Wednesday, May 7, 2014

Discussing Low Dose Daily Aspirin Use


Make sure that you understand the dosage and type of aspirin your physician has ordered.  Sometimes dissolving aspirin is ordered and other times enteric is chosen.  Low dose aspirin is usually 81 mg. per tablet.  The two aspirin you and I might take for a headache is a dosage of ten grains, or about 325 mg. per tablet.

      This week, the US FDA has cautioned people on the unsupervised use of a low dose aspirin tablet daily.  The fact is, that no one should have been using a low dose aspirin daily without having it been suggested/ordered by their physician.

            Aspirin is a remarkable drug. It not only is an effective anti-inflammatory, and an effective anti-pyretic (it lowers fevers), but it impedes clotting.  If aspirin hadn't been in widespread use for centuries, then the FDA would have made it a prescription drug !    It has miraculous properties and those same properties can be devastatingly dangerous when used on the wrong patient or during a particular period of vulnerability.  In a patient who has some degree of coronary artery disease, or who has had a heart attack, one solitary 81 mg (low dose) aspirin can prevent the formation of clots and can be an effective adjunct in the prevention of another heart attack.   However, in an alcoholic, or a person with problematic GERD, or a history of gastrointestinal bleeding, or liver disease, a daily aspirin, even in low dose, can cause gastrointestinal bleeding which can become so severe that I am left in the ICU transfusing a unit at a time in one arm, then the other, and then a third unit in the arm with which we started ! (Later that day, the patient will go for colonoscopy and for in effect, a cauterization of the bleeding area, but they still often need the blood they lost replaced.)
            Sometimes, a patient who really needs a daily low dose aspirin does actually have some other issues which make the practice dangerous, and then it's up to the physician to formulate a plan which manages such risks.  For example, in a patient with a history of controlled Crohn's Disease who also has coronary artery disease, he may need the aspirin, but there are concerns about potential activation of Crohn's Disease and gastrointestinal bleeding.  Sometimes the physician will order regular dissolving 81 mg. aspirin for a week, and then an enteric coated 81 mg aspirin they can alternate. This would at least, theoretically change the place of delivery to the gastrointestinal tract minimizing at least some of the potential for ulceration.
             Some of the patients who may benefit from a daily low dose aspirin a day are those with coronary artery disease, and especially those who have already had one heart attack (myocardial infarction).  Sometimes people with heart rhythm disturbances, especially atrial fibrillation have had low dose aspirin ordered.  This may help to prevent strokes and blood clots for them.  People who have something called anti-phospholipid syndrome also may benefit from daily low dose aspirin therapy. Certain patients who have had transient ischemic attacks, or mini-strokes might also benefit.   Some people with simple hypertension may also benefit.  Women who have a history of preeclampsia/toxemia in pregnancy can often avoid the syndrome using a physician ordered low dose aspirin until the last couple of weeks of their pregnancies. Some diabetics and those with certain types of dementia may also benefit.

            The patients for whom we worry a great deal about a daily low dose aspirin are those with a pre-existing clotting disorder, those with a known brain injury, (which could be bleeding), those with a liver disorder (as they may not clot readily), pregnant women who have had uterine bleeding during their pregnancy, those with known unhealed peptic or duodenal ulcers, those with esophageal ulcers or cancer, those with active Crohn's Disease or ulcerative colitis.

            There is a good recent study which seems to indicate that many patients who benefit from low dose aspirin could take it three times a week and enjoy the positive effects of the regimen while diminishing the bleeding risk somewhat.  This is something you should discuss with your physician.

            If you are taking 81 mg. aspirin daily, do not discontinue or wean this drug without first discussing this action with your physician.

               Be careful not to take aspirin along with other pain relievers (such as ibuprofen, which also impacts blood clotting times and gastrointestinal health.  As your physician or nurse practitioner for guidance when you need pain management and are taking a low dose daily aspirin.

          This one miraculous drug used in small dose is one of the reasons that so many people are attaining such a ripe and still productive old age.  Check with your primary physician as to whether you would benefit from its use, or whether you are one of the patients for whom it is potentially hazardous.


Gorges Smythe said...

Wouldn't taking the aspirin with food do away with most of the negative effects?

Matt said...

There was also a big study ( and I can't remember where I saw it ) but the gist was, a person taking an aspirin a day for something like 5 years greatly reduced their risk for certain cancers. Of course the bleeding risk and rules the day here, so as you said.... only under a doctors supervision...

JaneofVirginia said...

Gorges, Taking aspirin with food or with the major meal of one's day will help to reduce the potential negative gastrointestinal effects. Unfortunately, it will not completely ameliorate them. Great question !

JaneofVirginia said...

