Thursday, January 20, 2005

Plavix vs. Aspirin

The New York Times reports on a study comparing aspirin plus Nexium to Plavix:
Patients taking Plavix, a popular and expensive antistroke drug, experience more than 12 times as many ulcers as patients who take aspirin plus a heartburn pill, a study to be published today in The New England Journal of Medicine found.
This study was not a fair comparison of Plavix vs aspirin, since the Plavix group did not get a "heartburn pill":
Rob Hutchison, a spokesman for Bristol-Myers, said that the study did not directly compare aspirin and Plavix. Instead, the difference in ulcers could be entirely a result of the heartburn pill, which has long been known to prevent ulcers. He said the study should have included a group of patients who got Plavix plus a heartburn pill.
_
Both Plavix and aspirin are antiplatelet agents that are use to prevent heart attacks and strokes. Plavix costs several dollars per pill, while aspirin costs pennies. They are approximately equally effective in preventing heart attacks and strokes, though each has advantages in certain situations. When an antiplatelet agent is necessary, I usually start off with aspirin at a dose of 81-325 mg per day. Sometimes I add Plavix to aspirin (for example, in patients with recent cardiac stents). I rarely use Plavix instead of aspirin- the only situation in which I would commonly do this is in patients with a history of a serious allergic reaction to aspirin.
I haven't had too many difficulties with patients developing ulcers or GI bleeding on aspirin (unless they are also taking an NSAID such as ibuprofen/aleve). I question the main premise of this study- that many doctors are prescribing Plavix because they feel it is safer from a GI standpoint. I have never prescribed Plavix soley for this reason. I'm interested in hearing from anyone with experience in this area: have you prescribed Plavix instead of aspirin due to the past perceived GI safety of Plavix??

21 comments:

Anonymous said...

There have been a couple of occasions where I have used Plavix instead of ASA in patients who have had a hx of serious GIB (i.e., hospitalized/transfused). In one case the patient had been told not to take ASA ever again - who was I, as their NP to argue with the GI doc's recommendations?

CardioNP

senior said...

I'll take aspirin anytime.

A one adult aspirin beats a 75 mg plavix anytime - in cost and effectiveness.
plavix coattails on aspirin's antiplatelet activity with the current common Rx by M.D.s of using plavix with 81 mg ASA.
Costwise, there is no comparison, even if ASA is taken with one over-the-counter PepcidComplete for GI protection.

I get nosebleeds with one adult ASA (very tolerable and easily stopped), more often than with Plavix alone. In an age group with a higher incidence of osteoarthritis, ASA serves a dual purpose to boot.

Plavix sure got the cardiologist by the balls, having convinced them that it is the main antiplatelet they should use post -stenting.

hector said...

hello
i think patients have to take responsability for the treatments they follow.that's way they should get information about the best treatment considering all the pros and cons
Drugs Information

hector arriaga said...

I guess patients don't pay much attentions to the treatments they follow and that's an irresponsible attitud
they should take their health more seriously
health info

Anonymous said...

I am one of those patient who has two of their doctors with diffrent oppinions. I had a patch put in my heart to close a little hole from birth after a troke. I was taken both Plavix and aspirin. My Neurologist recently instructed me after 7 years after my stroke and placement of patch to take aspirin alone (81mg) Instead of both. My internal Medicins doctor says he prefers I take the plavix alone. I am currently on the Plavix by its self When I can afford it. When I can't I take the aspirim(81mg). It is working for me as far as I know.

Sugar said...

As a patient who cannot tolerate ASA, I was pleased (after having 4 strokes and carotid endarterectomy) to find that Plavix caused me no stomach problems at all.

I also have great difficulty tolerating any NSAID and I have GERD for which I take Nexium.

I heard on the news that patients with an elevated anti inflammatory rate should beware of stomach *sic* pills and Plavix in combination. I wonder what the problem would be.

Don said...

Three years ago I had 4 stents implanted. The interventionist MD said Plavix or ASA. The cardiologist said Plavix and ASA. Now the family doctor advises Plavix or ASA but not both. My drug plan no longer covers the Plavex ($100.00 per month). I am totally confused. any recommendations

dsalsysr

Anonymous said...

