Keith Roach, M.D., syndicated columnist

DEAR DR. ROACH: My 75-year-old wife had two third generation medicine-eluting stents inserted into a branch of the left anterior coronary artery in January 2020. On 75 mg of clopidogrel and 81 mg of aspirin for nine and a half months, she has endured several serious nosebleeds, one of which required hospitalization for three days. She just had emergency surgery for a life-threatening perforated ulcer. Going forward, we are scared to put her back on those blood thinners.

Could she get by with natural blood thinners, such as gingko, curcumin, vitamin E, natokinase, etc., since she is such a high risk and so sensitive to pharmaceutical blood thinners? — D.D.T.

ANSWER: One common treatment for blockages in the coronary arteries is to open the arteries with a balloon, and keep the artery open with the use of a stent. Older stents were made of bare metal, but most current stents are coated in medication that helps keep the arteries open. The downside is that stents, especially the new drug-eluting ones, are susceptible to clotting, and the risk is greatest in the first year after a stent is placed. To prevent this, people are placed on two medications to reduce clotting. Aspirin and clopidogrel (Plavix) in combination is the most common. The highest risk of clotting comes within the first month after stenting, where stopping even one of those drugs is associated with a very high risk of sudden clotting of the stent and a subsequent heart attack.

With longer time elapsed since the placement, the risk of stent closure decreases. Many cardiologists stop their patients’ clopidogrel at one year, and she is rapidly approaching that period of time. Other times, cardiologists continue double therapy for longer periods in people who have not had any bleeding complications. I think her cardiologist would be likely to stop the clopidogrel and continue aspirin alone, which has a much lower risk of bleeding complications, and which most people with coronary artery disease should take.

Although aspirin comes from willow bark — a natural substance — the anticoagulant effects of the natural substances you name are not as reliable nor as well-studied as aspirin and clopidogrel, so I would advise against using these in a high-risk situation such as after the placement of any stent, but especially a drug-eluting stent.