?? why?

[morqthana]

What convinced me, was the episodes becoming progressively much worse over time, much more frequent, which prompted me to do some research on my main suspect, the statins. Stopping taking them as a test, and the instant I stopped taking them, the episodes cleared up completely.

You sound like a candidate for a double-blind trial

 

[JohnW2]

What convinced me, was the episodes becoming progressively much worse over time, much more frequent, which prompted me to do some research on my main suspect, the statins. Stopping taking them as a test, and the instant I stopped taking them, the episodes cleared up completely.

As I've said, the fact that the episodes stopped when you stopped taking the drug gets you half-way to establishing that there was a causal relationship between the drug and the episodes.
I'm not sure that the fact that your problems "became progressively much worse over time" does much, if anything, to help establish a causal relationship.

 

[JohnW2]

And yet if I were on Warfarin it would be to reduce the risk of strokes...

Indeed - but, as I said, if a situation arose in which you were taking too high a dose of warfarin (and warfarin dose requirements often do vary quite a lot over time, which is why frequent blood tests are required) -in which case the warfarin can cause a ('haemorrhagic') stroke.

Given that strokes can be caused both by 'blood clotting too easily' (thrombotic & embolic strokes) and 'blood not clotting easily enough' (haemorrhagic strokes) It's quite a fine line that has to be trodden - but, as I've said, I personally have not yet come to understand how this problem has seemingly been avoided with rivaroxaban

 

[securespark]

I have been on a great deal of prescription drugs for many years, a lot since 2006.

I have had to take medicines as many as 52 times a day, but luckily, I am down to 26 now, not including 2 different kinds of inhaler and 2 different kinds of painkiller. It used to be four kinds of painkiller, but I stopped needing Gabapentin thankfully (it was horribly addictive!) and Ibuprofen I can't take because it counteracts my BP meds.

 

[JohnW2]

What is rather confusing, at least in the Summary (which is all I've seen so far) is that they have lumped together "death" (which is ultimately what the treatment aims to prevent) and "bleeding" (mainly from the stomach, which is a side effects of both clopidogrel and aspirin) - ..... So, although clopidogrel seems to result in a modest reduction in cardio-/cerebro-vascular 'events', it may not actual result in any fewer deaths.
The full paper, when I see it, will hopefully disentangle the deaths and the bleeding!

In terms of what I've seen so far, I would be inclined to conclude that 'the jury is still out', particularly given the probably price difference of clopidogrel and aspirin.

I've now had a quick look at the full paper, and I think that confirms my view that 'the jury is out' (particularly for people like yourself).

Perhaps the most important thing to note is that the entire study (looking at some 28k patients in 7 published studies) relates to patients with "established coronary arty disease" (i.e. those who had suffered heart attacks or were suffering from angina) who took either aspirin or clopidogrel primarily to reduce the risk of further cardiac events. I'm not aware of your being such a person, and the study cannot necessarily be taken to mean anything in relation to people without "established coronary artery disease" and who are taking aspirin or clopidogrel for non-cardiac reasons.

In terms of results for individual (not 'muddled together') outcomes/events (in the population described above):

1... The only highly 'statistically significant' ("p=0.0003") difference between aspirin and clopidogrel was in relation to myocardial infarction (heart attacks).​

​

2... Strokes as a whole were somewhat less common with clopidogrel than with aspirin, and this was just 'statistically significant' ("p=0.03"). However "ischaemic (thrombotic or embolic) strokes" (the only type of strokes that aspirin or clopidogrel would be expected to reduce) did not show a statistically significant difference ("p=0.09") - a significant difference only being seen when haemorrhagic strokes (which aspirin & clopidogrel could not prevent, and might even increase the risk of) were lumped together with the ischaemic ones"​

​

3... Deaths from any cause, and cardiovascular deaths, were almost identical with the two drugs.​

​

4... In terms of unwanted ("side") effects, "any bleeding", "major bleeding", "any gastrointestinal bleeding" and "major gastrointestinal bleeding" all failed to show any appreciable or significant difference between the two drugs.​

So, in patients with established coronary artery disease, patients taking clopidogrel suffered significantly less heart attacks than those taking aspirin, although cardiovascular death was not significantly reduced. Strokes as a whole were somewhat (but 'significantly') less common in patients taking clopidogrel but since this was not the case in relation to ischaemic strokes, this finding probably needs to be regarded with caution. There seemed to be no appreciable difference between the drugs in relation to the side effect of bleeding.

