Plavix and its effects on Divers

[George A]

Plavix has been prescribed for me recently. Does anyone have any documentation regarding the safety of diving while taking Plavix, a phamaceutical used to prevent platelet clumping?

From reading published literature, it appears that Plavix's safety record is in the same category as aspirin; but, I do question as to whether nitrogen bubbles (as a result of diving) will interact with the operation of Plavix.

Does anyone have any thoughts on this.

 

[TSandM]

There was a long discussion on the board a couple of months ago about aspirin and DCS. As I recall, the conclusion is that there are not enough data to make a valid statement about whether aspirin use can decrease the damage potential of nitrogen bubbles. I would assume it is the same with Plavix only more so, as far more people take aspirin.

I would be more concerned about the health problem which caused the physician to prescribe Plavix. It is not generally used for basic prophylaxis in asymptomatic, low risk individuals.

 

[AndyNZ]

Have a look at:

http://www.scuba-doc.com/antcoag.htm

 

[TSandM]

The link above is primarily with respect to Coumadin, which is a far more powerful anticoagulant than Plavix. The risk of uncontrolled bleeding from ears, sinuses or minor trauma is minimal with Plavix.

Plavix is usually prescribed for coronary artery disease, cerebrovascular arteriosclerosis, or symptomatic peripheral vascular disease, all of which could be significant contradindications to diving.

 

[Dr. Doug Ebersole]

I'm a cardiologist and agree with TSandM. I would not worry about diving on Plavix per se. I would be more concerned as to why Plavix was prescribed in the first place. George A -- feel free to PM me with your medical history and I'll be glad to give you more specific opinions.

 

[TN Traveler]

I began using Plavix 2 1/2 years ago after suffering a TIA. My doctors have seen no reason for me not to dive.

I had a series of nose bleeds last year due to a weak artery in the sinus area that required me to be off the Plavix for 3 months, before and after the surgery to correct the problem - but went back on Plavix a month after the surgery and have had no problems with diving since then.

Just my experience - you will have to make your own judgement in conjunction with your doctors.

My ENT, cardiologist and GP are all divers who dive with me at times and I'm sure they don't want to have to resue me - so they evaluated my condition very carefully.

 

[Saturation]

One should be cognizant that taking any antiplatelet or anticoagulant increases the risk of turning ischemic infarcts, such as when caused by DCS2 or AGE, into hemorrhagic infarcts. There should be no specific issues otherwise, other than the stability of the underlying disease Plavix is taken for.

 

[George A]

Thanks for all of the information on Plavix.

My cardiologist confirms much of the discussion on this subject. He feels that there should be no issue with diving while on Plavix; but, cautioned me that there can be clotting issues with Plavix. I have exhibited no side effects or clotting issues, so it appears that the risk is low.

As a note, I will probably be switching from "Plavix+baby aspirin" to a 325 mg aspirin. I have been told that studies indicate that this is equally effective.

Regarding my recovery from the CABG procedure, I am exercising daily, with vigourous exercise, for at least 20minutes and have never felt better in my life! I have more energy than I have had in a long time, so guess I had clogged arteries for quite some time.

 

[DocVikingo]

....agents:



“J Appl Physiol. 2011 Jan 6. [Epub ahead of print]



Pharmacological intervention against bubble-induced platelet aggregation in a rat model of decompression sickness.



Pontier JM, Vallée N, Ignatescu M, Bourdon L.



1 Naval Medical Institute.



Abstract



Decompression sickness (DCS) with alterations in coagulation system and formation of platelet thrombi occurs when a subject is subjected to a reduction in environmental pressure. Blood platelet consumption after decompression is clearly linked to bubble formation in humans and offers an index for evaluating DCS severity in animal models. Previous studies highlighted a predominant involvement of platelet activation and thrombin generation in bubble-induced platelet aggregation. In order to study the mechanism of the bubble-induced platelet aggregation in DCS, we examined the effect of acetylsalicylic acid (ASA), heparin (Hep) and clopidogrel (Clo), with anti-thrombotic dose pre-treatment in a rat model of decompression sickness. Male Sprague-Dawley rats were first compressed to 1000 kPa for 45 min then decompressed to surface in 38 min. In a control experiment, rats were treated with ASA, Clo, or Hep, and maintained at atmospheric pressure for an equivalent period of time. Onset of DCS symptoms and death were recorded during a 60-min observation period after surfacing. DCS evaluation included pulmonary and neurological signs. Blood samples for platelet count (PC) were taken before hyperbaric exposure and after surfacing. Clopidogrel reduces the DCS mortality risk and DCS severity. Clopidogrel reduced fall in platelet count and bubble-induced platelet aggregation (-4,5% with Clo, - 19.5% with ASA, -19,9% with Hep and -29,6% in the untreated group). ASA which inhibits the thromboxane A2 pathway and Hep which inhibits thrombin generation have no protective effect on DCS incidence. Clopidogrel, a specific ADP-receptor antagonist, reduces post-decompression platelet consumption. These results point to the predominant involvement of the ADP release in bubble-induced platelet aggregation but cannot differentiate definitively between bubble-induced vessel wall injury and bubble-blood component interactions in DCS.”

Regards,

DocVikingo

 

[Capt Doug]

I'm a cardiologist and agree with TSandM. I would not worry about diving on Plavix per se. I would be more concerned as to why Plavix was prescribed in the first place. George A -- feel free to PM me with your medical history and I'll be glad to give you more specific opinions.

I just received two stents to clear a 90% blocked artery, PAD I believe. All other arteries are excellent as well as the heart muscle. The Doc has put me on Plavix to keep the new stents clear. What do you think about my diving in this situation?

Thank you, Doug