POLL: Aspirin Therapy

[Momto3]

I was recently started on aspirin therapy and because this is so new to me, I am wondering how many others are taking an aspirin.  If so, what dose have you been prescribed?  I'm on one 325mg coated aspirin/day.

Thanks all!'

Connie

[leedee52]

If you ever forget to take your pills I found the answer.  My neighbor (a nurse) told me about a MED-Q pillbox.  I load it for a week.  It flashes and beeps at the exact times I set .  One at 8 before work, and one at 10 before bed.  It mkes forgetting impossible.  It has been the greatest cheapest way for my to help my heart health.  I recommend it highly

Lee

[leedee52]

If you ever forget to take your pills I found the answer.  My neighbor (a nurse) told me about a MED-Q pillbox.  I load it for a week.  It flashes and beeps at the exact times I set .  One at 8 before work, and one at 10 before bed.  It mkes forgetting impossible.  It has been the greatest cheapest way for my to help my heart health.  I recommend it highly

Lee

[skybluepink]

Just put medications into iguard check to find aspirin severely contraindicated with ginko biloba . In England Aspirin  is not prescribed can buy over the counter with supplements which one assumes is tested . Think this is potentially dangerous minefield!

[Momto3]

Great information!  I've got about 10 days until the appointment.  I definitely plan on discussing a lower dose with my cardio.  I even skipped yesterday...I know I shouldn't, but taking an aspirin a day at this dose seems to be overkill (or worse).

I'm sorry to hear about your brother-in-law's case.  Just goes to show how important it is to understand as much as we can.

Thank you so much for the thorough explanation!  You must be an avid reader : )  Your answers are so complete and informative.  I'll let you know what the docs says about changing the dose.  If he insists on the higher dose, I'll find out the reason behind the decision and post again.

Thanks again!
connie

[kenkeith]

When aspirin is given in low doses (75 mg/day), COMPLETE inhibition of the COX-1 enzyme and maximal antiplatelet effect may take several days. At a dose of 160-325 mg/day, the maximal antiplatelet effect of aspirin occurs within 30 minutes (take a larger dose if having a heaart attack, etc.) . Thus aspirin at low doses (75-150 mg/day) is used for the LONG-TERM prevention of heart attacks and strokes, but moderate doses (160-325 mg/day) of aspirin are used in situations where an IMMEDIATE antiplatelet effect is needed (such as in the treatment of acute heart attacks and unstable angina).  Personally, I would not take a dose greater than 81mg,

Like aspirin, the onset of action of Plavix is dose-related. Thus, maximal antiplatelet effects occur several days after initiation of Plavix (75 mg/day), but can occur within hours after larger doses of 300 or 600 mg. Therefore, the larger doses of Plavix are used as initial treatment when immediate antiplatelet action is needed while the lower doses are used for long-term therapy.  I had larger doses while in ER, and dosage was moderated later, and completely stopped after a year, but the medication may be continued longer for DES stents.

The risk for bleeding should be an important factor to consider.  A couple of years ago, my brother-in-law fell and hit is head causing intra cranial bleeding and the event was fatal.  He was on high dose of aspirin for back pain as well as a history for cardiovascular occlusion.  The probability is high the incident would not be fatal if not for a high dose of aspirin.

[Momto3]

So, if I understand correctly : ) .......

It is your impression (through sufficient, reliable sources), that 81mg should be adequate for treatment in almost all circumstances (if not all)??  Other than than opth. migraines and the one other "eye thing" (that's what I call it...lol), and perhaps some family history, I don't seem to have other risk factors.  I'm thinking my cardio is erring on the side of caution (although according to your research it appears to have little credance) until the tests are completed.....Sound about right?  

thanks sooo much!

connie

[kenkeith]

I have to say bluntly disagree, and  I say vociferously I have not read anything (numerous reads over 4 years) from any reputed source or study that even implies the number of risk factors is a criterion for dosage.

Two or three risk factors...dose 325mg.  Age is a risk factor as is history of occlusion.  So everyone over the age of 45? , whatever, and a history with a stent implant should be on 325mg.!!

Included is a factor there should be no history of bleeding.  There may not be any history of bleeding until dosed with 4325mg!  There are lab tests that time clotting, and a higher dose than a predictable range of efficacy for a specific individual should be the critereon.  

[ChatterAlly]

Thank you so much for the information. It sure helps to understand. And thanks to all the drs here that take the time to keep us informed. What a great reassurance.

Ally

[Momto3]

Thanks for the great information.......I'm somewhat stumped as to why I'm taking the higher dose.....and I sure don't want to end up with gastrointestinal bleeding!

[Momto3]

Thank you so much for the meta-analyses summary!!  Going from one single study to another is mind-boggling.  

So, I'm thinking that until a PFO and/or embolic problems are ruled out, I may be better off with the higher dose.  I have low cholesterol, good ratio, low triglycerides, normal glucose, low-normal BP, non smoker, but I do have family history for CAD.  Think I'm OK there.  But,what would you say are the risk factors for stroke?  What started this was a temporary, partial loss of vision in one eye (like a black splotch in my field of vision) - normal eye exam, history of MVP/MR, history of opthalmic migraines generally lasting about 20 minutes (jagged lines, flashing, shimmering).

Thanks again for the great summary!  I feel better with some clarification.

