Warfarin & ASA

[Bionic Orange]

Do any of you, who do not have coronary artery disease, take only warfarin?

Along with life long warfarin that is a given, my surgeon would like me to take life long ASA. (I haven't had my 3 month consult with my cardiologist yet, I'll also ask him his take on it)

 

[pellicle]

ASA

fancy word for aspirin.

Yes, I now take aspirin. I started, stopped, went for years with no problems, got minor issues, tried 150mg every alternate day, problem ceased (calling that sufficient evidence to continue).

both my surgeon and cardiologist are of the view that (well after surgery) if I'm not finding a need for it then there is no benefit and are happy to accept my own choices there. Aspirin is not a prescription drug anyway.

https://www.heart.org/-/media/Files...-On-Aspirin-Use-to-Prevent-CVD-UCM_432593.pdf
https://www.uspreventiveservicestas...-cardiovascular-disease-preventive-medication
https://www.ahajournals.org/doi/10.1161/ATVBAHA.122.318020


(*as undoubtedly some dick is going to say "don't listen to some random person on the internet", I say I agree, listen to the evidence of the actual specialist bodies. However as you're an adult and I'm probably adult enough we can both participate here as adults on a forum of {mostly} adults)

lastly
https://www.valvereplacement.org/threads/i-did-my-own-research-a-great-guide.889239/
HTH

 

[pellicle]

PS: always read the study, don't just be satisfied with the abstract. Look for statistical relevance and apply some critical thinking, because publications aren't what they used to be...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572812/

 

[Superman]

I take 81mg aspirin daily. Low cholesterol. No issues with it. Started after my second surgery almost 14 years ago. Never did before.

 

[David Robbins]

Do any of you, who do not have coronary artery disease, take only warfarin?

Along with life long warfarin that is a given, my surgeon would like me to take life long ASA. (I haven't had my 3 month consult with my cardiologist yet, I'll also ask him his take on it)

I had two AVRs in 2008 and have been only on Warfarin since. The cardiologist recommends taking Warfarn and Aspirin combined, but in my case she limited it to Warfarin because of a brain surgery that required a clip on a ruptured artery in my brain. I would consult with a cardiologist who knows your health history for a qualified answer specific to your health condition and prognosis.

 

[carolinemc]

Do any of you, who do not have coronary artery disease, take only warfarin?

Along with life long warfarin that is a given, my surgeon would like me to take life long ASA. (I haven't had my 3 month consult with my cardiologist yet, I'll also ask him his take on it)

Many of us have mechanical heart valves and have to be on Warfarin. And there are those who have to be on it for a short time. It is best to ask your cardiologist about it.

 

[lsquared18]

I had a TIA mini Stroke and the Neurologist put me on ASA. I asked him would it interfere with my Warfarin he said no. But it did. I took it for three years. My INR was so off with just one ASA. I finally saw my cardiologist last year and she said stop the ASA everything is good. Dont take the ASA anymore. So I have stopped it. I feel much better off of it. My skin felt like Dracula can puncture me and just suck out the blood easily and quickly. LOL But since I stopped I am much better.

 

[pellicle]

But it did. I took it for three years. My INR was so off with just one ASA.

this is the first to hear of this and goes against everything published and everything I personally know about how it works.

Could you provide something like evidence for this?

Aspirin is an antiplatelet drug and warfarin works on the thorombosis cascade.

The only possible known pathway for this is the interference with Cytochome P450 and this is at best a weak interaction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414920/
So its possible if you have a very vulnerable set of cytochome genes (VKORC1 and CYPx genes) this could in your case influence INR.

https://www.ncbi.nlm.nih.gov/books/NBK84174/

what exact effect did you experience? Was it just enhanced bruising or bleeding or was there a measurable INR component?

PS: Warfarin, antiplatelet drugs and their interactions

 

[ATHENS1964]

https://www.dicardiology.com/conten...replacement-lowers-mortality-risk-mayo-clinic

 

[pellicle]

Hi

https://www.dicardiology.com/conten...replacement-lowers-mortality-risk-mayo-clinic

gosh .. I didn't expect to see than name:

"The findings support early warfarin use in appropriately selected patients, such as patients with low bleeding risk," says Hartzell Schaff, M.D., a Mayo Clinic cardiovascular surgeon who contributed to the study."​

a segment of his excellent talk on valve choice that relates to anticoagulation.

 

[dick0236]

After decades on only warfarin, my cardiologist put me on 81mg Aspirin along with the warfarin a few years ago.....and I began experiencing significant nosebleeds. About 18 months ago, after having a nosebleed that required a visit to the ER, I asked him to stop the Aspirin. He reluctantly agreed and I have not had a serious nosebleed since. I still get them in the dryness of winter but they are easily stopped. BTW, I have noticed no changes in my heart issues since I stopped the aspirin.

