Warfarin & ASA

[pellicle]

Morning

{good stuff}

a good study but this point in particular is worth a quick mention ... I'm not specifically replying to you, but replying to give casual readers another perspective.

“Anticoagulation for people with mechanical prosthetic valves is a balance of the benefit of avoiding thromboembolism and the risk of bleeding.

this is exactly true but what is absent from this study is the following points.

• Who determines the values of what is a benefit and a risk? Sometimes benefit can not be fulfilled without too much of the risk (and perhaps lifestyle issues need to be addressed to reduce the risk)
• What training or support is given to the patient in doing this for themselves (utterly none in my case, save for some nurse reading me a bunch of stuff that sounded as genuinely interested as a checkout operator telling me "have a nice day" and when questioned about specifics had far less than "not a clue")
• Like the psychology gag, the lightbulb has got to want to change. My personal experience of others combined with the personal experience of a number of pharmacists, research on the topic and discussions here suggests that at least half of the patients just expect to be passive and "the doctor will do it"
• The doctor is usually only engaging in a 15 ~ 20 minute consult with a patient who is usually passive and will probably forget every commitment made in the office soon after starting the car or getting onto the bus.

But its not just me being cynical; from a study

Poor adherence to warfarin is common with one in five doses taken incorrectly even in the setting of a dedicated anticoagulation clinic (Platt et al., 2010). A study showed that up to 92% of the patients could not adhere to warfarin therapy and had under anticoagulation control.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720013/
So just by being interested and engaging properly with medical advice we can step ourselves up a lot from "the statistics"

Best Wishes

 

[Protimenow]

FWIW - I'm not taking the 81 mg enteric coated aspirin now - and probably won't return to it.

I'm not sure if the aspirin is making a difference, and the reports above sound a bit contradictory to me.

I'm not convinced about how much it has helped me - but either way, it's only anecdotal and hard to prove either way.

 

[MdaPA]

So just by being interested and engaging properly with medical advice we can step ourselves up a lot from "the statistics"

+1

 

[afraidofsurgery]

I always thought that baby aspirin on top of warfarin was overkill and unnecessary. I understand they work by different mechanisms but warfarin strikes me as the 'big guns' anticoagulant so why play around with a tiny dose of a drug where there's contradictory data? So I took the aspirin for a while then stopped it. The doc always asks about it and I have to admit it's easiest to fib and say 'yes I'm still on it' (that's the only white lie I ever tell the doc). I'm religious about my warfarin and INR monitoring and engage my doc in conversation as an active participant in my care. Hint - bringing a new journal article always helps get their attention!!

 

[carolinemc]

fyi....




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

And also if you ever had a stroke, then will put you on a baby aspirin regiment. I had an eye stroke, common and uncommon to diabetics. And I was not taking warfarin for three months. Had the eyestroke in the left eye. Was very lucky indeed.

 

[mecretired]

My cardiologist has me on both warfarin and 81mg aspirin. She explained that the do different things.

 

[Protimenow]

Aspirin makes the platelets less 'sticky' so clots don't form as easily. This effect can't be measured - at least, not in terms of prothrombin time and INR.

 

[tom in MO]

I have a St. Jude and take the 80mg aspirin with warfarin based upon my first and second cardiologist's prescription. It has no noticeable effect on me. I don't remember which valves they are, but in the past I've run across some literature where aspirin is recommended by the valve manufacturer.

 

[user 15848]

fyi....




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

Since jan-1-2024 asa 81 canceled, no more; and "for me" it already shows postive results, so family doctor is wrong, 2 cardiologist right, and last but not least my Dr Sister is right on. No good for me.

 

[Protimenow]

I've also stopped the ASA 81 mg enterics on 1/1/24. I haven't noticed any difference (nor did I expect to).

 

[dornole]

I’m the weirdo who is on only 325 mg aspirin (since native valve was repaired) but it’s my cardiologist who prescribed that. 20 years and counting. I seem to tolerate it fine. But a little creeped out - is anyone else on full dose aspirin only?

 

[pellicle]

I’m the weirdo who is on only 325 mg aspirin (since native valve was repaired) but it’s my cardiologist who prescribed that. 20 years and counting. I seem to tolerate it fine. But a little creeped out - is anyone else on full dose aspirin only?

I'm pretty sure no mech valver is

 

[MdaPA]

Since jan-1-2024 asa 81 canceled, no more; and "for me" it already shows postive results,

What positive results have you noticed?

