Aspirin part two

[yotphix]

There is another aspirin thread going just now but my question would really constitute a hijack so...a separate thread it will be. Apologies if this has been covered in the past.

At the time of my release from the hospital post-surgery(AVR with Carbomedics mechanical valve), I was prescribed only warfarin for protection from clotting. INR was meant to be in the range 2.0-3.0. At my first post-surgical cardiology appointment I was seen by a young doctor from Israel who was doing his fellowship with my cardio. He put me on 81 mg Aspirin as well, stating that the most recent studies suggested it afforded significantly more protection with statistically insignificant risk of bleeding events.

At my most recent visit to the actual, usual cardiologist he stopped the Aspirin, saying that he didn't think it was worth the extra risk. I dutifully stopped taking it and didn't think about it again until last night when I was reading everything the AHA has to say about anti-coagulation. According to them, the doc on the fellowship was right. Furthermore, they quoted a Dutch study of over 15,000 patients indicating that the risk of thrombotic events increased dramatically with an INR of less than 2.5.

I'm not going to ask for any advice, and I do plan to take it up with my doctor via email but I wonder what other people have been prescribed for the same condition, which is a modern, pyrolytic carbon valve in the aortic position with no atrial fibrillation and otherwise good health, including a very active lifestyle. I suspect that my doc may be operating from old information.

Another very interesting thing on the same very dense page was a bit about warfarin interfering with clotting and with coagulation by two quite separate actions. This is interesting because it holds out the hope that one day the two may be separated and we may be offered a drug which is able to interfere with clotting while leaving coagulation unhindered.

If anyone hasn't seen the page and would like to, here it is:
http://circ.ahajournals.org/cgi/content/full/107/12/1692
It does date back to 2003 but it hasn't been updated since, and it is my understanding that the AHA is considered the leading authority on this stuff. The guide is also associated with the American College of Cardiology.

Paul

 

[Jkm7]

After my first OHS but prior to my valve replacement, I was told to take 325 mg aspirin per day.

Immediately after my tissue valve replacement and while on a short course of coumdain, I was told to take 81 mg daily along with coumadin.

When coumadin was stopped, I was again told to take 325 mg aspirin.

This per the surgeons and cardiologists at Mass General.

 

[Greg a]

After my first OHS but prior to my valve replacement, I was told to take 325 mg aspirin per day.

Immediately after my tissue valve replacement and while on a short course or coumdain, I was told to take 81 mg daily along with coumadin.

When coumadin was stopped, I was again told to take 325 mg aspirin.

This per the surgeons and cardiologists at Mass General.

I was like Jkm7 but kept on the 81mg to this day during and after the coumdain here at the cardiac centre (Canadian spelling ; 0 ) in K-W




.

 

[yotphix]

Thanks to both of you for sharing that, two for two took simultaneously, and merry Christmas too.

centre (Canadian spelling ; 0 ) in K-W.

Canadian spelling is good for me, I speak eh! (and a little hein! as well but that's rusty) I was even in both K and W last October.

 

[Protimenow]

I'm taking 81 mg, too. The low dose aspirin provides other benefits (I think I even saw something recently about reducing risks of Alzheimer's disease and some cancers). I don't think making platelets a bit slippier puts me at any more risk of coagulopathy, so I'll continue with my low (really low - baby aspirin low) daily dose of aspirin.

 

[ALCapshaw2]

Low Dose Aspirin is the usual recommendation for patients with Coronary Artery Disease.
I also hear that it helps lower some cancer risks.

I have a vague recollection that anti-coagulants work better in one area and anti-platelets work better in another (i.e. veins vs. arteries) but the details are vague in my aging memory. Bottom Line: the combination seems to provide the best results.

I KNOW that Aspirin is recommended for patients with symptoms of Stroke. I have chewed either 1/2 or a full (325 mg) Aspirin whenever I had 'visual disturbances' (possible signs of clots / TIA/mini-stroke) following my surgery with my Cardio's approval.

