Eliquis (apixaban) is blood thinner shown to prevent stroke with fewer side effects than Warfarin (Coumadin). Aspirin does the same, but not as effectively for people over 75. My problem with eliquis is that it’s over-prescribed. The studies favoring it over aspirin found benefits for those over 75, and for those with A-Fib. And even in this cohort the advantage over aspirin is small or non-existent because eliquis has far more serious side effects; hemorrhage, or internal bleeding.
Statistically, the AVERROES study (Apixaban Versus Acetylsalicylic Acid to Prevent Stroke in AF Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment) found that apixaban is substantially better than aspirin at preventing stroke in atrial fibrillation patients, but worse at preventing heart attack.
Taking 50 mg of Eliquis twice a day, reduces the risk of stroke in people with A-Fib by more than 50% and reduces the rate of heart attack by about 15%. By comparison, taking 1/2 tablet of aspirin, 178 mg, reduces the risk of stroke by 17% and of heart attack by 42%. The benefits were higher in the elderly, those over 75, and non existent in those with A-Fib under 75, see here, and figure. Despite this, doctors prescribe Eliquis over aspirin, even to those without A-Fib and those under 75. I suspect the reason is advertising by the drug companies, as I’ve claimed earlier with Atenolol.
The major deadly side-effect is hemorrhage, brain hemorrhage and GI (stomach) hemorrhage. Here apixaban is far worse than with aspirin (but better than Warfarin). The net result is that in the AVERROES random-double blind study there was no difference in all-cause mortality between apixaban and aspirin for those with A-fib who were under 75, see here. Or here.
To reduce your chance of GI hemorrhage with Eliquis, it is a very good idea to take a stomach proton pump drug like Pantoprazole. If you have A-Fib, the combination of Eliquis and pantoprazole seems better than aspirin alone, even for those under 75. If you have no A-Fib and are under 75, I see no benefit to Eliquis, especially if you find you have headaches, stomach aches, back pain, or other signs of internal bleeding, you might switch to aspirin or choose a reduced dose.
A Japanese study found that half the normal dose of Eliquis, was approximately as effective as the full dose, 50 mg twice a day. I was prescribed Eliquis, full dose twice a day, but I’m under 70 and I have no A-Fib since my ablation.
Life expectancy has dropped in the US to undeveloped world levels. Biden blames COVID and racism. I think it’s too much drugs, and too few opportunities.
I’m struck by the fact that US life expectancy is uncommonly low, lower than in most developed countries. Lower too than in many semi-developed countries, and our life expectancy is decreasing while other countries are not seeing the same. It dropped by about 3 years over the last 2 years as shown. I wonder why the US has suffered more than other countries, and suspect we are over-prescribed. Too much of a good thing, typically isn’t good.
Atenolol and related beta blockers have been found to be effective reducing blood pressure and heart rate. Since high blood pressure is a warning sign for heart problems, doctors have been prescribing atenolol and related beta blockers for all sorts of heart problems, even problems that are not caused by high blood pressure. I was prescribed metoprolol and then atenolol for Atrial Fibrillation, A-Fib, beginning 2 yeas ago, even though I have low-moderate blood pressure. For someone like me, it might have been deadly. Even for patients with moderately high blood pressure (hypertension) studies suggest there is no heart benefit to atenolol and related ß-blockers, and only minimal stroke and renal benefit. As early as 1985 (37 years ago) the Medical Research Council trial found that “ß blockers are relatively ineffective for primary treatment of hypertensive outcomes.”
End point. Relative risk. 95% CI. All-cause mortality Cardiovascular mortality MI Stroke Carlberg B et al. Lancet 2004; 364:1684–1689.
There lots of adverse side-effects to atenolol, as listed at the end of this post. More recent studies (e.g. Carlsberg et al., at right) continue to find no positive effects on the heart, but lots of negatives. A review in Lancet (2004) 364,1684–9 was titled, “Review: atenolol may be ineffective for reducing cardiovascular morbidity or all cause mortality in hypertension” (link here). “In patients with essential hypertension, atenolol is not better than placebo or no treatment for reducing cardiovascular morbidity or all cause mortality.” It further concluded that, “compared to other antihypertensive drugs, it [atenolol] may increase the risk of stroke or death.” I showed this and related studies to my doctor, and pointed out that I have averaged to low blood pressure, but he persisted in pushing this drug, something that seems common among medical men. My guess is that the advertising or doctor subsidies are spectacular. By contrast, aspirin has long been known to be effective for heart problems; my doctor said to go off aspirin.
