Aspirin in conjunction with Warfarin

[Al3x]

Does anyone have any views on taking 75mg Aspirin alongside Warfarin? I have been doing this for a year on the advice of my surgeon (on-x aortic valve, target INR of 2.3). My cardiologist has suggested it may not be needed, although he was relatively relaxed about it. I'm all for taking fewer pills but I'm also keen to do everything possible to reduce the risk of clots.

 

[dick0236]

Some docs say to take an extra "baby aspirin" and some say don't. My docs tell me it is not for ACT but is to make my blood cells more "slippery". I've been doing it for several years along with the six other Rx's I take for various heart, lung issues with no problem.

 

[tom in MO]

I was told by surgeon and cardio that the use of aspirin with warafin is valve and position dependent. My cardiologist handles my anticoagulation therapy and wants me on 80mg. My surgeon said he doesn't do warfarin therapy and I should follow my cardiologist routine. Low dose aspirin can't hurt, and if not required for your valve, your cardio may just being conservative.

 

[dornole]

I’ve been on 325 mg aspirin daily for 20 years for my repaired mitral. No warfarin.

 

[pellicle]

My cardiologist has suggested it may not be needed, although he was relatively relaxed about it. I'm all for taking fewer pills but I'm also keen to do everything possible to reduce the risk of clots.

it depends. The data is unclear.

Some time after I had my OHS my aspirin ran out (75mg as you have) and when I had my next appointment with my surgeon (can't recall if it was 6mths or a year) I asked about it. He barely glanced up and said something nonchalant in the manner of "its up to you if you want to continue with it"

So I stopped.

Some years later I found that I had an occasional "dizzy" spell where I wasn't dizzy if I closed my eyes. I noticed that one eye was not perfectly coordinating with the other. It would clear up after about half an hour. On the off chance it was an indicator of a TIA I decided to start aspirin again (half a 300mg tablet every second day). I reasoned that the half life of aspirin in the body was a few hours and my platelets half life was in the order of a week that this would result in a mix of well formed and "aspirin changed" platelets.

Since I started doing that I don't have those dizzy spells.

However now and then I don't have any aspirin when I'm doing my pills up and for various reasons forget to get the aspirin. A couple of weeks after this I get a repeat of the dizzy spells and I immediately go buy some.

So that's how it is for me ... YMMV

If its not helping then no harm done, but if it is then keep using it.

Best Wishes

 

[pellicle]

PS: just ran a google search on the subject and my first hit was this (google seems to know me well)


https://www.ahajournals.org/doi/10.1161/01.CIR.101.10.1206

Mechanism of Action​

Aspirin exerts its effect primarily by interfering with the biosynthesis of cyclic prostanoids, ie, thromboxane A2 (TXA2), prostacyclin, and other prostaglandins. ... Arachidonic acid is metabolized by the enzyme prostaglandin (PG) H-synthase, which, through its cyclooxygenase (COX) and peroxidase activities, results in the production of PGG2 and PGH2, respectively. PGH2 is then modified by specific synthases, thus producing prostaglandins D2, E2, F2α, I2 (prostacyclin), and TXA2, all of which mediate specific cellular functions.​

​

...​

​

Aspirin is rapidly absorbed in the upper gastrointestinal (GI) tract and results in a measurable inhibition of platelet function within 60 minutes. This antiplatelet effect is associated with prolongation of the bleeding time and inhibition of TXA2-dependent platelet aggregation. These effects occur even before acetylsalicylic acid is detectable in the peripheral blood, owing to the exposure of platelets to aspirin in the portal circulation.34 Enteric coating of aspirin significantly delays its absorption. The plasma half-life of aspirin is only 20 minutes; however, because platelets cannot generate new COX, the effects of aspirin last for the duration of the life of the platelet (≈10 days). After a single dose of aspirin, platelet COX activity recovers by ≈10% per day as a function of platelet turnover. Although it may take 10 days for the total platelet population to be renewed, and thus restore normal COX activity, it has been shown that if as little as 20% of platelets have normal COX activity, hemostasis may be normal.​

Bold emphasis mine

 

[Protimenow]

I've been taking enteric coated 'baby' aspirin for years. I've had no apparent problems with it. I'm not sure if it's helped or not.

I take one full dose aspirin rarely for severe pain and swelling (actually, I took one tonight). I don't expect any negative consequences, but very rarely take it. (I got my first bottle last week, and did entirely without aspirin for many years.

I think the last time I took more than one aspirin was 2012 (I think) when I thought I was having a TIA (I was).

At close distances, my eyes don't work together. I don't remember when they did. Aspirin in any dose doesn't seem to make any difference. I'm glad it works for Pellicle.

 

[Critter]

It is supposed to increase the anticoagulative properties by 40% on top of the warfarin. I take an 81 mg asa a day. If I am going to do lower inr I am all in with taking both,

 

[ChuckM]

Does anyone have any views on taking 75mg Aspirin alongside Warfarin? I have been doing this for a year on the advice of my surgeon (on-x aortic valve, target INR of 2.3). My cardiologist has suggested it may not be needed, although he was relatively relaxed about it. I'm all for taking fewer pills but I'm also keen to do everything possible to reduce the risk of clots.

