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Old 2nd September 2022, 06:20 PM   #1
Skeptical Greg
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Which Blood Thinner for You?

I somehow managed to click into this ad for a blood thinning drug.

BRILINTA 90 mg + aspirin was proven to work better than Plavix + aspirin

Some of the facts are:

Quote:
BRILINTA 90 mg + Aspirin: 864 of 9,333 patients had a heart attack or stroke or died from a cardiovascular event

Plavix + Aspirin: 1,014 of 9,291 patients had a heart attack or stroke or died from a cardiovascular event
Seems to be a slight advantage there in favor of Brilinta..

But don't rush out and have that prescription filled.

Quote:
More people treated with BRILINTA experienced bleeding compared to those treated with Plavix. Of people given BRILINTA 90 mg + aspirin, 3.9% (362/9,235) experienced bleeding‡ that was serious or sometimes fatal, compared to 3.3% (306/9,186) of people given Plavix + aspirin.
Who would have guessed that a drug that results in fewer clots, also resulted in more bleeding?

I notice they don't give any exact numbers on how many people died on which drug, but I have a feeling if less people died with Brilinta, we would see those numbers in big bold letters if they were the least bit significant..

What were the numbers for a control group that did not take either drug?
it might be buried in there somewhere. I'll have to look closer and get back with you.


Just thought this was interesting with regard to the drug companies fighting for your drug dollars, and the question of how prepared medical professionals are to actually make the best therapy recommendations.
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Old 3rd September 2022, 03:13 AM   #2
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Neither: first started on apixaban, as I wouldn't countenance heparin/warfarin and the former is recommended here, but shifted to the related edoxaban as it is once per day rather than twice (suggested by pharmacist, as they find that helps compliance, which is definitely not an issue for me).

However, given I'm in the UK and our system is totally different and we don't allow advertising to patients or potential patients and marketing to medics is limited, not to mention there are official guidelines, which all have full references, which folk such as me really like, this is a whole nuther matter.

However, it will be intersting to see the full figures if you find them, as it always pays to be aware of who certain organisations might try to manipulate things.
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Old 3rd September 2022, 03:23 AM   #3
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alcohol
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Old 3rd September 2022, 05:46 AM   #4
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1.5% lower event rate. So a 98.5% chance of no advantage. Compare to a brain bleed from a minor fall, or an eye bleed from a blood pressure spike. Plus all the bleeding from my minor cuts and scrapes. Plus the fact that most studies are done in secondary prevention- those who are already proven clotters. I don't like blood thinners.

eta: I have doubts about studies that need to treat 10,000 patients to show an improvement... must be small improvement...
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Old 3rd September 2022, 05:57 AM   #5
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From the actual study, https://www.nejm.org/doi/full/10.1056/nejmoa0904327

Quote:
Results

At 12 months, the primary end point — a composite of death from vascular causes, myocardial infarction, or stroke — had occurred in 9.8% of patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points, as well as myocardial infarction alone (5.8% in the ticagrelor group vs. 6.9% in the clopidogrel group, P=0.005) and death from vascular causes (4.0% vs. 5.1%, P=0.001) but not stroke alone (1.5% vs. 1.3%, P=0.22). The rate of death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogrel; P<0.001). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively; P=0.43), but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%, P=0.03), including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types.
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Old 3rd September 2022, 06:07 AM   #6
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Way back when I got stents, they prescribed Plavix+Asprin for me.

A couple of weeks after I got home, I nearly fainted in a fast-food restaurant. I was experiencing severe intestinal bleeding and had to have a rather large transfusion…. The bleeding stopped as soon as I stopped taking the drub.
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Old 3rd September 2022, 06:29 AM   #7
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Is "blood thinner" the proper term?
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Old 3rd September 2022, 06:48 AM   #8
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Originally Posted by Puppycow View Post
Is "blood thinner" the proper term?
Anti-coagulant is and is more accurate. Blood thinner is the common usage.
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Old 3rd September 2022, 10:46 AM   #9
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Originally Posted by Bikewer View Post
Way back when I got stents, they prescribed Plavix+Asprin for me.

