Warfarin and aspirin?

I am 63 and have metabolic syndrome-but am not obese.Two years ago I had a stenosis in my small intestine which required surgery to correct.Seven months ago I had a pulmonary embolism and am told this may have been the second time this happened.I am still taking 7 mg of warfarin a day and my INR is 2.5.I had a liver transplant 10 months ago and was told my vascular system was not that good.I take immuno-suppressants daily.Given my overall situation I have concerns about the risk of heart attacks or strokes.Do you think I should be taking 75mg of aspirin daily as well as the warfarin?Do you think I should undergo tests to determine the state of my cardio-vascular system-if so,what tests would you recommend?My heart has undergone several tests and there are no problems there.Thanks.

[Lee Kirksey, MD]

Hello
The decision to use medications such as ASA or coumadin are made after careful risk benefit analysis with consideration of the indication for treatment. The risk of bleeding when one is on either medication is elevated compared to not being on the medication. When the two agents are combined, the risk becomes greater. The decision should be made by some one who carefully considers your previous medical history, your current conditions etc. For people in whom the benefits outweigh the risks, daily ASA can reduce stroke and heart attack risk. Considering you have had cardiac clearance to date, an additional study to assess risk of stroke would be a carotid ultrasound which you may have had prior to transplant

Best of luck