I currently take an 81 mg ENTERIC (coated) Aspirin - before bedtime (as recommended by Dr. Oz on his TV show - Dr. Oz is a Cardiothoracic Surgeon with an obvious interest in patient education).

'AL'

 

[bdryer]

I'm yet to have my shinny new MAV installed. That will be later Jan 2011.I will also have an ascending aorta graft. The surgeon concluded our meeting saying, I will be on warfarin and 81 mg aspirin after the transplant. I also am very athletic. My dentist thinks every one should be on 81 mg aspirin 1x daily for life after age 25. Presently on Metoprolol and 81 mg prior to my later Jan surgery.

 

[bigsidster]

Hello Yotphix---had aortic valve replacedwith mech jt jude and double bypass===also 81mg coated asprin and coumadin .

 

[olefin]

My first cardiologist started me taking 81 mg coated aspirin several years before having AVR. Since then I've had two more different cardiologist and they said stay with the daily aspirin. After taking aspirin for over 25 years I for sure wouldn't stop it on the advice of one doctor. I've always been active and still at it.
My INR control is 2.5 to 3.5.

Wife had severe blood clots 32 years ago. Afterward she was on warfarin for couple years. Then switched to 4 coated 325 mg aspirin daily for several years. Since then she has taken one coated 325 mg aspirin daily.

 

[yotphix]

It really does seem that the coated aspirin is prescribed in conjunction with the Warfarin quite often. I have a friend with subscriptions to all of the major medical online publishing sites looking for the latest info on this. I will definitely be speaking to the doc in the new year!

One thing that I noticed after stopping the 81 mg Aspirin was that I was less prone to bruising. I never really minded that part much but it was a distinct difference.

Thanks for all the input.

 

[Guest]

Immediately after my tissue valve replacement and while on a short course of coumdain, I was told to take 81 mg daily along with coumadin.

When coumadin was stopped, I was again told to take 325 mg aspirin.

This was my experience, too ... and I'm still on the 325 mg aspirin per day.



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"Never settle for the path of least resistance" ... Lee Ann Womack ... 'I Hope You Dance'

 

[ALCapshaw2]

Is 325 mg Aspirin available with a Coating (Enteric) to minimize/prevent stomach irritation / bleeding?

 

[Jkm7]

Is 325 mg Aspirin available with a Coating (Enteric) to minimize/prevent stomach irritation / bleeding?

Yes. I take one Ecotrin, safety coated aspirin, 325 mg per day.

Ecotrin’s enteric safety coating offers maximum stomach protection while still providing the heart benefits of daily aspirin therapy. As always talk to your doctor first before starting a new heart health daily aspirin regimen.

 

[olefin]

Is 325 mg Aspirin available with a Coating (Enteric) to minimize/prevent stomach irritation / bleeding?

Yes, my wife has taken 325 mg Enteric coated aspirin daily for 12 years. She had taken took 4 uncoated daily for 20 years with no stomach problems.
We use Walmart's Equate brand.

 

[Protimenow]

I"m wondering why someone on warfarin would take an enteric coated 325 mg aspirin instead of an enteric coated 81 mg. I thought that the beneficial effects of low dose were actually observed with low dose. Isn't 325 a bit of overkill, and perhaps even asking for problems?

(For myself, I used to take a baby aspirin - and once it appeared that I tolerate that dose without the enteric coating, I started quartering generic 325 mg aspirin. (This is probably as cheap as you can get -- I'm getting 200 aspirin for a buck. I haven't seen anything that said there's added benefit of using the 325 mg aspirin.)

 

[yotphix]

I"m wondering why someone on warfarin would take an enteric coated 325 mg aspirin instead of an enteric coated 81 mg. I thought that the beneficial effects of low dose were actually observed with low dose. Isn't 325 a bit of overkill, and perhaps even asking for problems?

