81mg Aspirin, and then another NSAID as needed?

[jyg]

Hello VR friends,

I did some searching on VR.org before I wrote this question and all I saw were answers in reference to questions about warfarin plus NSAIDs, not doubling up if you already take 81mg daily. So, obviously, I take 81mg daily, and no other thinners, for my bioprosthetic aortic valve and Dacron graft in my proximal arch . Once in a while, usually for migraines I take one or two Aleve. It's the only thing that's ever helped. Then I read how doubling up might not be a good idea for the stomach, similar to warfarin (etc.) plus 81mg. But I can never get a feel for the risk or the circumstances being evaluated, if the resource I'm reading is referring to the occasional dose of extra NSAIDs or taking the daily 81mg plus a sustained regimen of another. So, for migraines, I've pretty much stopped taking anything and just deal with it. I've sort of got a mind-over-matter way of dealing with it that's works pretty well. But, right now, I've ever got a mild strain/sprain in my toe, or it's a mild dose of gout, and I would just love to take 400mg of Aleve to knock the edge off... in addition to my daily 81mg. Before my VR, in a situation like this I would take 2 Aleve, and then 1 more every 12 hours for perhaps another day.

To be honest, I'm going to take that initial dose right now But, since I cannot find a straight answer from the pencil pushers, I'm curious to know the opinions of the actually experienced folk on VR.org. Is the occasional extra NSAID not a problem, or is it just as risky as a sustained regimen? Secondly, if I haven't yet taken my 81mg that does, and I take Aleve, would it be a good or bad idea to skip the 81mg? I always figured 81mg was taken because it is the smallest effective dose and plain, old aspirin is much cheaper than any other NSAID. True?

Thanks for your thoughts,

jyg

 

[honeybunny]

My cardio told me it was fine to take Aleve for headaches and I am on 325 aspirin. I suggest you check with your cardio.

 

[AZ Don]

81mg is what used to be a children's dose, before children were advised not to take aspirin. I take 1-2 ibuprofen as needed for headache. When recovering from a shoulder issue I was prescribed to take up to 4 ibuprofen at a time. I don't think the small dose of aspirin is an issue when combined with meds that you only take once in a while.

 

[Protimenow]

81 mg is 1/4 of a regular aspirin. Many are enteric coated, which means that they don't dissolve in your stomach (although I'm not sure where the actual platelet effect happens - but it won't hurt your stomach, because it doesn't dissolve IN your stomach). I doubt that an extra dose of 81mg of aspirin is likely to cause you any problems.

I'm not sure if Advil's effects on your INR will show up - NSAIDs make the platelets less 'sticky,' which means that clotting speeds change - but I'm not sure if testers show this effect.

I doubt that adding an NSAID to take the edge off, short-term, is that big a deal.

 

[dornole]

I'm on 325 mg aspirin a day and I just take more if I need pain relief, which is thankfully rare.

 

[Protimenow]

The idea behind limiting the use of NSAIDs is that they may cause gastric bleeding if your stomach can't handle the acid. The concern about NSAIDs and warfarin is that, if your INR is high, and your stomach bleeds because of the aspirin/aleve/etc., your stomach may bleed more than it should.

If you tolerate NSAIDs, I personally don't see much of a problem taking them.

Also - if you are not taking warfarin, or are taking a small dose and keeping your INR low, the risk of excessive bleeding is not particularly great.

For old people like me, with a 25 year old valve, and the need to keep INR between 2.5 and 3.5, the risk of a stomach bleed is higher than it is for people on lower dose warfarin.

NSAIDs will not, technically, raise your INR - although they make your platelets less 'sticky' so they may increase clotting times.

Personally, I take 81 mg enteric coated aspirin at night (the coating keeps the aspirin from dissolving in my stomach), and an occasional ibuprofen for pain. I see little reason to AVOID NSAIDs outright - unless they irritate the stomach and cause bleeding.

Remember, too, that a higher INR (2-3, versus the 1.7 or so for newer valves) is protective - it helps to reduce clot risk.

 

[jyg]

Thanks for all of your answers. I should also add that I eventually got the chance to ask my cardiologist and he said it was certainly not a problem. The warnings really apply to people who take at least the recommended dose of NSAIDs beyond the cardio-dose on a very regular basis, like someone with chronic pain.

 

[Jamey T]

It is good to see your reply, that being said, I take an 81 mg. and was advised not to take Aleve. Like you, it was the only thing that seemed to help with my migraines. Since my surgery, I have had the auras a few times, but no headache to follow. I used to like Aleve.

 

[DachsieMom]

I have a mechanical valve with graft. I was advised to take Tylenol as soon as the aura starts - never aleve - and most of the time, I never get the headache. I also take 81 mg aspirin per day, plus Coumadin. I never had migraines until the week of my surgery, but it could be hormonal (aconicidence of timing).

 

[Protimenow]

I get the aura - sometimes way more frequently than I'd like to get them (of course, I'd prefer to NEVER get them, or have them come on when I'm asleep and not aware of them). I've been getting them for decades, although the location and severity seem to have switched.

I haven't really found that aspirin, ibuprofen, or other NSAIDs have done any good. They seem to have helped to make the auras that usually last about 1/2 hour go away in 30 minutes. Occasionally, something with caffeine or a piece of dark chocolate will turn the damned things off.

As far as fear of Aspirin or other NSAIDs go, these particular 'drugs' act differently on clotting than Warfarin does -- they make platelets less sticky. Warfarin has an effect on the formation of fibrin. As long as the NSAIDs don't burn your stomach, causing a bleed, and you don't take too much of the stuff, an occasional boost in your intake of a pain reliever shouldn't be much of a concern. (Tylenol never seems to work for me - I've stopped trying).