The graph at right is from “Trial of Secondary Prevention with Atenolol after transient Ischemic Attack or Nondisabling Ischemic Stroke”, published in Stroke, 24 4 (1993), (see link here). a Thje study involved 1473 at-risk patients, randomly prescribed atenolol or placebo. It found no outcome benefit from atenolol, and several negatives. After 3 years, in two equal-size randomized groups, there were 64 deaths among the atenolol group, 58 among the placebo group; there were 11 fatal strokes with atenolol, versus 8 with placebo. There were somewhat fewer non-fatal strokes with atenolol, but the sum-total of fatal and non-fatal strokes was equal; there were 81 in each group.
“Trial of Secondary Prevention with Atenolol after transient Ischemic Attack or Nondisabling Ischemic Stroke”, published in Stroke, 24 4 (1993).
Newer beta blockers seem marginally better, as in “Effect of nebivolol or atenolol vs. placebo on cardiovascular health in subjects with borderline blood pressure: the EVIDENCE study.” “Nebivolol (NEB) in contrast to atenolol (ATE) may have a beneficial effect on endothelial function …. there was no significant change in the ATE and PLAC groups.” My question: why not use one of these, or better yet aspirin. Aspirin is shown to be beneficial, and relatively side-effect free. If you tolerate aspirin, and most people do, beneficial has to be better than maybe beneficial.
Among atenolol’s ugly side effects, as listed by the Mayo Clinic, there are: tiredness, sweating, shortness of breath, confusion, loss of sex drive, cold fingers and toes, diarrhea, nausea, and general confusion. I had some of these. There was no increase in heart stability (decrease in A-fib). My heart rate went as low at 32 bpm at night. My doctor was unconcerned, but I was. I suspected the low heart rate put me at extreme risk. Eventually, the same doctor gave me ablation therapy, and that seemed to cure the A-Fib.
Following my ablation, I was told I could get off atenolol. I then discovered another negative effect of atenolol: you have to ease off it or your heart will race. If you have A-fib, or modest hypertension, consider aspirin, eliquis, ablation, or exercise. If you are prescribed atenolol for heart issues and don’t have symptoms of very-high blood pressure, consider other options and/or changing doctors.
Brazil has decided to go its own route in response to the Corona virus pandemic. They’re using minimal social distancing with a heavy reliance on hydroxychloroquine (HCQ), a cheap drug that they claim is effective (as has our president). Brazil has been widely criticized for this, despite so far having lower death rate per million than the US, Canada, or most of Europe. In an open letter, copied in part below, 25 Brazilian scientists speak out against the politicalization of science, and in favor of their approach to COVID-19. The full letter (here). The whole letter is very worth reading, IMHO, but especially worthwhile is their section on hydroxychloroquine (HCQ), copied below.
….. Numerous countries such as the USA, Spain, France, Italy, India, Israel, Russia, Costa Rica and Senegal use the drug (HCQ) to fight covid-19, whereas other countries refrain from using HCQ as one of the strategies to contain the pandemic, betting on other controversial tactics.
Who then speaks here in the name of “science”? Which group has a monopoly on reason and its exclusive authorization to be the spokesperson of “science”? Where is such authorization found?One can choose an opinion, and base his strategy on it, this is fine, but no one should commit the sacrilege of protecting his decision risking to tarnish with it the “sacred mantle of science”.
Outraged, every day I hear mayors and governors saying at the top of their lungs that they “have followed science”. Presidents of councils and some of their advisers, and of academies and deans in their offices write letters on behalf of their entire community, as if they reflect everyone’s consensual position. Nothing could be more false.Have they followed science? Not at all! They have followed the science wing which they like, and the scientists who they chose to place around them. They ignore the other wing of science, since there are also hundreds of scientists and articles that oppose their positions and measures.
Worse, scientists are not angels. Scientists are people, and people have likes and dislikes, passions and political party preferences. Or wouldn’t they? There are many scientists, therefore, who do good without looking at whom, I know and admire many of them. But there are also pseudoscientists who use science to defend their opinion, their own pocket, or their passion. Scientists have worked and still work hard and detached to contribute to the good of humanity, many of whom are now in their laboratories, risking their lives to develop new methods of detecting coronavirus, drugs and vaccines, when they could stay “safe at home”. But, to illustrate my point, I know scientists who have published articles, some even in major journals such as “Science” or “Nature”, with data they have manufactured “during the night”; others who have removed points from their curves, or used other similar strategies. Many scientists were at Hitler’s side, weren’t they? Did they act in the name of “science”? Others have developed atom bombs. Others still develop chemical and biological weapons and illicit drugs, by design.
