is it safe to change blood thinners in a patient with a history of transient ischemic attack?

Question

Hello doctor,

This query is about my father.

He had suffered a right side hemiparesis about 16 years back and was admitted in a hospital. He recovered well and also started driving. Though his right side is now more sensitive to weather changes and sometimes he feels tingling or stiffness. He also underwent hospitalization 11 years back for left thalamic infarct and also underwent triple CABG 9 years back.

Last week while on his morning walk he felt some numbness on his right side. The feeling persisted for about 30 minutes. He was fine and able to walk during that time and has been feeling fine since then. We had visited the hospital.

They felt that it could have been a TIA and asked to change his blood thinner.

1) I wanted to check with you as my cousin who is a Doctor felt that the Clopilet and Aspirin blood thinner combination was better than the Aspirin and Dipyridamole- 25mg/200mg combination.

They felt that being on Clopilet and Aspirin for so many years he still gets these episodes so change might help.

2) His heart surgeon was also not very confident of changing the medicines.

Earlier he was taking the following medicines Mixtard Insulin 30/70- 38 units morning and 15 units night, Glycomet GP, Linagliptin 5 mg, Fibrator 10 mg, metolar 25 mg, Dynapress 0.4 mg, Clopilet 75 mg, Ecosprin 150 mg, Thyronorm 25 mg 1 tablet.

Now he is taking Mixtard Insulin 30/70- 38 units morning and 15 units night, Glycomet GP2, Linagliptin 5 mg, Fibrator 10 mg, Metolar 25 mg, Dynapress 0.4 mg, Arreno, Ecosprin 75 mg, Thyronorm 25 mg 1 tablet.

My father was taking Clopilet 75 mg and Ecosprin 150 mg once daily which the doctors have now changed to Arenno (Aspirin 25 mg and Dipyridamole 200 mg) two times a day and Ecosprin 75 mg once a day.

Is this better for him?

Also please advise about his other medicines and lifestyle.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concerns.

First of all I do not think there is something wrong or right in the current or prior treatment.

From my personal expertise, I found combination of Aspirin and Clopidogrel more tolerable to the patient while the side effects of Dipyridamole are more difficult to tolerate amongst some group of patients.

In regard to efficacy the studies has not reported any difference although there is better experience with Aspirin and Clopidogrel combination.

In addition I feel there is a need to start neuroprotective medication like Citicoline or Pentoxifylline as recurrent stroke or transient ischemic attack (TIA) lead to damage to his brain and need something better than conventional treatment.

I hope this answers helps you.

If you have more questions feel free to write back to me.

Thanks and regards.