(For myself, I used to take a baby aspirin - and once it appeared that I tolerate that dose without the enteric coating, I started quartering generic 325 mg aspirin. (This is probably as cheap as you can get -- I'm getting 200 aspirin for a buck. I haven't seen anything that said there's added benefit of using the 325 mg aspirin.)

Just out of curiosity Protime, how do you quarter an aspirin neatly? Do you use a razor blade or something?

 

[Jkm7]

I"m wondering why someone on warfarin would take an enteric coated 325 mg aspirin instead of an enteric coated 81 mg. I thought that the beneficial effects of low dose were actually observed with low dose. Isn't 325 a bit of overkill, and perhaps even asking for problems?

(For myself, I used to take a baby aspirin - and once it appeared that I tolerate that dose without the enteric coating, I started quartering generic 325 mg aspirin. (This is probably as cheap as you can get -- I'm getting 200 aspirin for a buck. I haven't seen anything that said there's added benefit of using the 325 mg aspirin.)

Without knowing a patient's medical history and full reason their M.D. had prescribed 325 mg daily aspirin, I wouldn't expect to know.
Some heart valvers have other heart issues aside from their valve replacement/repair. Some may be high heart attack risk, may have had heart attacks or who knows what else.
I imagine all those years of medical school, internship, residency, fellowships etc must teach these doctors something about which we non-professional are unaware.

 

[Protimenow]

Just out of curiosity Protime, how do you quarter an aspirin neatly? Do you use a razor blade or something?

Actually, no. I've got strong thumbnails and I'm able to break the 325 in half pretty easily (I could probably use a pill splitter for a more accurate cut). However, getting the quarters evenly is another matter. I'm not taking exacty 81 mg with each dose, but I figure that it will average out - and being a little above or a little below 81 mg shouldn't make that big a difference over time. (This isn't like warfarin where you have to be much more exact -- 70 mg aspirin one day and 90 the next probably won't make a whole lot of difference). Of course, if I wasn't so damned cheap, I could get the 81 mg Enteric coated aspirin for a few bucks for a hundred or two at Costco.

 

[normofthenorth]

I'm with Protimenow on the splitting, but I use a "real" pill splitter from the Dollar store (Dollarama). It's got a "base" that holds the pill securely, and a "lid" with a little razor blade. One cut, rotate 90 degrees, cut again, voila! I'm sure my dose is varying from ~75-~88 mg/day, but it's pretty close.

I've never noticed any gastro-intestinal upset from taking uncoated aspirin/ASA, and the premium they charge for smaller pills deeply offends me. Heck, I could understand if pills FOUR times smaller were only TWO times cheaper. But they're MUCH MORE EXPENSIVE PER PILL!! So you know the whole issue is competition, or lack of it, willingness of most baby-aspirin customers to pay the huge premium, etc., etc. And I won't play. (Of course, the premium is only "huge" in percentage terms, since baby aspirin is still a pretty cheap drug.)

Actually, when my DW filled my Coumadin prescription, she also filled a prescription for coated baby Aspririn, so I'm currently taking those 'til they run out! And my huge cheap jug of generic 325 Aspirins has finally reached its best-before date, and is starting to have a wiff of vinegar to it (a sign that the ASA is starting to break down into Salycilic Acid and Acetic Acid), so it'll be time for a new huge cheap jug when these fancy little coated things run out.

My Cardiologist thinks that everybody (and certainly all full-grown males) should be on a daily baby aspirin, regardless of heart history, HVRs, or Coumadin. I think most of the evidence supports that view, at least for the average among us.

 

[yotphix]

"My Cardiologist thinks that everybody (and certainly all full-grown males) should be on a daily baby aspirin, regardless of heart history, HVRs, or Coumadin. I think most of the evidence supports that view, at least for the average among us."

There are cardiologists who think that all men over 40 should be on the full cardiac cocktail. Asabetastatipril or something like that, though some would also include plavix.