Warfarin and Asprin

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dick0236

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Odd my surgeon has me on both and cardiologist was fine with it. I believe it is an accepted practice as long as you don;t have high risk bleed risks as it makes the platelets less sticky.
Many years ago my docs had me on Coumadin and regular asparin (325mg). That was in the early 1970s and another cardio soon took me off the asparin. A couple years ago my current cardio put me back on "baby asparin"(80mg) along with warfarin for the reason you stated in your post above. Now I understand that this warfarin/80mg asparin combination is being questioned again. I'll probably discuss this with my cardio during my annual checkup.
 

Zoltania

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For the first three months after my mitral valve surgery I was on both warfarin and 81mg of aspirin. Since then I still take the aspirin, but no prescription medications. Clearly the warfarin and aspirin were thought to play together well for that post-surgery period where endothelialization was occuring.
 

afraidofsurgery

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I was informed by my new cardiologist that 80 mg aspirin in addition to warfarin is the Amer Coll of Cardiology guideline, see https://www.acc.org/latest-in-cardiology/articles/2015/05/18/09/58/anticoagulation-for-valvular-heart-disease
My prior cardiologist didn't bother with this, IMHO won't make a difference either way. The ACC guideline states low risk for bleeding (presumably with the warfarin therapy) as a prerequisite. The warfarin is a coagulation pathway vitamin K inhibitor, the aspirin is an anti-platelet therapy.
So now I take warfarin and the 80 mg/d aspirin, after 10 years without it. Go figure.
 

dornole

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Wow Jane, our dx stories are pretty similar. I also received the brushoff and an inhaler, even when said I couldn't go up a flight of stairs without stopping to rest, couldn't lie down to sleep due to the extreme coughing, and was coughing up some blood. (I was 34, pregnant and it was the genius OB GYN who totally missed the boat). It was only when I went to the urgent care with the same symptoms that a random doc sent me to the hospital IMMEDIATELY for an echo. Admitted then sent to a DIFFERENT hospital in an ambulance. Within 24 hours I had a dx of rheumatic heart disease and two 27-weeker babies.

My OB completely missed the boat. I saw him the day before all this with all the same symptoms. I tried to excuse it but I was also angry. Very angry. New doctor for me,just ghosted him and went elsewhere. Had to fire the babies' pediatrician too as he clearly had no idea how to deal with preemies. I would not have done that before, like you I respect doctors as a whole, but both those docs were out of their depth. I learned to stick up for myself and for my kids.

I think your anger is here to tell you something, that you need to act. Your doc is out of his depth. In addition, he screwed up royally on your dx, and he seems to be a dismissive, grumpy, arrogant guy you don't even like. I would not even have the discussion. Start by getting a second opinion somewhere, make a consult appt and ask the new doc their approach to warfarin management. Another town if need be. You deserve a doc who listens to you and is kind and competent. I'm not sure your current doc is any of those.
 
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Jane, I hope you have some good feelings about how you’re going to proceed. I didn’t get a chance to read all the replies (so many, which is awesome!), but I wanted to add in my 2 cents based on 2 years post OHS mechanical aortic valve for my 13 year old son. He takes 6 mg Coumadin, which seems to keep his INR between 2 and 3 nicely. We have blood drawn, which is more reliable than finger prick when your levels are in the higher range (could be more accurate and correlate to blood draw when lower - 2-2.5?), so I’m glad you’re looking into (or have now) a finger stick machine at home. I don’t see the point of doing it at the dr office. Also, my sons primary or cardiologist doesn’t manage his INR, but then anticoagulation clinic at children’s hospital does. They draw blood (we love close) and we follow their adjustments when necessary to the T. They can’t make reliable recommendations if they don’t know what’s going on and we are not consistent with dosing. We have missed a dose before and just call in to ask what to do.
I dont think you have to ditch your doctor, just don’t use him for monitoring your INR as the people who do it all day long are much better at it.
 

SHARKY

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Aspirin and Coumadin do not mix well. Your doctor should have told you that.
I had been told to take the adult/ASPRIN {one tablet} along with the Coumadin, and I over the years I stopped the aspirin, now I am glad that I did, the VA placed me on baby/aspirin though, and I was taking that, but as I said, I stopped. how long ago i don't remember now, many years back. They have had me on Warfrin now for like a ton of years, as my Mitral Valve went bad back in 1998, the time of my first surgery to fix it, then they gave me a MECH one JUNE/2015! WOW, doctors, what is going on? dont they take an oath of some sort to become one? who knows, maybe they stopped that AND DIDNT tell anyone!!?? say what??
 

