low dose aspirin

[Fundy]

I have a St Jude tissue valve and have been told to be taking a low dose aspirin once a day for life I guess. Anyone have insight on why and how important this is?
I work rotating shift work and constant time each day isn't really available which leads to a bit of a problem. For instance before work could be the time but I don't work everyday. When I wake up could work but somedays I wake up twice.

Also sometimes I realize after work that I didn't take it and take it right then, sometimes not sure and take it anyway. So basically sometimes I'm taking it once a day, sometimes twice or maybe at an extreme three times a day, sometimes I'm missing a day here and there, maybe even two in a row missed I think.

I kind of think its not too vital anyway. but I'm kind of wondering what's the risks of missing a day or two. What are the risks of taking two or three in a day. What about stopping altogether.

 

[mattswife]

I am no cardiologist, but I always thought of aspirin as fairly forgiving in terms of strict dosing requirements. I do not stress about taking it at the same time every day, as long as I remember to take it.

 

[dornole]

For gosh sake, don't stop taking it without checking with your doc. I can't say why your doc put you on it, but in my case (I still have my native repaired valve) it is because I'm at increased risk for stroke post-procedure. My doc explained that there is increased turbulence in my heart that might make clot formation more likely and also I now have a hole in the septum of my heart from the repair procedure that also increases the risk of clots traveling to the brain. Instead of taking warfarin I get to take a full strength 325 mg aspirin to reduce this risk. I don't obsess about it if I take it a few hours late, but it is certainly easier to have as much of a routine as you can so you don't forget. I use a pill box so I can remember if I took it or not. Ask your doc to explain why it's needed in your case so you are more motivated.

 

[pellicle]

Hey Fundy

as far as I know low dose aspirin is the "go to" drug because it seems to have little harm and can do some good in preventing angina and other stuff like myocardial infarcs (sorry for the buzz words)

for instance:

http://www.bmj.com/content/324/7329/...&height=100%25

Conclusions: Aspirin (or another oral antiplatelet drug) is protective in most types of patient at increased risk of occlusive vascular events, including those with an acute myocardial infarction or ischaemic stroke, unstable or stable angina, previous myocardial infarction, stroke or cerebral ischaemia, peripheral arterial disease, or atrial fibrillation.

http://www.sciencedirect.com/science...40673698043116

Methods

18 790 patients, from 26 countries, aged 50–80 years (mean 61·5 years) with hypertension and diastolic blood pressure between 100 mm Hg and 115 mm Hg (mean 105 mm Hg) were randomly assigned a target diastolic blood pressure...
Findings

Diastolic blood pressure was reduced by 20·3 mm Hg, 22·3 mm Hg, and 24·3 mm Hg, in the ⩽90 mm Hg, ⩽85 mm Hg, and ⩽80 mm Hg target groups, respectively. The lowest incidence of major cardiovascular events occurred at a mean achieved diastolic blood pressure of 82·6 mm Hg; the lowest risk of cardiovascular mortality occurred at 86·5 mm Hg. Further reduction below these blood pressures was safe. In patients with diabetes mellitus there was a 51% reduction in major cardiovascular events in target group ⩽80 mm Hg compared with target group ⩽90 mm Hg (p for trend=0·005). Acetylsalicylic acid reduced major cardiovascular events by 15% (p=0·03) and all myocardial infarction by 36% (p=0·002), with no effect on stroke. There were seven fatal bleeds in the acetylsalicylic acid group and eight in the placebo group, and 129 versus 70 non-fatal major bleeds in the two groups, respectively (p<0·001).

note, aspirin is acetylcalicylic acid. They go on to note that those seven fatal bleeds were not an increase in incidence ...

http://archinte.jamanetwork.com/article.aspx?articleid=213656&resultclick=1

Results Aspirin reduced all-cause mortality by 18%. In addition, aspirin use reduced the number of strokes by 20%, myocardial infarctions by 30%, and other "vascular events" by 30%. Alternately, patients who took aspirin were 2.5 times more likely than those in the placebo group to have gastrointestinal tract bleeding. The number needed to treat for aspirin to prevent 1 death from any cause of mortality was 67, while 100 needed to be treated to detect 1 nonfatal gastrointestinal tract bleeding.

so I would suppose that if you were given to GI issues, don't take it...

Lastly, recently there's also been talk of some sort of observation that its good for cancer too ... but the results are mixed. I read something the other day and didn't bother putting it into my evernote, so I can't list that one...