I take a 81mg Bayer "Heart" aspirin every day. Target INR is 2.5-3.5 with a Medtronic mech and 7.5mg warfarin. I don't know if its any more protective vs a regular "baby" aspirin or not, but my brother-in-law is a doc and has cases and cases of these Bayer aspirins from the reps, so I don't forsee paying for aspirin any time soon, provided my doc recommends staying on it.

 

[TGM]

Once my son hit adulthood, his cardiologist added aspirin to his warfarin. Initially I was very surprised and uneasy but once it was explained that it improves the anticoagulant therapy, we went along with it. He’s had no issues that I’m aware of.

 

[pellicle]

If I am going to do lower inr I am all in with taking both

If you are following a lower INR (near 2) you need to do both

 

[MdaPA]

I take a 81mg Bayer "Heart" aspirin every day. Target INR is 2.5-3.5 with a Medtronic mech and 7.5mg warfarin. I don't know if its any more protective vs a regular "baby" aspirin or not, but my brother-in-law is a doc and has cases and cases of these Bayer aspirins from the reps, so I don't forsee paying for aspirin any time soon, provided my doc recommends staying on it.

81mg Bayer aspirin is much more expensive than other "baby" asprin, at least in our neck of the woods, so my wife buys the lowest price aspirin, as long as it's enteric coated. My wife's target INR is 2.5-3.5 for mechanical AV and MV's and takes a baby aspirin daily.

 

[pellicle]

so my wife buys the lowest price aspirin,

I'm with her. I buy supermarket aspirin, which is 300mg (and split it), because "why not".
I know its not much actual money different, but IMO if you just take it with food or a small glass of milk then the enteric coating seems pointless (or at least doesn't effect me).

 

[Dodgy Ticker]

Folks - I'm rather confused. I have read the last few posts, however was told quite categorically by my cardio and subsequent doctors that Aspirin was most def NOT to be taken when on Warfarin. Paracetamol WAS an option, however, and I do take one (with added codeine) when needed, and have had no negative effects, although I must admit that I don't monitor things as closely as Pellicle...

I sign off still somewhat confused on the matter...

 

[treichert0312]

I’m on the asp 80 mg since I got the pig valve in 2014. The On-X was later added in June 2022 to replace the flailed pig valve and I have continued with baby aspirin since, per cardiologist.
I take the aspirin in the morning and the warfarin at night. There was a reason to switch to enteric coated with the aortic MV but do not recall if it was symptomatic or doctor’s suggestion.

 

[thomas999]

Okay, I am a bit confused. Don't we want our INR in a certain range with Warfarin? And if we take an aspirin it further raises the INR., probably out of the range we want to be in. Is aspirin better than Warfarin for anticoagulation? Or is warfarin at the desired range adequate for anticoagulation for a particular valve?

 

[pellicle]

Hi

Okay, I am a bit confused. Don't we want our INR in a certain range with Warfarin?

we do ...

And if we take an aspirin it further raises the INR.

it does not. Aspirin has no influence on INR

Is aspirin better than Warfarin for anticoagulation?

no, and aspirin is not an anticoagulant. Aspirin works on blood platelets the other half of forming clots. It has no effect on INR because INR is a measure of the reduction of effectivness of thrombin

Have a peek again at this diagram (which I've added emphasis to) and read the link about coagulation if you want the details

https://en.wikipedia.org/wiki/Coagulation
Basically if you think about the two (platelets and thrombin) as being separate Part A and Part B for epoxy and its mixing them that causes clots.

HTH

 

[Chuck C]

I'm on 81mg aspirin. I was taking it long before I had valve surgery. I've gone over all of the studies I can find, and have toggled back and forth between 81mg every other day, to 81mg daily. I currently take it daily.

However, my motivation to take aspirin is not just valve related. In addition to my valve issue, I have a genetic dyslipidemia with very high levels of Lp(a). One of my cardiologists is a top Lp(a) researcher and recently published this study which found reduced levels of MACE for those with elevated Lp(a) on low dose aspirin. In my last appointment I made the point of discussing it with him, as another study was published recently which brought into question the benefit of aspirin for many elderly patients. He pointed out that his study was among elderly, 70+ year olds, but felt that it would likely benefit me and reduce my risk as well, given my Lp(a) level. He is well aware that I am on warfarin. So, I am currently taking 81mg daily and will continue to do so unless the evidence suggests otherwise.

https://www.sciencedirect.com/science/article/abs/pii/S0735109722057205

 

[thomas999]

I have never been told, or has the option been offered, to add aspirin to my regime of warfarin. In fact, just the opposite. Who knows for sure, maybe it is the future for me? Again, I have been dosing this way for over 35 years. Also, one must always concern themselves with still having the capability to clot when needed for injuries and such. It often runs through my mind what would happen to me if I were involved in a serious car accident, a trip and fall, or some other trauma, the ability to clot could also save one's life !

 

[tom in MO]

I have never been told, or has the option been offered, to add aspirin to my regime of warfarin. In fact, just the opposite. Who knows for sure, maybe it is the future for me? Again, I have been dosing this way for over 35 years. Also, one must always concern themselves with still having the capability to clot when needed for injuries and such. It often runs through my mind what would happen to me if I were involved in a serious car accident, a trip and fall, or some other trauma, the ability to clot could also save one's life !

Your valve is not my valve. Your cardiologist is not mine. Just because I was told to take 80mg aspirin doesn't mean it applies to you. My valve is a St. Jude mechanical, aortic position, INR 2-2.5 target range.