardiology doctor originally told me that Iam ok after one year. One year is over. I consulted another for second opinion. He said that normally they do not suggest stopping Prasita for two years and there may be 1% chance of Paralasys. I consulted Anastassia doctor. He said it preferred to stop. But if the Cardiologist suggest not to stop, it is ok to do surgery but blood loss will be more. Iam in dialoma. Pl give me your firm opinion whether I can go ahead with spine surgery by stopping Prasita.
Thanks
XXXX
Thanks
XXXX
Brief Answer:
please see below
Detailed Answer:
Dear sir
Whatever international guidelines say about duration of prasugrel therapy, I have already narrated. People do give it for li get duration in practice.
Ideally closed space surgeries like that of spine should be done without presugrel. Risk of excessive bleeding and paralysis will be there if done on prasugrel, extent of which is best explained by your surgeon.
As I told you before, I will consider the site and size of stent, your diabetic status and will discuss with surgeon the risk of not doing surgery, risk of bleeding and paralysis. Then it will be discussed with patient in-toto before arriving at a decision.
If surgery is absolutely necessary and I do not see high risk factors, normally I ask my patients to take a small but tangible risk.
Still do discuss with your surgeon. And the cardiologist who did your stenting.
Sincerely
Sukhvinder
please see below
Detailed Answer:
Dear sir
Whatever international guidelines say about duration of prasugrel therapy, I have already narrated. People do give it for li get duration in practice.
Ideally closed space surgeries like that of spine should be done without presugrel. Risk of excessive bleeding and paralysis will be there if done on prasugrel, extent of which is best explained by your surgeon.
As I told you before, I will consider the site and size of stent, your diabetic status and will discuss with surgeon the risk of not doing surgery, risk of bleeding and paralysis. Then it will be discussed with patient in-toto before arriving at a decision.
If surgery is absolutely necessary and I do not see high risk factors, normally I ask my patients to take a small but tangible risk.
Still do discuss with your surgeon. And the cardiologist who did your stenting.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor for much clarity on the subject. Iam Diabetic taking Cetaphin XR 500 mg morning and night. I underwent two stents in March and April 2013 because the first BVS stent ruptured the artery. My TMT in Dec 13 was negative. Sugar is under control. Parameters are fairly under control. Iam attaching my reports for better appreciation. I suppose you may now express opinion based on facts.Attached are discharge summary, recent blood test report and the medicines I use for Cardiology.
Thanks
XXXXXXX
Thanks
XXXXXXX
Brief Answer:
please see details.
Detailed Answer:
Dear Sir
I have gone through your reports.
Sir, I can not take a final decision. I can only provide you with information and answer your queries and guide you in understanding things. A real life cardiologist will only take an appropriate decision. It will be inappropriate and unethical to take a final decision through this forum.
A patient with such a profile has small but tangible risk of stent thrombosis/ other cardiac events during peri-operative period. If the surgeons think that the risk of bleeding will be too much and surgery can not be performed safely, the prasugrel may be stopped with some risk. If risk of bleeding is minimal in the procedure even with drugs, the other option may be exercised.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Sir
I have gone through your reports.
Sir, I can not take a final decision. I can only provide you with information and answer your queries and guide you in understanding things. A real life cardiologist will only take an appropriate decision. It will be inappropriate and unethical to take a final decision through this forum.
A patient with such a profile has small but tangible risk of stent thrombosis/ other cardiac events during peri-operative period. If the surgeons think that the risk of bleeding will be too much and surgery can not be performed safely, the prasugrel may be stopped with some risk. If risk of bleeding is minimal in the procedure even with drugs, the other option may be exercised.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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