Almost on a daily basis, one may read about a new medication being developed or approved for the benefit of patients with a particular medical condition or disease state that they may have at the time. At times, these announcements may praise the innovation and novelty of such new drugs that are available to all in need of it, and rightfully so, in many situations.
But it’s possible the one super drug is not new and really may be a super drug. In fact, it’s one of the oldest medications available, and that would be aspirin- the first non-steroidal anti-inflammatory drug (NSAID) initially for those patients experiencing pain.
Noted as ASA by doctors typically, aspirin effects have been noted for thousands of years, as the active ingredient comes from the bark of a White Willow tree, and long ago, patients with pain or a fever would chew on this bark for relief. Yet due to the harshness of the natural chemical of this bark, Bayer decided to synthesize it to make it more tolerable for the user.
Fast forward to over a hundred years ago and Bayer pharmaceuticals (pronounced ‘Beier’), which is the same company that brought us heroin (named so due to its perceived ‘heroic’ qualities as a believed non-addictive substitute for morphine addicts) and mustard gas, as well as methadone. The company originated in Germany, but presently has its U.S. headquarters in New York. Felix Hoffman, seeking to develop an agent for his father’s rheumatism, was involved in the development of what is known now as aspirin.
And it was a difficult task to develop this drug, as it was toxic to the stomach due to the nature of the active ingredient again obtained from the bark of the white willow tree. Dr. Hoffman and others at Bayer developed a drug that proved to be tolerable to patients while keeping the active ingredient in tact through a method of delivery developed by Dr. Hoffman’s team at Bayer. After launching the medication, aspirin was priced at about 50 cents an ounce, as at the time it was only available in power form. Soon before 1920, aspirin developed the tablet form of the drug and was then available by prescription. Regardless, aspirin was responsible for one third of sales for Bayer during this time, due to its popularity due to the effects of this medication in need of relief.
While all drugs have side effects, aspirin is one of very few drugs that offers suitable efficacy with perhaps mild side effects associated with the drug, comparatively speaking. Aspirin has been found to be beneficial for a wide variety of disease states. In fact, some of aspirin’s additional uses have been only recently discovered. This may be why the New York Times called aspirin a wonder drug in the 1960s, according to others. In the 1970s, the mechanism of aspirin was isolated, which is the blockage of prostaglandins. Prostaglandins are inside the human body and are a contributor for physiological inflammation.
Aspirin has been associated with decreased risk of asthma and prostate cancer in the elderly. Also, aspirin has been linked with lowering the risk of breast cancer and colon cancer as well. Yet these conclusions are based on limited research with aspirin.
Aspirin is a blood thinner, and has been associated with decreasing the risk of heart attacks and strokes in certain patient populations, as the drug prevents clots. However, aspirin has not been shown to prevent heart attacks in diabetic patients. The cardiovascular benefits of aspirin were first suggested in the 1940s, and the FDA suggested that it be the drug of choice for those who experienced a heart attack over a decade ago. Aspirin intake is also beneficial for those after coronary bypass procedure. In addition, aspirin has been shown to reduced blood pressure with those who have mild hypertension, if aspirin is taken at night with such patients.
A topical formulation of aspirin was developed recently for those experiencing Herpes pain. The drug has been proven beneficial for those experiencing migraine pains. Aspirin at low doses is taken by many as a preventive drug to decrease cardiovascular incidents that may occur.
Aspirin has been the best selling painkiller absent of the past addictive qualities of opiate meds since the 1950s. It is also the most studied drug- with over 3000 scientific papers published worldwide. Also, over 15 billion tablets of aspirin are sold annually, which amounts to about 80 million aspirin tablets consumed daily by others. This amounts to over 16,000 tons of aspirin consumed during this time, or about 70,000 metric tons of aspirin a year. Over a decade ago, a study was performed and concluded that twice as many people would choose aspirin over a computer, given the two choices, because of the benefits of the drug.
Side effects would include GI bleeding if taken in large amounts, along with an association of Reye’s syndrome in children, yet both are relatively rare. Yet all things considered, clearly the benefits of aspirin outweigh any risks of the drug.
Lately, there have been issues with other NSAIDs, such as Cox II inhibitors, without full recollection or knowledge that aspirin is in fact the world’s most widely used drug, and for good reasons.
At times, something newer is not always better.
“There is no genius without a touch of madness.” --- Vaslav Nijinsky
Dan Abshear

rxrobert@aol.com said...

Because plavix works no better than 325mg ASA, why does the medical profession seem to put everyone on Plavix? Plavix cost the average patient (or their insurance company) 150.00 a month vs $2.00 a month for ASA. No wonder our national health care bill is so bloated. Don't you docs have a mind of your own or do you honestly believe what the sale rep tells you?

