Heart Failure and Aspirin

[soleole]

Dear Doctor,
My dad was diagnosed with Heart Failure and he normally takes low dosage aspirin as part of his medication arsenal, however he also suffers from chronic back pain and the doctor told him to stop taking ibuprofen for it so now he takes more aspirin and some paracetamol for the pain. I've read that too much aspirin can be detrimental for Heat Failure patients, so my question is how much aspirin is safe for him to take? and which other painkillers could he take as an alternative?
Thank you.

[kenkeith]

It seems there remains a controversy.  The doctors that favor aspirin therapy is that many patients that have chronic heart failure and of those patients many patients have underlying coronary disease, and aspirin prevents reinfarction and other vascular events.

Arguments against the routine use of aspirin are that many heart failure patients do not have underlying coronary disease, and that the benefit of aspirin lessens after the first 6 to 12 months after infarction. "Several analyses suggest that aspirin may actually worsen outcomes in CHF patients, possibly because it inhibits prostaglandins, with resulting adverse hemodynamic and renal effects" (have regular tests for kidney disease).

Two recent prospective randomized studies have found that aspirin is associated with more frequent hospitalizations for worsening heart failure, although it did not have an adverse effect on vascular events. These results suggest that aspirin should not be routinely used in CHF patients and be avoided in those with refractory CHF, but that it may be beneficial in patients with recent infarction or multiple vascular risk factors.

Have you talked to the doctor about the benefits and risks of increased aspirin therapy?.

Recent research indicates an appropriate dose of aspirin is between 80 and 160 mg per day. This is actually half of the standard 325-milligram aspirin commonly prescribed. Many studies show the lower dose works just as well as the higher dose, while reducing the risk of internal bleeding.

AHA/AAC: "Anyone who has had a heart attack should take a daily low dose of aspirin to prevent another attack, unless they are in the 1 or 2% of the adult population who can't take aspirin because of one of these reasons:

•Liver or kidney disease
•Peptic ulcer or other intestinal disease
•Intestinal bleeding or other bleeding problems
•Allergy to aspirin
•Use of alcohol
The daily dose of aspirin recommended to deter a repeat heart attack is quite low, namely 81 mg.

I have a history of a heart attack and coronary artery disease and my cardiologist has prescribed 87 mg. for the past 6 years.

Hope this helps and if you have any follow-up questions you are welcome to ask.  Take care and thanks for sharing.