SHARKY

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I took an 80 mg baby aspirin for a couple of years after my mechanical mitral valve replacement in 2005. Right up until I developed a bleeding ulcer. I can no longer take any NSAIDs.
I am very sad and sorry to hear that, they had me on ASPIRIN for many years, and that with the Coumadin, WOW, i had no idea, and no one says anything, not even the heart doctor, even the VA had me on BABY ASPIRIN....WOW. haven't take it for years now, for some reason it didnt feel right, now I know my angel was watching on me, and told me to not do it, that i really believe is where feelings sometimes come from, yes i and a believer for sure. your heart will never lie to you I think!
 

vitdoc

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I was not aware of evidence that Aspirin augments the effects of Warfarin in reducing emboli/thrombotic events after artificial valve surgery. The reference noted by afraidofsurgery https://www.acc.org/latest-in-cardiology/articles/2015/05/18/09/58/anticoagulation-for-valvular-heart-disease clearly states that low dose Aspirin improves the odds of not having embolic/thrombotic events. If you look at this article it mentions different level of evidence for the recommendations. This link talks about the different levels of evidence. https://libguides.winona.edu/c.php?g=11614&p=61584
As I have mentioned in other posts the buzzword in medicine now is "Evidenced based". Much of medicine is based on theoretical or gut feeling some is based on good studies. The better the studies the better the evidence. So there have been studies that were deemed solid that suggested that adding Aspirin to Warfarin may be a good thing in patients with mechanical valves.
The only caveat to this recommendation by the cardiology community was throwing in the idea that if there is a high bleeding risk then the Aspirin should be avoided. Exactly what a higher risk for bleeding means is not defined in the recommendation.
So there appears to be good evidence that adding Aspirin to Warfarin may be good except for increasing the bleeding tendency. I am trying to decide if I will start taking Aspirin. Not sure since I am still pretty active and I don't like increasing my bleeding tendencies.
 

dick0236

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I am on 5mg warfarin and 80mg "baby aspirin" daily. I have been on warfarin 52+ years and started the 80mg aspirin about 4 years ago. I have noticed no change in my INR (2.5-3.5), bruising or bleeding tendency since the aspirin was added. My cardio told me the aspirin helped in making blood cells "slick" and had little to do with anti-coagulation. I've seen a number of posts in the past couple of years that question the use of these two drugs together. I'll need to discuss this with my doc.
 

Warrick

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What about everyone with an onx valve and the 1.5-2.0 inr range WITH asprin, it must be doing something right...
There was the poster last year who had a stroke on this low inr protocol because as I remember their genetics meant asprin didnt have the desired affect on their platelets-
 
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Warrick

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From the link posted above by afraidof surgery-
  • With mechanical mitral or aortic valve at low risk of bleeding, an antiplatelet agent such as low-dose aspirin (50 to 100 mg/day) is recommended in addition to long-term VKA therapy (Grade 1B recommendation)
I know the link is from 2015 but has anyone got anything newer to suggest otherwise?
From Onx-

And from that page if you subscribe to the low INR protocol-
“INR can be safely maintained at 1.5 – 2.0* in On-X Aortic Valve patients. Combined with low dose aspirin, this therapy reduces the risk of bleeding by >60% compared to the standard INR range of 2.0 to 3.0, without an increase in TE events1 (Table 2).”

This isn’t based on some willow the wisp idea
 

Keithl

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What about everyone with an onx valve and the 1.5-2.0 inr range WITH asprin, it must be doing something right...
There was the poster last year who had a stroke on this low inr protocol because as I remember their genetics meant asprin didnt have the desired affect on their platelets-

I am new to this as my On-X valve is 4 weeks old, but I don’t care that they say I can go 1.5-2.0 my plan is go go 2.0-2.5 once my initial 90 days of 2-3 is over. My goal now and going forward is get to as close to a steady 2.5 as possible. My surgeon has my on baby Asprin every day which I had been taking for over 20 years anyway. There is someone on here that had a TIA with an On-X between 1.5 - 2.0 and bumped himself up. The difference in bleed risk is minimal to me to go to 2.5 vs the reduction in TIA or other thrombotic event. To me it also gives me a better cushion should I eat something that causes a dip in my INR.