 

[Lynn]

I have an ASA allergy (anaphylaxis reaction to aspirin) and a sensitivity to pretty much any derived from salicylic acid. This includes NSAIDs and topical products. Sunscreens and cosmetics are big culprits. My bicuspid valve was discovered by a rheumatologist who picked up a murmur and thought I likely has lupus. What I had was a sensitivity to the salicylic derivatives in the sunscreen I covered myself with every spring and summer. This produced rather sever lupus like symptoms. It’s a long list and a long story.

Bottom line, I have a mechanical valve, no other coronary disease and I can’t take aspirin. I, and my docs all knew this and it was factored into the valve choice. I still went mechanical, because as my cardiologist said, he prescribes ASA to his patients with tissue valves as well to prevent clots. This would never be an option for me. After lots of discussion, The decided course agreed on by my cardiologist, surgeon and myself was mechanical with a plan to keep my INR slightly above the minimum range for Onyx valve. I strive to keep my INR above 2.5. Though ASA and warfarin work differently, the docs felt it was a safe approach.

It will be 3 years in April, and I haven’t had any issues. Would I take aspirin if I could? Probably.

As an aside, my warfarin dose is very low compared to what I read here from others, even though I eat a tremendous amount of greens and am very active.
If I don’t eat greens my daily dosage needs fall below 3mg. Some reading about this has highlighted the possibility of an issue with the CYP2C9 gene that regulates both warfarin and NASAID metabolism.

 

[pellicle]

Hi Lynn

I strive to keep my INR above 2.5.

I think that's an excellent goal, does this mean it falls much below 2? Do you keep records?

As an aside, my warfarin dose is very low compared to what I read here from others, even though I eat a tremendous amount of greens and am very active.

it takes what it takes. Having a low warfarin dose is not in and of itself a good thing. It simply makes managing your dose harder

If I don’t eat greens my daily dosage needs fall below 3mg.

what is your average dose?

If I recall right one of the members here takes 1.25mg daily (yes that's painful to make adjustments).

Reach out if you want to chat about this.

 

[Protimenow]

INR on warfarin is fairly easy to manage -- and the meters can accurately detect your INR.

The effects of NSAIDS (including aspirin) on INR can't be determined by an INR tester. I'm not entirely certain they can be determined using other tests, either. But, since you're allergic to NSAIDs, the issue of aspirin is moot.

It's good that you're keeping your INR on the 'high' side. Even with an On-X valve, keeping an INR above 2.5 or so won't change your lifestyle, but should help prevent any clotting on the valve.

 

[Lynn]

Thanks, Pellicle, I seldom fall below 2 (much more likely to be high) and I do keep old schools pen and paper records, (I gave up spreadsheets when I retired lol). I knew from the onset an INR below 2 was out if the question due to the ASA allergy even with Onyx. This was moved to 2.5 in part due to the information on risk you provided in this board so I thank you for that. It promoted me to discuss the risk vs safety of staying at 2.5 vs 2 with my cardiologist and he completely agreed that 2.5 made good sense For me.

My daily dose is 3.5 to 4 mg per day. Even a small adjustment of a mg over a week can push me a bit high. As you say this a bit tricky, but after 3 years not to hard to manage. I know from experience that if I am not working out daily and eating several servings of veg, I need to adjust down to 3 or even 2.5. Because my lifestyle is very consistent (read boring) it seldom happens. Generally when we travel or have company. Now I know enough to adjsut slightly in advance and test more frequently.

Home testing is huge here. The first 6 weeks after surgery the surgeon made me promise I would lab test twice a week along with Home testing because he and my doctor wanted to keep an eye on my results. The problem was, my doctors office would call and make adjustments to my dosage that were too large, and it was creating higher than necessary swings. It didn’t take long to see this was the case and I simply made smaller adjustments than recommended by the nurse, and my INR fell nicely into line. I felt confident with this due to home testing and as I had gained a minor understanding of the risk of various INR levels from this board.

Reading here the larger dosage relative to mine that most people require is interesting. With my low dose, it makes sense that adjustments need to also be lower to achieve the same ends, as you say, it takes what it takes.

 

[Protimenow]

It's sometimes interesting how these 'experts' (the nurses) can give bad advice and, if you aren't paying close attention, can get you on the INR roller coaster.

I'm glad to see, Lynn, that you ignored the experts and took control of your own INR management.