 

[T in YVR]

It's just 1 low dose aspirin a day...if your daily time changes a bit, it's no big deal. I take mine some days around 8 or 9 am and other days around noon if I got busy and briefly forgot. You may want to get a pill organizer if you forget whether you took the dose or not. I gave in and bought one and it helps.
Tony

 

[Fundy]

As best I can tell or remember, the reason for the low dose aspirin is as an anti-platelet solution for stroke prevention that all tissue valvers(possibly mechanical valvers) are recommended you take for life. I'm assuming extra dosage is just a concern for the stomach type issues commonly occurring with long term aspirin use. So extra dosage isn't really much of a concern to me I'd think. But I'm really concerned with how much higher stroke risk develops with missing one day, two days or even forever.

For some reason I'm thinking its almost a non-issue, but then if it was a non-issue the surgeon wouldn't have said I need to take it forever. But then again I don't ever recall any actual valvers stressing that its very important.

 

[tom in MO]

As others have said it helps reduce your risk of stroke. Don't sweat what time you take it, but do take it. If you do it twice in a day, no harm no foul. And the low dose will not affect your stomach.

 

[dornole]

How much stroke risk are you willing to accept vs. taking a tiny and super cheap pill prescribed by your cardiologist because you have a serious heart condition?

 

[dornole]

But to answer the original question:

If you take 2-3 low dose by accident, no harm no foul. I take the equivalent of 4 baby aspirin every day for my heart (for 13 years now) and the max "headache" dose in a day would be like 48 low-dose aspirin. So don't worry about overdosing unless you are a crazy guy who pours a whole bottle down your throat.

Missing days - I don't have info on how quickly stroke risk increases specifically. But, I pretty reliably will get a visual migraine if I miss two days in a row (sometimes this alerts me that I forgot to take it) so I think that may indicate a wearing off of some effect it has on me. For surgery they want me off for 5 days, so I assume that means the effects are completely gone at that point.

Maybe ask your doc if you can just take it before you go to work each shift or something so it is easy to remember. He /she will obviously know a lot more about it. : )

 

[pellicle]

Hi

... but then if it was a non-issue the surgeon wouldn't have said I need to take it forever. But then again I don't ever recall any actual valvers stressing that its very important.

I'm gonna go out on limb here and and say "perhaps many actual valvers haven't done the research"

(disclaimer .. I stopped mine when my packet ran out, but I do wonder about taking it, its just that I am usually too lazy to get it and forget about it for ages. ... probably I'll burn in pharmacological hell ... anyway I'm on warfarin so stroke is not as likely for me .. [sniff sniff] is that brimstone?)

 

[epstns]

My approach is the opposite of pellicle's - I bought a large sized bottle of generic 81 mg aspirin for just a few dollars. The one bottle is about 1,200 tablets -- several years' supply so I won't run out for a while. I just take one with the rest of my meds daily and go on with life. IIRC, the "normal" aspirin dosage for pain is 2 X 250 mg tablets every 4 to 6 hours. 81 mg versus 500 mg? Just take one every calendar day and you'll be fine.

 

[Fundy]

My core concern really is just how much the stroke risk is affected by missing a day or two. I'm finding it hard to find some specific data. I have found some relating to aspirin effect with mechanical valve and knowing mechanical with proper warfarin and aspirin is about 1% stroke risk, and tissue with aspirin is the same. Based on the following data I'm thinking the risk may double on the days I miss. For instance up from 1% to 2%. I'm basing a very uneducated type of guess on the following words out of this concerning mechanical valves:
http://bjcardio.co.uk/2008/05/the-ma...l-haemorrhage/
----
Aspirin reduces the risk of valve thrombosis from 1.7% to 1.0%. Anticoagulation reduces it further to 0.2%. Use of aspirin reduces the risk of major embolism from 4% to 2.2% per year, while warfarin reduces it to 1% per year.
---
So based on that it seems that risk almost doubles without the aspirin. But its kind of a poor way to go about guessing.
But if so, it would definitely be worth my while to leave work to get an aspirin, rather than wait 8-12 hours to take it when I get home I'd think.

It'd be interesting to see what the stroke numbers are mentioned to be for a tissue valver without taking an aspirin. I didn't think it would be so hard to find.

 

[pellicle]

H

My core concern really is just how much the stroke risk is affected by missing a day or two.

something just over nothing ... given that the reduction is expressed as 1% per annum, less than 0.002 would be my feeling. Probably less because you may be part of the population who had no effect. Recall that those stats are about population data not your data. It assume we are homogeonus ... and we aren't

 

[dornole]

I don't know what kind of job you have, but I'd think you could bring it from home and swallow an aspirin and a sip of water sometime during your shift as needed if you want to be more consistent in your timing.

 

[Agian]

I have found some relating to aspirin effect with mechanical valve and knowing mechanical with proper warfarin and aspirin is about 1% stroke risk

It may be less than 1%, for someone who self-monitors their INR. I think Pellicle mentioned some data.