A couple of weeks after I got home, I nearly fainted in a fast-food restaurant. I was experiencing severe intestinal bleeding and had to have a rather large transfusion…. The bleeding stopped as soon as I stopped taking the drub.
Same. Hated Plavix. Before my bypass they took me off plavix and went with heparin I believe for 5 days before the surgery. One of the issues compared to earlier anti-coagulants is there is no way to stop Plavix' action quickly. However, heparin blood levels need monitoring to adjust dosing.

Mrs slyjoe, a former nurse, hated anti-coagulants because they were so hard to control.

Friend is taking Eliquis. Seems more targeted.
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Old 3rd September 2022, 11:50 AM   #10
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I read some where that there is an 11 link chain to make a clot. We've all heard of vitamin K and hemophiliacs. But that leaves 10 other points where you may be a poor clotter. The stuff newer than warfarin and aspirin work at some of those points.

But what if I have a weak gene for one of those points? Do I need any meds? Most studies of blood thinners are for "secondary prevention". And I haven't had a primary clot yet.

A couple years ago they had me on Plavix and Pradaxa both. I think it was a covert study.
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Old 3rd September 2022, 11:55 AM   #11
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None. Doc told me a few months ago to discontinue the low-dose aspirin. I keep a bottle of chewable ones around so we can chew up a handful in case of a heart attack. But neither of us has any heart disease.
My blood is thin enough anyhow. I bruise very easily.
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Old 3rd September 2022, 01:37 PM   #12
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I'm at high risk for clots due to cancer treatment and I just started on apixaban after I developed a blood clot in my leg. I think a fair bit of heparin goes into my port to keep it clot free as well.

I'm also at high risk for infection so I'm supposed to avoid drugs like asprin that can mask syptoms
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Old 3rd September 2022, 02:03 PM   #13
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I'm with TGZ.

Alcohol is a blood thinner, right?
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Old 3rd September 2022, 02:04 PM   #14
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Originally Posted by Carrot Flower King View Post
Anti-coagulant is and is more accurate. Blood thinner is the common usage.
Heparin and warfarin and edoxaban are anti coagulants. Aspirin, clopidogrel and ticagrelor are anti-platelets drugs. The latter do not affect the clotting of the blood, but do prevent platelets from becoming 'sticky' and triggering the clotting cascade. Aspirin may cause gastritis and cause bleeding from the stomach, the others don't actively increase your risk of bleeding but do make the bleeding worse if it happens. All have their issues, heparin is an injection, warfarin needs regular blood tests, but edoxaban has lots of drug interactions so depending on your drugs may not be an option.
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Old 3rd September 2022, 02:18 PM   #15
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My wife is on rivaroxaban, trade name Xarelto, to prevent DVT's.
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Old 3rd September 2022, 03:10 PM   #16
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Which blood thinner for you?

Anything 80+ proof, if recent history is any indicator
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Old 3rd September 2022, 04:35 PM   #17
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Originally Posted by Thermal View Post
Which blood thinner for you?

Anything 80+ proof, if recent history is any indicator
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Old 3rd September 2022, 04:50 PM   #18
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Other than the alcohol as mentioned by several here - warfarin to counter the clotting effects of my atrial fibrillations. No side effects that I have noticed. Blood test every two weeks to make sure my INR remains in the desired range.
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Old 4th September 2022, 03:51 AM   #19
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Originally Posted by Carrot Flower King View Post
Anti-coagulant is and is more accurate. Blood thinner is the common usage.
More technically "platelet aggregation inhibitor"; they prevent the clumping of platelets.
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Old 4th September 2022, 03:54 AM   #20
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Originally Posted by Norman Alexander View Post
My wife is on rivaroxaban, trade name Xarelto, to prevent DVT's.
Ah that's a different kind of agent, doesn't effect the platelets (like Clopidogrel and Ticagrelor) but inhibits Factor 10.
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