Platelet effect

[David Dufurrena]

I underwent a dual coronary bypass in 1988, and have since been on aspirin therapy.  Please understand that my question for you is not a request for a prescription of any kind; that is done by my cardiologist.  Studies have ahown that, while aspirin's platelet effect protects people from heart problems, at the same time study groups have experienced significant increases in hemorrhagic stroke incidence, even with dosages as small as 350 mg every other day.  It is thus obvious that the dosage of aspirin, together with intake of other agents which act on platelets just as aspirin does, is an important decision.  I take daily doses of Vitamin E and naproxen sodium tabs.  Do not either or both of these agents have platelet effect identical to that of aspirin?  And if that is so, then would not dosage decisions depend on the relative and cumulative amounts of all such similar agents taken on a regular basis?

[CCF CARDIO MD - DLB]

In general, patients with coronary artery disease should be on aspirin therapy. If they need medicines for pain, Tylenol ought to be the first choice. If that is inadequate, NSAIDS can be used, but with caution. The Cox-2 inhibitors appear to be safer, but are still relatively new and expensive.

[ginny]

Dear Doctor,
I was reading a post to Reuters news service that addressed this issue.  The post was on 16 November 1999 and was titled, "Daily aspirin may not be needed when taking NSAIDs".  This was the finding of a study presented at the annual meeting of the American College of Rheumatology.  In the write-up, the study author, Doctor Elliot Rosenstein, also stated that using aspirin and NSAIDs in combination intensifies(as much as five- to seven-fold)their tendency to cause stomach upset and bleeding.
The study found that adding aspirin to therapy with ketoprofen did not offer additional anti-clotting benefit over placebo.  The author also stated that these findings apply to other NSAIDs but not to the subcategory known as Cox-2 inhibitors.(Celebrex or Vioxx)  Aspirin's cardiovascular benefits are anti-clotting of blood, affect on red blood cells that does not initiate platelet activity, and as an anti-inflammatory agent.  Other NSAIDs are proven to provide two of these three effects.(The affect on red blood cells has not yet been studied.)  Tylenol does not provide the anti-inflammatory benefits that NSAIDs such as Naprosyn do for rheumatological conditions.(i.e. RA, OA, Lupus, etc.) and so is not an option for David.  My husband's rheumatologist prescribed Celebrex for my husband's arthritic pain in combination with 1 regular strength enteric coated aspirin a day.
Would this not be a better option for David also?
Sincerely,
Ginny

[CCF CARDIO MD - DLB]

Patients who have had bypass surgery should definitely be on aspirin, unless they have had bleeding problems. The role of Vitamine E in preventing heart disease is still not clear, but it is safe to take, in reasonable doses, with aspirin. Naproxen has an anti-platelet effect that increases your chances of bleeding, but it provides no protection against heart disease. I would recommend switching to Tylenol.