81 mg aspirin no longer recommended?

[AZ Don]

I don't believe that aspirin, dissolved in the intestines, causes intestinal bleeding. The bleeding issues are in the stomach. Taking a pill that doesn't dissolve in the stomach bypasses the gastric bleeds that some untreated aspirin can produce. That's why people take the enteric coated aspirin.

Although I can find references to coated aspirin causing less stomach upset I find nothing indicating it reduces the risk of bleeding, and apparently neither did Harvard:

Although enteric-coated aspirin might lead to less stomach irritation, the covering has not been proven to lower the risk of aspirin's most common worrisome side effect — bleeding in the stomach or intestines. No matter where aspirin dissolves, the drug gets into the bloodstream, and once there, it interferes with blood clotting (which is why it helps prevent heart attacks).

https://www.health.harvard.edu/heart-health/aspirin-advice-coated-vs-plain

 

[Keithl]

I don't believe that aspirin, dissolved in the intestines, causes intestinal bleeding. The bleeding issues are in the stomach. Taking a pill that doesn't dissolve in the stomach bypasses the gastric bleeds that some untreated aspirin can produce. That's why people take the enteric coated aspirin.

I will need to do some digging, but that is the issue I recall reading about. The aspirin causes intestinal bleeding and I believe my GI reminded me of that a few years back. Again I have been on aspirin for over 20 years with no issues and have no plans to give them up.

 

[carolinemc]

Enteric coated aspirins don't coat the stomach. They've got a coating that prevents the stomach acids from dissolving it. Enteric coated aspirins dissolve in the intestines, and the aspirin is absorbed in the intestines.

Thanks for repeating my comment, the coating is to coat the stomach. Thanks for the repeat.

 

[carolinemc]

“What a coumadin(warafarin) emergency is, when the INR(protime) numbers are so low, that you risk a very serious bleed.”

@carolinemc dont you mean high?
A high protime or inr is the bleeding risk, low is clot risk increases

Also applies to a High INR. Stand corrected.

 

[Protimenow]

NO. I DID NOT REPEAT YOUR MESSAGE. The coating in the enteric coated aspirin DOES NOT COAT THE STOMACH. It prevents the aspirin from DISSOLVING in the stomach.

 

[Amy]

This sounds scary:

https://pubmed.ncbi.nlm.nih.gov/25501289/
I’ve had constant lower abdominal pain for three months now, and am trying to find a potential cause. It’s two years post op, and I’ve been on 81 mg aspirin a day with warfarin. Has anyone else had chronic pain develop in your lower abdomen? Any thoughts on what else it could be?

Hope you’re all well.

 

[dick0236]

My cardio put me on 81mg aspirin a couple of years ago. I have a nose bleed problem due to deviated septum (crook in nose) that aggravates the nose bleed problem. A couple weeks ago I had a serious nose bleed that required treatment in an ER. A few days later I saw an ENT for followup and he strongly suggested I discontinued the 81 mg aspirin. I notified my cardio that I was stopping the aspirin. He said it would be OK for a couple of weeks. My next appointment in June I will tell my Cardio that I am discontinuing the aspirin....for good. I've gone many years without taking aspirin and I am not going to start now. At my age quality of life rules!

 

[pellicle]

At my age quality of life rules!

I totally agree ****, further if you haven't had any TIA's to indicate you may benefit from aspirin I'd eschew it too.

 

[dick0236]

I totally agree ****, further if you haven't had any TIA's to indicate you may benefit from aspirin I'd eschew it too.

Actually, I did have a TIA.......in 1974 (almost 50 years ago) that I am sure was triggered by my own lack of knowledge about Warfarin that was compounded by the medical docs maintaining my PT (that was before the INR system was developed) at 1-1/2 x normal.......about 18 seconds?? (1.6 INR). I am not a doc but it doesn't take a genius to figure that was a disaster waiting to happen.

 

[pellicle]

Hi

Have you discussed this issue above with your GP

Any thoughts on what else it could be?

I don't, but equally (as I just mentioned above to ****) if your INR is in range you could just discontinue the aspirin and see if you develop any issues from that (such as a TIA).

If none emerge then perhaps aspirin is not needed.

I would however be cautious about ascribing a symptom you read about to aspirin, but a good first step would be to eliminate that and see if it makes any difference.

Myself I have my aspirin every second day because I find that if I don't have aspirin now that I do get slightly TIA sorts of symptoms (which I don't get when I take aspirin).

 

[pellicle]

Hi

Actually, I did have a TIA.......in 1974 (almost 50 years ago)

I was sorta meaning more recently ;-)

that I am sure was triggered by my own lack of knowledge about Warfarin that was compounded by the medical docs maintaining my PT (that was before the INR system was developed) at 1-1/2 x normal.......about 18 seconds?? (1.6 INR).

agreed, especially since that valve is rated higher in thrombogenicity than a modern bi-leaflet in the mitral postion is ... but now your INR is more like >2.5 isn't it?

So I was meaning with respect to your current situation and the now emergence of evidence (a bleed event) which would suggest you should tune anticoagulation / anti-platelet a bit lower.

