Coumadin and Aspirin Therapy

[RobThatsMe]

Hi Everyone,

Well, seems I am facing the reality of changing doctors and have come upon an issue. My cardiologist, which I have seen since my emergency surgery has had to step down from practice due to illness.... So.. I went to a new doctor that he highly recommended.

My visit with him was good, but as he looked over my medications, he commented that I may want to consider lowering my 325 mg aspirin dose to 81 mg per day. I told him that both my vascular surgeon and my other cardiologist said that in my case 325 mg was better. They told me this after I showed them the latest publications of the benefits of taking an 81 mg aspirin a day.

I have 2 doctors that told me to stay on the 325 mg, and the new one that strongly suggests that I consider cutting the dose to 81 mg per day.

I am looking all over the internet for articles on the combined Coumadin and aspirin therapy for valve replacement patients. I posted some of these in the past, but cannot seem to locate the old posts. Top that off with my hard drive crash on my computer, and all my old files are lost.

Anyone have any resent articles on this topic that they can share. I am up in the air on what to do. I haven't had any problems with the aspirin dose that I take, but guess I am thinking more about the long range effects.

Thanks.
Rob

 

[ALCapshaw2]

Hi Rob,

There was some discussion on the aspirin question recently but I forgot where. I do recall mention of one or TWO 81mg tablets so maybe a compromise at 162 mg might be a good alternative. I assume (and hope) you are taking an enteric (coated) tablet to prevent stomach irritation. No sense in creating some GI issues while trying to manage your heart issues.

'AL'

 

[RobThatsMe]

Hi Al,

Thanks for the information, and yes, you assumed right! I do take an enteric (coated) tablet. Whew....

I am still going to search some and try and dig up some Cardiologist or Heart surgeon reports on this. Once I get some more info... I'll decide on if I cut my dose or not.

I sure thank you for your input! I am not too worried over it... Just want to get some peace of mind again. Changing doctors is not a pleasant experience sometimes. But then again.... change is good..new ideas...etc..

Thanks and Good health,

Rob

 

[Missy]

I posted recently under Coumadin forum title Aspirin. I got some good responses and some sites.

 

[RobThatsMe]

Hi Missy,

Thanks! I visited the thread you mentioned. I even posted there...hehehehe

I still want to locate the medical studies on-line to print out and forward to my doctors to comment. The 325 mg aspirin I have been taking for 4 years has been trouble free, but perhaps long term it could pose issues for me.
I'll see if I can find out any more and share it with you if Ihave any luck, since you also have similiar concerns on this topic.

Rob

 

[Guest]

http://www.warfarinfo.com/aspirin-platelets.htm

 

[Susan BAV]

I received a tissue valve and was on Coumadin for the first three months post-op.

About five years ago I began having some TIA's (brief episodes of facial numbness) and was put on (81mg) aspirin therapy. Each doctor (ob/gyn, cardiologists, primary care physicians) that I saw after that disagreed on whether I should be on aspirin therapy, and/or how much I should take, and/or how frequently; reminds me that "opinions are like butt-holes... everyone has one and they all stink!"

I did think then that I bruised too easily and bled a bit much so I just reduced the aspirin to every other day and then every third day and then I would forget to take it for some periods of time.

Now, with the new tissue valve, I take 81 mg aspirin every morning, as instructed by my cardiologist, and I don't seem to have the bruising and bleeding problem that I did before. I always take it with breakfast and I take a coated one.

 

[JimL]

My card told me last fall to take an 81mg baby aspirin several times a week, not because of any specific problem with me, but because of a general recommendation from the cardiologists association. I read the literature, and thought that the recommendation was rather vague. I bought the aspirin, but I've yet to take one. Thanks, Rob, for raising this question. I'd like to know if I should take the aspirin or not. I sure don't mind taking a baby aspirin, but I'm concerned about the longterm issue of coumadin and aspirin for the rest of my life.

 

[Birky]

baby aspirin

baby aspirin

The surgeon and the cardiologist both agreed on taking the baby aspirin with the coumadin. As they explained, each does something different. Then they wonder why a person is having stomach problems,

 

[Missy]

Thanks Rob.
I would appreciate information on anything you find out?

 

[ALCapshaw2]

Here is some pertinent information on Aspirin and Coumadin Therapy I found while searching with the keywords "Heart Valve" (36000 pages of hits !)

'AL'
............................

From The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. All rights reserved.

Antiplatelet and anticoagulation for patients with prosthetic heart valves (Cochrane Review)

Little SH, Massel DR


ABSTRACT

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A substantive amendment to this systematic review was last made on 09 June 2003. Cochrane reviews are regularly checked and updated if necessary.Background: Patients with prosthetic heart valves are at increased risk for valve thrombosis and arterial thromboembolism. Oral anticoagulation alone, or the addition of antiplatelet drugs, has been used to minimize this risk. An important issue is the effectiveness and safety of the latter strategy.

Objectives: To compare the effectiveness and safety of adding antiplatelet therapy to standard oral anticoagulation among patients with prosthetic heart valves.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 2, 2003), MEDLINE (January 1966 to August 2002), EMBASE (January 1988 to July 2001) and reference lists of individual reports, review articles, meta-analyses, and consensus statements.

Selection criteria: All reports of randomised controlled trials comparing standard dose oral anticoagulation to standard dose oral anticoagulation and antiplatelet therapy in patients with one or more prosthetic heart valves. We included reports published in any language or in abstract form.

Data collection and analysis: Two reviewers independently performed the search strategy, assessed trials for inclusion criteria, study quality, and extracted data. Adverse effects information was collected from the trials.

Main results: Eleven studies involving 2,428 subjects met the inclusion criteria. Year of publication ranged from 1971 to 2000. Compared with anticoagulation alone, the addition of an antiplatelet agent reduced the risk of thromboembolic events (odds ratio 0.39 (95% confidence interval 0.28 to 0.56; p<0.00001)) and total mortality (odds ratio 0.55 (95% confidence interval 0.40 to 0.77; p=0.0003)). Aspirin and dipyridamole reduced these events similarly. The risk of major bleeding was increased when antiplatelet agents were added to oral anticoagulants (odds ratio 1.66 (95% confidence interval 1.18 to 2.34; p=0.003)).For major bleeding, there was no evidence of heterogeneity between aspirin and dipyridamole and in the comparison of trials performed before and after 1990, around the time when anticoagulation standardization with the international normalized ratio was being implemented.

Reviewers' conclusions: Adding antiplatelet therapy, either dipyridamole or low-dose aspirin, to oral anticoagulation decreases the risk of systemic embolism or death among patients with prosthetic heart valves. The risk of major bleeding is increased with antiplatelet therapy. These results apply to patients with mechanical prosthetic valves or those with biological valves and indicators of high risk such as atrial fibrillation or prior thromboembolic events. The effectiveness and safety of low dose aspirin (100 mg daily) appears to be similar to higher dose aspirin and dipyridamole.

Citation: Little SH, Massel DR. Antiplatelet and anticoagulation for patients with prosthetic heart valves (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.


This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).


The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons Ltd.

 

[LUVMyBirman]

Hi Rob,

The only time I feel Coumadin and Aspirin therapy could be risky would be in the early weeks following surgery. I am only saying this as I feel it may have contributed to my cardiac tamponade/Internal bleeding episode. Fresh surgical areas need to be treated gently. Understanding fully now....if I have to go for a second...they may want to keep my INR on the lower end of the range until I heal.

Anyway, hope all is well. Let us know how you make out!