Anonymous said...

I had two stents last summer, otherwise I was a fair weather biker/runner/kayaker, w/ average cholesterol, who was a low risk for atherosclerosis.

American dctors & hospitals exist in a country w/ more lawyers than the rest of the world combined. Drs often feel that they MUST follow standard (experimentally "proven") procedures or they are at risk of being sued should something go wrong.

I feel that there is a tendency to apply general results to specific individuals. SO a treatment that was beneficial to the average participant in a 30,000 person study might be unnecessary for some individuals w/ non-average characteristics.

I have been on both morning Plavix & 1 baby aspirin (night) for 16 months, plus a beta blocker, Lipitor, and 5 mg (x2) Dexadrine for ADD. I have no other cardio-pulminary complications.

Up until last March I was on 3 baby aspirin a day but was bruising like crazy & the doc dropped it to 1 baby aspirin a day.

My weight is excellent, total cholesterol at 112-115: much different than the average test/study participant. I just phoned my cardiologist to request reduction/ellimination of the Plavix. It seems reasonable that the aspirin dosage will increase.

Anonymous said...

Aspirin is tried and true. Everything newer is jaded with profit. Sad.

Delphinus said...
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Delphinus said...
This comment has been removed by the author.
Delphinus said...

I recently had a heart attack and had two stents placed in me immediately afterwards.

Once I started taking the Plavix(well several days after) I began to experience severe vision impairment and still am.

I am taking one 75mg pill a day and my quality of life has actually gone down hill. My doctor is very adamant I continue taking it or I could die.

I did a significant amount of research and apparently there is no actual evidence it is any better then aspiring and in people who have high BP and high cholesterol it can even put them at greater risk for another attack.

I may start breaking them in half, or dropping it altogether and sticking with the aspirin.

I am tired of being coerced into taking all of this shit and only prescribed it using fear on me. Why not show papers to the patients about how great it is, some peer reviews, etc, they can take home and read to reassure us instead?

No, they just have the "I am the doc" attitude, so do as I say.

Anonymous said...

The only reason your doctor tells you to take Plavix and neglets to tell you about the thinning propeties of Aspirin is the kickbacks from the pharmacudical companies. Doctors get paid by them to write scrips. The Aspirin companies dont pay for them to tell their patients about it.What a sad world we live in where money rules instead of helping mankind. What ever happened to the oath that doctors are supposed to take. SAD

Anonymous said...

I am taking 75 mg plavix a day.....

am an "outside" person...when in the sun I turn bright red and get extremly(SP) sick unless I stay out of direct sun I eventually get to the point of almost passing out...65 have a couple of mini-strokes 11/07 any ideas ?? could be plavix or lasix ??

Barrie said...

This can't have effect in actual fact, that's exactly what I suppose.
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Anonymous said...

The guy is absolutely fair, and there is no suspicion.
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Eyad Hafiz said...

Dear mr. Dan
I realy liked the historical informations about the discovery of aspirin and the naming Heroin. I would realy like to get that kind of information on every drug I study at my medical school so I can create a character for each drug thus remember it well.
I hope that you can help me with that by guidance to where can O get that kind of information especially naming of drugs.

I enjoyed reading what you had written and I wish you the best.

thanks a lot

Anonymous said...

Boy do I have a story to tell regarding Plavix. My father of 81 years old was displaying total weakness and actually what was happening was a GI bleed....the common side effect of this horrible medication. HGB 9.0 (bloody stools)so I immediately stopped this absolute horrific medicine. Oh my goodness...48 hours his personality changed for the better and was hungry to eat so I went out and got Arby's for him, LOL
Dad was dying thank God for past nursing skills with the ability to call it like it is.

Queen Tillie said...

7 years ago I was diagnosed with a TIA. Plavix 76 mgs was prescribed along with atenolol for HBP. 50 mgs. 2 yeas ago I was put on low dose aspirin therapy. and atenolol dosage cut in half to 25 mgs.. a month ago I had TIA symptoms but all ct scans and mri showed no TIA activity, no clogged arteries, but diagnosed with Hypertension. but the dr put me back on Plavix. In one month side effects depression, no energy, loss of appetite. terible bruising. I took myself off the plavix and back to the aspirin. I have nevr had heart surgery, stents etc. I am 81 yrs od. my dr. said take 2 81 mgs daily, BP for one month has been running on the low side so my atenolol was cut to 1/2 of the 25 mg. tablet. My is the aspirin therapy sufficient.