I was focusing on the aspirin (anti-platelet).

Your call really, I'm just throwing around ideas and support

 

[carolinemc]

This sounds scary:

https://pubmed.ncbi.nlm.nih.gov/25501289/
I’ve had constant lower abdominal pain for three months now, and am trying to find a potential cause. It’s two years post op, and I’ve been on 81 mg aspirin a day with warfarin. Has anyone else had chronic pain develop in your lower abdomen? Any thoughts on what else it could be?

Hope you’re all well.

I used baby or coated aspirin with my warfarin. I had an eye stroke a few years ago and before it happened, I was off the aspirin for several years. But after, they wanted me back on it.

 

[dick0236]

agreed, especially since that valve is rated higher in thrombogenicity than a modern bi-leaflet in the mitral postion is ... but now your INR is more like >2.5 isn't it?
[/QUOTE]

Yes, I have maintained or tried to maintain an INR above 3 for decades.

 

[Beach77]

@Amy I've been having lower abdominal pain for a few months too, also 2 years postop. At first, it was like a UTI but those tests said no. He ordered an ultrasound and everything looked good. The doctor is stumped. I started taking coq-10, my crestor meds were increased and my thyroids meds were recently changed too. All these were in the last few months too. He thought I should start to drink miralax daily but that doesn't seem like the issue for me. Thanks for this publication! I'm definitely will read it!

 

[brijeshb]

Dear All , Just wondering if taking Aspirin 81 only on alternate days be a good idea to further strike a balance between its benefits and potential side effects ?

 

[Chuck C]

Dear All , Just wondering if taking Aspirin 81 only on alternate days be a good idea to further strike a balance between its benefits and potential side effects ?

It is a tough call, and depends on the individual and what other risk factors that they have, but I think that it might be a good balance. I did just that myself, taking 81mg every other day, up until about a year ago. About a year ago I started taking it daily. My reason for going from every other day to daily was based on something entirely different than valve concerns, but because I have very elevated levels of Lp(a). Last year my cardiologist published a study which found significantly lower cardio vascular events for those with elevated Lp(a), when given 81mg/day aspirin. So, after discussing the issue with him, decided to go back to 81mg daily.

The important point is that each patient is different and the pros and cons of taking 81mg daily or every other day should be discussed with your doctor. I think for many, perhaps taking every other day might be a good balance.

So, discuss with your doctor, but it is one of those areas where you are likely to get opinions across the spectrum. The recent study which brings into question the benefits vs risk of 81mg aspirin, was not targeting patients with prosthetic valves, so we are a different group. There are still unknowns about whether it is best to take it for valve patients or not or whether to take it daily or every other day. Even my cardiologist, who published the paper targeting individuals with high Lp(a) on aspirin, could not say for certain if I should be on it daily or every other day. His study was for elderly patients and I am in my 50s. But, he felt that on that balance, if it was beneficial for elderly, probably would benefit me as well, especially in that I also have a mechanical valve. He said it was my call to make, but felt that the evidence at this point would lean towards taking it daily for me. I agreed and switched back to daily.

 

[pellicle]

Dear All , Just wondering if taking Aspirin 81 only on alternate days be a good idea to further strike a balance between its benefits and potential side effects ?

This is more or less what I do

 

[dick0236]

Because of a "deviated septum" in my nose, I am susceptible to nosebleeds. The only thing I know is that 81mg of aspirin aggravates that problem. My cardio put me on 81mg of aspirin a year ago and, sure enough, my nosebleeds got worse.....I even had to go to a hospital ER recently to have my nose packed. I have told my cardio I am discontinuing the aspirin...... permanently. I have made it 56 years w/o aspirin and I'll trust that I'll make it the rest of the way. I live by the simple philosophy that.....if it ain't broke, don't fix it. Oftentimes doctors get enamored with what they read in the medical journals without regard for how it might affect their individual patients. I choose not to take it.

 

[carolinemc]

Dear All , Just wondering if taking Aspirin 81 only on alternate days be a good idea to further strike a balance between its benefits and potential side effects ?

Nope, needs to be taken daily unless the doctor tells you otherwise.

 

[JohnnyD]

Because of a "deviated septum" in my nose, I am susceptible to nosebleeds. The only thing I know is that 81mg of aspirin aggravates that problem. My cardio put me on 81mg of aspirin a year ago and, sure enough, my nosebleeds got worse.....I even had to go to a hospital ER recently to have my nose packed. I have told my cardio I am discontinuing the aspirin...... permanently. I have made it 56 years w/o aspirin and I'll trust that I'll make it the rest of the way. I live by the simple philosophy that.....if it ain't broke, don't fix it. Oftentimes doctors get enamored with what they read in the medical journals without regard for how it might affect their individual patients. I choose not to take it.

Hi, I had the same issue, the nosebleeds were so bad I would have to pull over in my car and use a lot of tissue to stem the bleeding. I was taken off of it shortly after. My new cardiologist is thinking go placing me on blood thinners and I wonder if I would have the same issues.