To me it is about finding a cardiologist that will collaborate with you. I am in the middle of switching cardios as my current one was being a pissy ass because I went out of state and chose a mechanical valve vs. tissue.
 

Gustav

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On-X user here for these past 3 years and have been on 75mg daily Aspirin. I try to keep my INR at around 2.0-2.2 with weekly checks my average dose varies around 7-8mg I realise when temperatures increase around summer time I always need to take that extra 1mg every now and then, could be more salads not sure. I also questioned this extra aspirin as it bothers me to take that something extra knowing that I may have repercussions in years to come btw I'm turning 40 in a couple of weeks time. My cardio tells me no issues we have millions of ppl on aspirin with no relevant issues. I'm a pretty active person training 2-3 times a week lifting weights and doing cardio and never had any issues of bruising etc. I was also put on a beta blocker (carvedilol) from day one after my op but pushed that down to a 6.25mg per day half morning half evening. Honestly think its useless. I always think that this mix could one day effect my liver but again my cardio told me nothing proven.

Apart from the above I'm the fittest I've ever been and lead a normal life with only the odd thought here or there.

Any questions fire away.

Gus



I am new to this as my On-X valve is 4 weeks old, but I don’t care that they say I can go 1.5-2.0 my plan is go go 2.0-2.5 once my initial 90 days of 2-3 is over. My goal now and going forward is get to as close to a steady 2.5 as possible. My surgeon has my on baby Asprin every day which I had been taking for over 20 years anyway. There is someone on here that had a TIA with an On-X between 1.5 - 2.0 and bumped himself up. The difference in bleed risk is minimal to me to go to 2.5 vs the reduction in TIA or other thrombotic event. To me it also gives me a better cushion should I eat something that causes a dip in my INR.

To me it is about finding a cardiologist that will collaborate with you. I am in the middle of switching cardios as my current one was being a pissy ass because I went out of state and chose a mechanical valve vs. tissue.
 

Keithl

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On-X user here for these past 3 years and have been on 75mg daily Aspirin. I try to keep my INR at around 2.0-2.2 with weekly checks my average dose varies around 7-8mg I realise when temperatures increase around summer time I always need to take that extra 1mg every now and then, could be more salads not sure. I also questioned this extra aspirin as it bothers me to take that something extra knowing that I may have repercussions in years to come btw I'm turning 40 in a couple of weeks time. My cardio tells me no issues we have millions of ppl on aspirin with no relevant issues. I'm a pretty active person training 2-3 times a week lifting weights and doing cardio and never had any issues of bruising etc. I was also put on a beta blocker (carvedilol) from day one after my op but pushed that down to a 6.25mg per day half morning half evening. Honestly think its useless. I always think that this mix could one day effect my liver but again my cardio told me nothing proven.

Apart from the above I'm the fittest I've ever been and lead a normal life with only the odd thought here or there.

Any questions fire away.

Gus
My surgeon switched me form an ACE inhibitor to a beta blocker and I am not thrilled with side effects. HE had me on 50mg but my BP was running 99/60 which was compounding the beta blocker side effects, I cut that in half and not run 105-110/70. I understand the move to a beta blocker during recovery as it shields the heart from adrenaline and sudden increases in heart rate and BP, but I would think after 3 months that should not be needed and I can go back to my ACE inhibitor.
 

LondonAndy

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If helpful, here in the UK I have been on baby aspirin with my warfarin since leaving hospital almost 5 years ago, and have understood it to be intended to be permanent.
 

Protimenow

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I take baby aspirin and warfarin. I doubt that it has any effect on my INR. Because I DO take the baby aspirin daily, whatever impact it has on my INR is consistent.

Low dose aspirin (well, the same as baby aspirin, but a tiny pill that I swallow at bedtime) is supposed to help heart patients. KeithL said that it relaxes the blood vessels. For me, I don't know what, if anything, would happen if I stop taking it. (BTW- at Costco, the 81 mg aspirin are about a penny apiece). I plan to continue taking the low dose aspirin.
 

vivekd

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I hope you don’t mind if I jump into the conversation. I have been a long time reader, but rare commenter, and have found some very valuable information on this site. All that being said, my 2 year anniversary is coming up next week on May 23rd and I have been on the 81 mg aspirin and warfarin regimen since surgery. My target INR is 2.5 - 3.5 and I typically test approximately every 3 weeks, IF I am with in range. If not in range then I will test again in 7 - 10 days.

I would like to ask some of you if you are having the same problems that I am experiencing. My INR is like a roller coaster, as I might be in range at 3.0 and the next test be at 1.5 then the next test back at 2.5 and the next at 5.5.
My current dosage is 12 mg Tues & Sat and 8 mg all other days.

I have tried to control this via diet, as my diet varies very little since my surgery. My doctor has tried to be conservative in adjusting my warfarin dosage. I finally got frustrated and asked if there was a different blood thinner we could try and was told there was not another that was approved for mechanical heart valves. I will add that this has been going on since OHS.

Anyone else struggling with this problem? Is there a different thread for this topic, if so my apologies for hijacking this one!
I'd the same issue.

I'm trying to maintain INR 2.5 - 3.5 and take 13-15 mg warfarin and 1 baby aspirin.

My INR also has a wild range and my body does not keep any residual warfarin, so if I miss my warfarin dosage, my INR nose dives from around 3 to 2.
I've been advised to move from generics Warfarin to brand name coumadin.

-- Vivek
 

dick0236

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I'm trying to maintain INR 2.5 - 3.5 and take 13-15 mg warfarin and 1 baby aspirin..........
My INR also has a wild range and my body does not keep any residual warfarin, so if I miss my warfarin dosage, my INR nose dives from around 3 to 2.
I've been advised to move from generics Warfarin to brand name coumadin.
My range is also 2.5-3.5 on 5mg warfarin for the last several years. I started 81mg aspirin daily a couple years ago with no effect on INR. I was on Coumadin while it was still patent protected and for several years after it was off patent because doctors were scared to prescribe the generic warfarin. I have been on generic warfarin for the past 10-15 years with no effect on INR. I have found that changing brands of warfarin (mfg. tolerances and/or inactive ingredients) can affect my INR......so I am careful to stay with one brand "Taro".

PS: If I miss a dose my INR will also drop like a rock.......that's why I keep pills in a seven day pill box.
 

sharky7

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My range is also 2.5-3.5 on 5mg warfarin for the last several years. I started 81mg aspirin daily a couple years ago with no effect on INR. I was on Coumadin while it was still patent protected and for several years after it was off patent because doctors were scared to prescribe the generic warfarin. I have been on generic warfarin for the past 10-15 years with no effect on INR. I have found that changing brands of warfarin (mfg. tolerances and/or inactive ingredients) can affect my INR......so I am careful to stay with one brand "Taro".

PS: If I miss a dose my INR will also drop like a rock.......that's why I keep pills in a seven day pill box.
I have not seen your entire story, but I am 2015/JUNE with a brand new SAINT JUDE MITRAL VALVE, some have told me, baby aspirin perhaps for life. before this surgery, I had been on regular adult aspirin for many years, i am currently taking none, my INR is suppose to be 2.5-3.5 and is becoming more difficult to maintain as of lately, the VA has had me coming in every 7 days for awhile now, over a month or so. I am going to try and get a machine to self test. the last two tests it was 2.2, so i am now..hmmm steady, ya right I should be so lucky, for the longest I have been on 4mg per day, now they just adjusted it to, 4mg per day, FRIDAY 4.5mg. Mine also sinks, or at least seems to on doses missed, what I do now, is if i catch it fast enough, I will take my missed dose as early the next day then take that days dose a tad later then the time i normally take it, as in...late that night, then back to normal dose that next day, i find this works well. And when they tell you it takes at least 5-7 for Warfarin to kick in, i think that time is a bit less then that, well seems to me anyway. more like 2-3 days to kick in, or less. [what i dont understand is, the first 2.2 INR i had recently, they took me off the shots, then when i tested 2.2INR again, the VA calls me back and tells me, that they had a "chat" and come to the conclusion that i needed to go back onto the shots, uugghhhh, I am not taking them. they even sent me overnight mail, those extra SHOTS even though I already had them from not using them. [[[DOES ANYONE HERE self test, please give me all the data, machine you are using, and the details about using it, cost, and all. I think the insurance covers but i am not sure, am trying to find out now.]]]
Well i do have some very good news, Fla. is a MEDICAL WEED state now, and I came off from using a bit of TRAMADOL [dont use it at all now], + some others i dont remember the name right now, and am using WEED OILS just before sleep at night.
 
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