 

[pellicle]

Just to bounce off Dicks post here

my cardiologist put me on 81mg Aspirin along with the warfarin a few years ago.....and I began experiencing significant nosebleeds. About 18 months ago, after having a nosebleed that required a visit to the ER,

I agree that aspirin is not a panacea and needs to be considered thoughtfully by any practitioner and evaluated as to its "risks and benefits". In particular if one is already on ACT then an addition of an AntiPlatelet drug may do more harm than good. I had thought that we were past that "just take it because its good for your heart"

Some readings I'll underline points which I think warrant attention

https://www.hopkinsmedicine.org/health/wellness-and-prevention/is-taking-aspirin-good-for-your-heart

Is there more harm than benefit?​

Previous guidelines from the United States Preventive Services Task Force warned against taking aspirin for the primary prevention of heart disease unless you’re at an elevated risk — typically if you’re 50 to 69 years old with a 10 percent or greater chance of having a heart attack or stroke within the next 10 years.​

​

There is good reason to be wary of aspirin, warns Michos, particularly for women. The Women’s Health Study was a large trial that looked at whether women with no history of heart disease would benefit from taking a low dose of aspirin. Researchers found that in the overall group of women, aspirin didn’t reduce the risk of heart attacks, but it did increase the risk of bleeding. Some benefit was seen for women over the age of 65.​

​

“So not only was there lack of benefit for the younger women taking aspirin, but there was also a question of harm,” says Michos. “It’s important for people to realize that just because aspirin is over-the-counter does not mean it is necessarily safe. Many patients take aspirin because they think it’s good for their hearts, but it carries some serious risks. ”​

​

More recently, two large clinical trials comparing aspirin with placebo among people without known heart disease give even more reason to be cautious with an aspirin. The ARRIVE trial included men over the age of 55 and women over age 60 who were deemed to be at elevated risk for heart disease by having several risk factors. The ASPREE trial enrolled older adults (70 and older; African-Americans and Hispanics 65 and older). Both trials showed that low dose aspirin (at 100 milligrams per day) did not prevent subsequent heart attacks or strokes over a period of approximately five years. However, aspirin did increase the risk for major bleeding. Furthermore, in the ASPREE trial, there were more deaths attributed to aspirin use. Michos finds the new results “alarming” and says that most adults without known heart disease should not take aspirin routinely for heart attack and stroke prevention.​

​

“I still recommend aspirin for those with known heart disease or stroke, or for select individuals who might be at particularly high risk due to evidence of significant plaque in their arteries, if they are not at high bleeding risk,” Michos says. “But for the rest of my patients at lower or intermediate risk, it seems that the risks of aspirin outweigh the benefits. Particularly for elderly patients, if they don’t have known heart disease, I would think carefully about using it.​

This is where I would say that someone like Dick, while he has a mechanical heart valve does not have the "stereotypical heart disease". Accordingly unless there was a specific case to be made for its use I would do as advised above.

Further counsel is here:
https://www.mayoclinic.org/diseases...e/in-depth/daily-aspirin-therapy/art-20046797

What are the possible side effects of daily aspirin therapy?​

Side effects and complications of taking daily aspirin include:

• Stroke caused by a burst blood vessel. While daily aspirin can help prevent a clot-related stroke, it may increase the risk of a bleeding stroke. A bleeding stroke also is called a hemorrhagic stroke.
• Gastrointestinal bleeding. Daily aspirin use increases the risk of developing a stomach ulcer. If you already have a bleeding ulcer or gastrointestinal bleeding, taking aspirin may cause more bleeding. The bleeding may be life-threatening.
• Allergic reaction. If you're allergic to aspirin, taking any dose of aspirin can trigger a serious allergic reaction.

 

[carolinemc]

I had a TIA mini Stroke and the Neurologist put me on ASA. I asked him would it interfere with my Warfarin he said no. But it did. I took it for three years. My INR was so off with just one ASA. I finally saw my cardiologist last year and she said stop the ASA everything is good. Dont take the ASA anymore. So I have stopped it. I feel much better off of it. My skin felt like Dracula can puncture me and just suck out the blood easily and quickly. LOL But since I stopped I am much better.

Some doctors do not keep up with the latest information on meds and interactions. Kudos to your Cardio. And happy you are feeling better.

 

[Protimenow]

I've been taking 81 mg aspirin daily for probably 20 years or so. I don't think I had any adverse reactions to it.

When I had my first TIA (probably an actual stroke, a result of a clot traveling to my brain because I trusted my meter too much), I took 2 aspirin right away because I read that this can help. I don't know that it did--especially because I was already taking warfarin (but my INR was dangerously low, so it may have helped).

Based on what I've read here, I may just stop taking 81 mg./day -- it may not have helped during all that time, and it's possible that, as indicated above, 'the benefits aren't worth the risk.'