However, as discussed above, it cannot necessary be assumed that these results could be extrapolated to patients who did not have "established coronary artery disease"

Kind Regards, John

 

[JohnW2]

By coincidence, a neighbour has just waved a copy of today's Daily Mail at me, In their article about this study, the quote a professor of cardiology as having pointed out that clopidogrel costs about 80p per dose, as compared with about 2p for aspirin.

Maybe it shouldn't, but in the times that we (and the NHS) are living in, I fear that this is a consideration that needs to go into the melting pot.

 

[EFLImpudence]

Yes, that would go down well with the drug companies.

 

[JohnW2]

Yes, that would go down well with the drug companies.

They are used to it - and certainly have been since the appearance of NICE.

The problem is that the development of new drugs has become so incredibly expensive (primarily due to increased expectations of 'safety', resulting in increasingly demanding regulations) that if they could not sell drugs at seemingly very high prices (for at least a few years) the development of new drugs (which is another 'expectation' of society) would simply grind to a halt.

 

[morqthana]

I've now had a quick look at the full paper, and I think that confirms my view that 'the jury is out' (particularly for people like yourself).

Perhaps the most important thing to note is that the entire study (looking at some 28k patients in 7 published studies) relates to patients with "established coronary arty disease" (i.e. those who had suffered heart attacks or were suffering from angina) who took either aspirin or clopidogrel primarily to reduce the risk of further cardiac events. I'm not aware of your being such a person, and the study cannot necessarily be taken to mean anything in relation to people without "established coronary artery disease" and who are taking aspirin or clopidogrel for non-cardiac reasons.

In terms of results for individual (not 'muddled together') outcomes/events (in the population described above):

1... The only highly 'statistically significant' ("p=0.0003") difference between aspirin and clopidogrel was in relation to myocardial infarction (heart attacks).​

​

2... Strokes as a whole were somewhat less common with clopidogrel than with aspirin, and this was just 'statistically significant' ("p=0.03"). However "ischaemic (thrombotic or embolic) strokes" (the only type of strokes that aspirin or clopidogrel would be expected to reduce) did not show a statistically significant difference ("p=0.09") - a significant difference only being seen when haemorrhagic strokes (which aspirin & clopidogrel could not prevent, and might even increase the risk of) were lumped together with the ischaemic ones"​

​

3... Deaths from any cause, and cardiovascular deaths, were almost identical with the two drugs.​

​

4... In terms of unwanted ("side") effects, "any bleeding", "major bleeding", "any gastrointestinal bleeding" and "major gastrointestinal bleeding" all failed to show any appreciable or significant difference between the two drugs.​

So, in patients with established coronary artery disease, patients taking clopidogrel suffered significantly less heart attacks than those taking aspirin, although cardiovascular death was not significantly reduced. Strokes as a whole were somewhat (but 'significantly') less common in patients taking clopidogrel but since this was not the case in relation to ischaemic strokes, this finding probably needs to be regarded with caution. There seemed to be no appreciable difference between the drugs in relation to the side effect of bleeding.

However, as discussed above, it cannot necessary be assumed that these results could be extrapolated to patients who did not have "established coronary artery disease"

Kind Regards, John

I don't have coronary artery disease (AFAIK ), and I don't take aspirin, so a possible alternative to that isn't of great personal interest. I take a blood thinner because of AF.

 

[JohnW2]

I don't have coronary artery disease (AFAIK ), and I don't take aspirin, so a possible alternative to that isn't of great personal interest. I take a blood thinner because of AF.

Quite so - which is why, as I said, the study you have cited does not really seem to be relevant to your personal situation - since it appears to relate to a population to which you don't belong and to a reason for taking an anti-thrombotic agent different from your reason.

.... unless, I suppose, your AF could be shown to be due to "established coronary artery disease" (which is quite possible) - although you would then still be taking the drug for a reason different from those reported in the study.