The Manaus’ study with chloroquine (CQ) performed here in Brazil and published in the Journal of the American Medical Association (JAMA) [1], is emblematic to this discussion of “science”. Scientists there used, the manuscript reveals, lethal doses in debilitated patients, many in severe conditions and with comorbidities. The profiles of the groups do not seem to have been “randomized”, since a clear “preference” in the HIGH DOSE group for risk factors is noted. Chloroquine, which is more toxic than HCQ, was used, and it seems that they even made “childish mistakes” in simple stoichiometric calculations, doubling the dosage with the error. I’m incapable of judging intentions, but justice will do it. The former Brazilian Health Minister Luiz Henrique Mandetta quoted this study, supported it, and based on it, categorically stated: “I do not approve HCQ because I am based on ‘science, science, science’!”.
Another study published by Chinese researchers in the British Medical Journal (BMJ) and which is still persistently used against HCQ was also at least revolting [2]. In it, the authors declared: “we administer 1,200 mg for 3 days, followed by 800 mg for 12 to 21 days, in patients with moderate to severe symptoms”. In other words, they gave a huge dosage of the drug that could reach the absurdity of 20 grams in the end, and it given was too late to patients (HCQ should be administered in the first symptoms or even earlier). And even worse, overdosing on HCQ or any other drug for severe cases is poisonous. What do you think, was it good science? The recommended dosage in Brazil, since May 20th, 2020, by the new Ministry of Health, for mild symptoms is 2 times 400 mg in the first day (every 12 hours) and 400 mg for 5 days for a total of 2.8 grams.
In other published studies, also in these internationally renowned journals such as The New England Journal of Medicine, JAMA and BMJ [3-5], once again, “problems” are clearly noted, since or the patients were randomized in irregular ways, placing older, more susceptible or most severe and hypoxemic patients in the higher (lethal) dose groups, or more men (almost 3 times more deadly by covid than women), or more black people (in the USA, black people have displayed higher mortality) and more smokers, and where most of the deaths occurred in the first days of the studies (signs that were deaths of critically ill patients, who at this stage would be more “intoxicated” than “treated” with HCQ), or they administered HCQ isolated, when it is known that it is necessary to associate HCQ at least with azithromycin. One of these studies [5] administered HCQ only on the sixteenth day of symptoms (for really early treatment, HCQ administration should be started up to fifth day), in other words, at the end of the disease, when the drug can do little good or nothing to the patient.
These studies indicate that some scientists either forgot how “science” is done or that there is a huge effort to disprove, whatever it takes, that HCQ works. How can someone or even Councils and Academies of Medicine cite such studies as the “science” of their decisions? How can that be?
On the contrary, the study published – and today with more than 3 thousand patients tested – and carried out by Dr. Didier Raoult in France [6], using the correct dosage and at the right time, with a very low mortality rate (0.4%), and the Prevent Senior’s clinical experience in Brazil – also quite encouraging – are disqualified with very “futile” arguments such as: “Didier Raoult is a controversial and unworthy researcher”, “At Prevent Senior Clinic they were not sure of the diagnosis” (but none of the hospitalized patients with clear COVID symptoms died), “Placebo effect” (what a supernatural power of inducing our mind that reduces mortality from 40% to zero, I want this placebo!), “Study performed by a health plan company” (I do not doubt that this people indeed want to save lives, because the patients were their customers who pay their bills), and similar ephemeral arguments.…
I admire the spunk of these fellows going agains the doctors, WHO. Beyond being a critique of bad research on a particular drug, it is a defense of science. Science is a discussion, a striving for truth. It is not supposed to demand blind allegiance to a few politically appointed experts. They’ve convinced me that the tests sponsored by the world health organization seem designed to show failure, and reminded me that there is rarely a one-size-fits-all for problems and all times.
I also find striking the highly critical response of my local newspapers and TV reporters. While they both like to highlight efforts by South America as they try entering the first world, with help from Bill gates and leftist politicians, they have been uniformly condemned Brazil for its non-left approach and now for use of HCQ. They want Sous Americans to think, but only if their conclusions are no different from those of their favorite, liberal thinkers.