 

[user 15848]

Very interesting topic, for me because i feel i am making a mistake taking 81 mg daily since nov-2015. All began with the OnX 1.5 -2.0 INR that i jumped in during the first year; and although after 12 months i decided it was too much of a risk to play with that range, OnX did work just fine during those 12 months that is not the point, But then i asked my family doctor about it because i wanted to drop the daily 81mg asa, he told me to keep on taking it as it was good for me...., Then i saw 2 different cardiologists and they both asked me WHY i am taking Aspirin 81mg.... So today waiting for 2024 i do would like to get rid of the aspirin, but not sure if then i have to rise my INR range; at the moment my target range is 2.0 - 2.5 it has been below 2.0 , no issues. Will have to read the Pellicle's posting and links, i am not sure what exactly does the ASA does for my Mech Valve. Just sharing, but this is something i keep thinking about....; The 2 cardiologists did tell me to Drop the ASA...., comments welcome, thank you.

 

[user 15848]

I take 81mg aspirin daily. Low cholesterol. No issues with it. Started after my second surgery almost 14 years ago. Never did before.

hi Super, i also take the 81mg since first day after surgery, but have been thinking about stpp taking it, may i ask you, what could be a reason to keep taking the 81 mg?, my family doctor says take it, my 2 cardiologists say drop it

 

[user 15848]

I've been taking 81 mg aspirin daily for probably 20 years or so. I don't think I had any adverse reactions to it.

When I had my first TIA (probably an actual stroke, a result of a clot traveling to my brain because I trusted my meter too much), I took 2 aspirin right away because I read that this can help. I don't know that it did--especially because I was already taking warfarin (but my INR was dangerously low, so it may have helped).

Based on what I've read here, I may just stop taking 81 mg./day -- it may not have helped during all that time, and it's possible that, as indicated above, 'the benefits aren't worth the risk.'

I am taking the 81mg daily since after the OPS, because was recommended by OnX and their 1.5 -2 range that I only followed first 12 months, now on 2 - 2.5; but i keep thinking of dropping the asa; family doctor says keep at it, cardiologist says Why u taking ASA ?, so, that is my 2024 Resolution, find an answer for me on this, thank you for yor posting

 

[Protimenow]

In my case, I still take it. I may stop when my bottle gets empty.

It doesn't cause any digestive issues, but AFAIK, it might, possibly, be a contributing factor in some bruising I had after a procedure a few weeks ago. I'm not sure if it protects me from TIA or stroke any more than just plain warfarin.

I may just enter 2024 without it.

 

[user 15848]

In my case, I still take it. I may stop when my bottle gets empty.

It doesn't cause any digestive issues, but AFAIK, it might, possibly, be a contributing factor in some bruising I had after a procedure a few weeks ago. I'm not sure if it protects me from TIA or stroke any more than just plain warfarin.

I may just enter 2024 without it.

Hi, thank you for your posting. i have been for a long while thinking about this, and silly me, my 2 sisters are doctor and i never asked their opinions, family things i am sure you all understand the closer they are the less we want to bother them , BUT, finally reached to my sister in NZLND and she got very, very, upset i never asked this question, and her message IS : STOP THAT RIGHT NOW. Also, digging around came across the link below, but as per Tomorrow Jan-01-2024 i will no longer take ASA + W. Happy 2024 !!!
https://pubmed.ncbi.nlm.nih.gov/17070169/

 

[MdaPA]

fyi....

Key Learnings About Baby Aspirin After Heart Valve Replacement Surgery​

Here are important learnings from our discussion with Dr. Gerdisch:

• Dr. Gerdisch is a heart valve expert having performed over 4,000 heart valve repair and replacement procedures.
• New medical research advises against the use of baby aspirin for the prevention of heart disease for people who do not have heart valve disease or undergone heart valve replacement surgery and/or coronary artery bypass grafts (CABG). As Dr. Gerdisch states, “That means someone who does not have a diagnosis of vascular disease, someone who has not had their valve replaced, someone who has not had coronary bypass surgery, those patients, those people should not be taking a baby aspirin.”
• The reason is that the risk of bleeding outweighs whatever potential benefit there is for somebody who doesn’t have a cardiac disorder.
• However, patients who have had a valve replacement and/or a CABG do experience a benefit of taking a low-dose aspirin when prescribed by their doctor.
• There are additional considerations that patients and their medical teams should be aware of specific to gastrointestinal bleeding, allergies, low platelets, etc.
• It’s critical for patients to really understand that baby aspirin is a treatment as it minimizes thrombosis

Shortly after positing the video above, we received a follow-up question from Arsal, at YouTube, who asks, “You specifically asked for tissue valve patient. How about patients, like me, with mechanical valves and taking permanent warfarin to consider aspirin as cardiologists in my country are not sure because I do not have coronary disease?”

Here is Dr. Gerdisch’s response to Arsal:

“Anticoagulation for people with mechanical prosthetic valves is a balance of the benefit of avoiding thromboembolism and the risk of bleeding. In addition to the basic principles of maintaining a safe level of anticoagulation, patient specific risks may be present in the form of vascular disease, frailty, atrial fibrillation, or bleeding tendency that will influence both the degree of anticoagulation and the use of aspirin in conjunction with warfarin.”

Baby Aspirin After Heart Valve Surgery: What Should You Know?