Yes, I remember the study well. However the physician needs to look at the history of the patient and weigh the benefits against the risks of the daily aspirin. This is something people should discuss at their annual physical, especially after 50. Thanks for posting.

Tewshooz said...

I use natural mixed tophcopherals (vitamin E) to keep my blood flowing. A century ago people consumed 100 more vitamin E than now because of the flour milling process now. Aspirin is a drug, according to my doctor and all drugs are poison to the body. Works for me

JaneofVirginia said...

Each person and situation is different. For those with antiphospholipid syndrome or atrial fibrillation, then an aspirin a day is a low tech alternative to daily coumadin and regular labwork. Vitamin E would not be a sensible alternative for those patients. However, I use a fair amount of vitamin supplementation myself which I run past both of my doctors.

lotta joy said...

Within minutes of meeting doctors, I'm advised to take an aspirin a day, and advised to take Coumadin because of my A-fib. I don't have a clotting factor. If I had listened to them BECAUSE they're DOCTORS, I'd have bled out by now. I don't like being present, yet treated from the textbook. Doctors assume too much and forget about individuality.

Practical Parsimony said...

When I was in grad school, I ate about ten aspirin one day because my throat was so sore. I chewed a regular aspirin every hour. At the end of my last class at 10 pm, I had a nose bleed that would not stop. I had to be driven to the ER. It turns out a nose bleed can be fatal. Attilla the Hun died of a nose bleed on his wedding might.

At another time, I decided to take a baby aspirin every day. I ended up having to be driven to the ob/gyn and have an emergency D and C right in the office. The uncontrolled bleeding was getting worse and he said in a few hours, I would have had to be admitted in order to replace blood I was losing. The doctor thought it could be cancer, so sent off biopsies. I had nothing for pain for this procedure.

He gave me a stern lecture and told me never to take anything anti-inflammatory EVER again, even the Vitamin E I took. He was sort of angry, but he was not my regular ob/gyn, just one of his partners. I will now take an aspirin about once a week for my back.

I argued with the ortho doc who repaired my torn meniscus. Finally, I told him the name of the ob/gyn and said if he said it was safe for me, I would take the anti-inflammatory he wanted me to take.

Right now, I am chewing baby aspirins judicially. I coughed/sneezed, you know that kind of I had food in my mouth, also. So, trying to control not aspirating food and not spewing food and trying to get the cough/sneeze under control, I bit the side of my tongue. I did not bite it in the normal place. I bit it so far back that I can barely close my mouth or swallow. I will only chew four baby aspirin a day for three days so maybe I will not have a nose bleed. Or worse.

Practical Parsimony said...

I am glad to hear you run your vitamin supplementation past your doctor. I am slow to take herbs and vitamins people tout as the cure for whatever. It insults people who make suggestions that are guaranteed to cure me when I say I will have to study it and ask my doctor..

When a woman who works the register at the gas station heard of my strep and bronchitis in one week, she assured me that only prayer saved me. When I told her I don't depend on prayer for my health, she said someone in the world prayed for me. Just shoot me now! I told her that babies and children must not have anyone praying for their health before they died. She did not know what to say.

When I told her about my bleeding from uterus for six months, she declared that only a full hysterectomy would "save me."

I have known her for twenty years, and if I cough, she insists I MUST take her cure. She really has low-tech cures for me while she has beaten cancer twice and lived the Guillane Barre (sp) with no lingering problems by using high-tech solutions. I just wonder why she expects me to pray when obviously she goes for high-tech and lost both breasts even with prayer.

Sorry about the rant. But, people with obvious problems with what is good for me and what is good for them really annoy

My aspirin problems are very much respected by doctors. They don't assure me aspirin is the way to go like this woman does or I should take aspirin and just pray like she does. .

JaneofVirginia said...

I don't think that anyone, even those without known health issues should use non-medically trained people, without your labwork to tell you what you should and should not take. Supplements and aspirin are not innocuous. Anything that can make a positive change can produce fatalities when given to the wrong patient.

JaneofVirginia said...

It can be difficult when dealing with some specialists because some of them may need prompting to recall ALL of your labs and medical history. Generally people with chronic a-fib take daily aspirin or coumadin. However, adjustments must be made for those with low prothrombin levels. Best wishes,

JaneofVirginia said...

Yes, epistaxis or nosebleeds can cause death. I have done a blogpost of epistaxis management here. Never take aspirin in excess of package directions.

Practical Parsimony said...

I just wanted to get through three graduate level English courses and knew better. Some smart people are stupid. And desperate. I will look for that post.

JaneofVirginia said...

Answering your post does not allow me to place a clickable link here. You would need to copy and paste the link for epistaxis, which is: