unexpected new warning on my new warfarin supply

pellicle · Dec 20, 2024

weird IMO

but lurking around the corner

which is weird and potentially dangerous because for valvers (esp those on lower INR ratings) aspirin is actually usually guidance.

So if you get this then consult with your Cardio or Surgeon

Best Wishes

3mm · Dec 21, 2024

My recent refills here in the USA have that same warning, but in much smaller print.

Superman · Dec 21, 2024

Seems a standard warning. Most only take low dose aspirin with warfarin based on their cardiologists instructions anyway.

You don’t want to randomly take pain relief doses unless you have no other choice.

Chuck C · Dec 21, 2024

Just checked mine. It also has the warning but in very small print.

pellicle · Dec 21, 2024

Thanks guys, seems weird to me because almost every study into mech valve warfarin usage uses low dose aspirin with that. Further I would have thought that its only us valvers who are on warfarin nowdays.

Lastly the studies mentioned by this guy should dispel the idea that aspirin causes bleeds (when its usually a heliobacter infection)
https://www.valvereplacement.org/th...ysis-study-focus-on-bleeds-and-cancer.889418/

¯\_(ツ)_/¯

carolinemc · Dec 22, 2024

pellicle said:
weird IMO

View attachment 890752

but lurking around the corner

View attachment 890755

which is weird and potentially dangerous because for valvers (esp those on lower INR ratings) aspirin is actually usually guidance.

So if you get this then consult with your Cardio or Surgeon

Best Wishes

This might a new thing there in Australia. Good to ask your Cardio or Surgeon.

Lisa from LJ · Dec 22, 2024

Between moving and changing jobs, I've had 7 Cardiologists since having my valve replaced in 1998. None have recommended aspirin, even a baby aspirin. I've only actually asked two of them and one said he didn't recommend it for me because I haven't had any emboli or CAD. The other said she didn't think it was necessary, but I could try if I wanted, but to make sure I watched for excessive bruising. Within 2 weeks, I had several bruises on my legs and stomach even though my INR was in range, so I stopped.

My bottle and the pages of information they give me have always said to avoid NSAIDs without consulting a physician.

Protimenow · Dec 23, 2024

this seems like CYA from the makers of Marevan/Warfarin. No, you shouldn't take high doses of aspirin or other NSAIDs when you take warfarin. Too much can cause gastric bleeds - which are even worse if you're on warfarin. Aspirin messes with platelets, so it takes longer for your blood to clot.

I've been taking 81 mg for years - I now take 162mg every other day - recent research indicates that low dose aspirin may help reduce cancer risk.

I haven't had a clotting issue with low dose aspirin, and I wouldn't be surprised if others similarly report that they haven't had any issues with aspirin and warfarin.

But, to cover MY butt, I am not suggesting that ANYONE should take an NSAID if they're taking warfarin.

Windfinder · Dec 23, 2024

Lisa from LJ said:
Between moving and changing jobs, I've had 7 Cardiologists since having my valve replaced in 1998. None have recommended aspirin, even a baby aspirin. I've only actually asked two of them and one said he didn't recommend it for me because I haven't had any emboli or CAD. The other said she didn't think it was necessary, but I could try if I wanted, but to make sure I watched for excessive bruising. Within 2 weeks, I had several bruises on my legs and stomach even though my INR was in range, so I stopped.

My bottle and the pages of information they give me have always said to avoid NSAIDs without consulting a physician.

Unless you have an On-x in aortic position and are shooting for the low INR range of 1.5-2.0 aspiring is not part of a regular ACT protocol.

3mm · Dec 23, 2024

Windfinder said:
Unless you have an On-x in aortic position and are shooting for the low INR range of 1.5-2.0 aspiring is not part of a regular ACT protocol.

Some cardiologists think low dose aspirin is a good insurance policy.

I have an On-X aortic valve. I maintain my INR at 2.5 and I take 81 mg aspirin daily per my cardiologist. She said there are mixed study reports, but it seems to be a good insurance policy as long as I tolerate the aspirin well. If I start having problems, then we may stop the aspirin.

My cardiologist was visible hurt when she told me that a patient earlier that year had a stroke despite maintaining correct INR. She thinks aspirin may have helped that patient.

Protimenow · Dec 23, 2024

There is NO ADVANTAGE to following the ridiculous protocol that On-X recommends. Maintaining an INR above at least 2.0, and ideally around 2.5 will be more protection against strokes. As far as bleeding risks between 1.5 and 2.0 -- you won't see any. You'll live your life the same with 2.5 as you would at 1.5 - but you will be much less likely to have a stroke.
Aspirin (81 mg) shouldn't hurt you, but should also help slightly extend your clotting time.

Personally, if I had an On-X valve, I'd ignore the ridiculous dosing they suggest (it's all marketing BS) and shoot for a higher INR. I'd consider that my life depends on it.

pellicle · Dec 23, 2024

Good morning

I'm curious

3mm said:
My cardiologist was visible hurt when she told me that a patient earlier that year had a stroke despite maintaining correct INR. She thinks aspirin may have helped that patient.

what was the INR they were maintaining?

guidelines typically suggest a target of 2.5

11.2 Antithrombic Therapy

It only goes up from there if there is any other compounding risk factor (such as AFib ...).

Thanks

3mm · Dec 23, 2024

pellicle said:
what was the INR they were maintaining?

I don't know that patient. Hence, I don't know their target, nor do I know how well they maintained their target.

This was an example of my cardiologist's deep concern for her patient's health and her knowledge of the medical issues.

pellicle · Dec 23, 2024

3mm said:
I don't know that patient. Hence, I don't know their target, nor do I know how well they maintained their target.

It was a long shot, but worth asking

Protimenow · Dec 24, 2024

This person was talking about the On-X recommendation of 1.5-1.8, with an 18mg aspirin daily.

pellicle · Dec 24, 2024

Protimenow said:
This person was talking about the On-X recommendation of 1.5-1.8, with an 18mg aspirin daily.

which person? If this person

then the other person didn't seem to be

dornole · Dec 24, 2024

Like 3mm I’m prescribed 81mg aspirin daily by my cardiologist, in addition to warfarin at a range of 2.5 to 3.5. I have a mechanical mitral and repaired tricuspid. I don’t have any coronary artery disease but I did have a TIA and afib prior to surgery. This use of aspirin when indicated seems to track with the AHA guidelines, which is unsurprising as my cardiologist is listed as an author.

I will say that I have had no bruising at all on this regimen, whereas when I was on 325 mg aspirin daily after my mitral repair for more than 20 years, I bruised a lot more.

carolinemc · Dec 25, 2024

3mm said:
My recent refills here in the USA have that same warning, but in much smaller print.

I am in the USA looking at my bottle and no warning at all. I just go by my cardio instructions. My cardio is at a teaching hospital.

unexpected new warning on my new warfarin supply

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