 

[morqthana]

All I did was mention a report of a new drug which might supplant aspirin in some use cases...

 

[JohnW2]

All I did was mention a report of a new drug which might supplant aspirin in some use cases...

You did, but you went a little further than just 'mentioning' it, since you wrote that, if the recent study report was accurate, then "... it's goodbye low-dose aspirin for blood thinning and hello clopidogrel".

In turn, I have pointed out that even if the report is accurate in what it says, it relates to only one indication for the drugs in one particular population of patients - so probably doesn't represent a lot more than 'dipping our toes into the water' of the overall question of whether clopidogrel (or something similar) may perhaps one day replace low-dose aspirin in general .

I would add that, whilst I don't know about anyone else, I've been getting somewhat confused by the fact that this discussion has jumped around, from Harry's original question about statins and alternatives to both anticoagulants (warfarin and alternatives such as rivaroxaban) and anti-platelet drugs (low-dose aspirin and/or alternatives such as clopidogrel) - and I also fear that the latter two types of drug may be getting lumped together in some people's minds as 'blood thinners'.

I would also add that, although you refer to clopidogrel as a "new drug", it has been authorised/licenced for clinical use in most countries since 1997/1998 !

 

[ebee]

I do find that most of us can sometimes be easily swayed by "evidence" and get things wrong, sometimes a bit wrong, sometimes quite wrong and sometimes very wrong, when viewing evidence there is sometimes a heck of a lot to take into account.
This can be very true with medical thingys but also other things too.
I can affect how we perceive "facts" and other peoples, politics, races, creed and dogma.
Look at some of the conspiracy theorists, they take a factoid or two and completely misinterpret it either deliberately or innocently with good intent.
Yes we need to be very careful about "conclusions" they can be very wrong.
Peer review can be a wonderful thing. hopefully somebody knowledgeable spots some error.
Take parliament for example, how long does it take to produce a law? Ages and ages, they send it this way and that, take soundings and opinions then years later make the law, hopefully they`ve ironed out a few snags but even then there is the danger of unintended consequences turning up.
Look what Rishi Sunak did as Chancellor - get the money out fast to do most good, no time for parliament to ratify it, time was of the essence, yes he knew that some folks would accidentally claim it, yes he knew that some folks would fraudulently claim it but he balanced this against the damage that would be done if it was not done quickly, amazed me, especially for a Conservative but yet I admit I reckon he took the lest worst of the view and went for it and left the mopping up till later (ironic from me because usually I am pretty much anti-Tory by habit, although I did vote to get Thatcher in first time around).
We each form opinions and sometimes they serve us well, if we touch that hot pan it will hurt us - thats a good one.
Sometimes we get one and it might be correct.
Sometimes we get something and form an opinion but it still does us good - placebo effect - we think it makes us better so we do get better because we have convinced ourselves of it, and yes that can work because our mental abilities can be so strong.
But then people start jumping on band wagons stirred up by the press, or by politicians or by cynics or even by our own selves then yes we can get it wrong or mislead ourselves.
I have a pet theory - everyone will get cancer if they live long enough, it is inevitable.
My theory might have some truth in it or I might be completely Bonkers, it might even be "a bit true" LOL.

I would have the tendency to accept the consensus of the medical profession to get it right (if you can get them to agree with each other), but even then we can not be 100% sure about a lot of things and humans do have some differences in their make up although not that many from Chimpanzees genetically either. Sobering thought?

 

[morqthana]

You did, but you went a little further than just 'mentioning' it, since you wrote that, if the recent study report was accurate, then "... it's goodbye low-dose aspirin for blood thinning and hello clopidogrel".

That's a mention.

...low-dose aspirin for blood thinning...

... aspirin in some use cases...

Not the same?

 

[JohnW2]

Not the same?

I'm not sure as to your point/question.

As I wrote, there is potential confusion because 'blood thinning'/'blood thinner' is seemingly being used to refer to both anti-platelet drugs (e.g. low-dose aspirin and/or clopidogrel) and anticoagulants (e.g. warfarin and rivaroxaban) - which ae totally different (and should not be used together without extreme caution, if ever).