Connie    

[kenkeith]

Although pharmacodynamic data demonstrate that long-term aspirin dosages as low as 30 mg/d are adequate to fully inhibit platelet thromboxane production, dosages as high as 1300 mg/d are approved for use. In the United States, 81 mg/d of aspirin is prescribed most commonly (60%), followed by 325 mg/d (35%). The available evidence, predominantly from secondary-prevention observational studies, supports that dosages greater than 75 to 81 mg/d do not enhance efficacy, whereas larger dosages are associated with an increased incidence of bleeding events, primarily related to gastrointestinal tract toxicity.

Currently available clinical data do not support the routine, long-term use of aspirin dosages greater than 75 to 81 mg/d in the setting of cardiovascular disease prevention. Higher dosages, which may be commonly prescribed, do not better prevent events but are associated with increased risks of gastrointestinal bleeding.

If is someone is over weight, a larger does may be indicated?.  There is no reliable  evidence that supports a higher dose than 81 mg for thrombosis prevention or thromboartritis (clotting with inflammation).

[Lee Kirksey, MD]

Great Question

50 Million People Take Aspirin for CVD Prevention in United States Alone
In the current review, Campbell and colleagues note that approximately 36% of the adult US population — more than 50 million people — are estimated to take aspirin regularly for heart disease prevention. This translates into roughly 10 to 20 billion aspirin tablets consumed annually in the United States alone. The authors stress that, as aspirin is so widely used, maximizing benefits and minimizing risks by providing optimal dosing is of great importance. They note that clinical trials in patients with heart disease have evaluated dosages as low as 30 mg/day and as high as 1500 mg/day, and the US Food and Drug Administration recommends dosages ranging from 50 to 1300 mg/day for treatment of the clinical manifestations of atherosclerotic disease. Because of this, there is substantial debate regarding what represents the "correct" dosage of aspirin and whether it is the same in all patients.

The authors therefore conducted a systematic review of the literature of prospective studies using different aspirin dosages in the setting of cardiovascular disease (CVD). A total of 2415 references were identified and manually sorted using the abstracts or full-text publications.

The authors report that clinical outcomes trials directly comparing different dosages of aspirin (from 30 - 1300 mg/day) in almost 10,000 patients with various clinical manifestations of atherosclerotic disease have not shown a significant benefit of higher dosages, and in most trials, the lowest event rates were seen among patients randomized to the low-dosage groups.

The authors also point out that several meta-analyses have shown similar results. One meta-analysis of 11 clinical trials including 5228 patients randomized to aspirin or placebo following a transient ischemic attack or stroke, found similar efficacy for aspirin dosages ranging from 50 to 1500 mg/day. And in the Antithrombotic Trialists' Collaboration, a meta-analysis of more than 60 aspirin trials also found no relationship between dose and efficacy, with the greatest risk reduction shown in trials using a 75- to 150-mg dose of aspirin. The authors add that retrospective analyses of several recent large-scale clinical trials (including Global Use of Strategies to Open Occluded Arteries [GUSTO] IIb, Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Antagonism Using Integrilin Therapy [PURSUIT], and Clopidogrel in Unstable Angina to Prevent Recurrent Events [CURE]) are also consistent with the lack of any increase in benefit with higher dosages of aspirin.

But in contrast to the efficacy data, larger doses of aspirin are associated with an increased incidence of bleeding events, primarily related to gastrointestinal tract toxicity. Campbell and colleagues note that if the differences in major bleeding found in the aspirin-only group of the CURE trial are translated to the general US aspirin-taking population, daily treatment with 325 mg of aspirin would lead to an excess of more than 900,000 major bleeding events per year compared with a daily dose of 81 mg.

My Summary: I believe that everyone should be on aspirin daily. The benefits are clear in reduction of heart attack and stroke and even in the reduction of colon polyps. The optimal dose is unclear. For patients at low risk for stroke or heart attack, I recommend 81 mg/day. For patients with 2-3 risk factors and no history of bleeding, I recommend 325 mg/day,

[ChatterAlly]

I am not really sure why the preference of one dose over the other. I know my blood is not thin at all.  Everytime I had to have the angio they had to administer heparin to thin my blood.  After the last one I had to take 8 (yes 8) Plavix lying flat on my back because of that.  Not easy to swallow at all. Had that stuck feeling in my esophagus for a long time after.                                                                            
Yes, it's been awhile sincewe chatted and I have to tell you that this has been the best 6 months in the last 5 years. It just took the right tests, diagnosis and medicines I suppose.
I too have the ringing in my ears and you get used to it.  Just stick to the docs orders for now. It's hard for me to get good health care without insurance (long story there and now with the heart disease won't be able to afford one without great cost), so I listen. After the big bucks I have to shell out, I listen.

God bless you and yours. Keep me up to date on you.

Ally

[Momto3]

Hi Ally!!!

Long time, no talk to...Nice to see you : )

Do you think it's just a matter of preference among doctors?  I do remember having to take 325mg for 6 weeks after the LVOT ablation, but that was because of the docs being on the left side and the slightly increased risk of a clot.  

I guess until they figure out what's going on, I'll be taking the 325mg  : (   I usually have ringing in my ears from aspirin, but so far, so good.

Sounds like you are doing well : )

If you decide to try the fish oil, let us know what you think.

connie  

[ChatterAlly]

Hey there. I also take the 325mg of aspirin and have for 5 years now. I do have a problem with bruising easily and my skin is so thin it breaks easy. I may try what the other chatter suggested and take the Fish Oil. I have it in my pantry, just have trouble remember to take this.  As I do with all my meds. *sigh*  Yes, I really do. Even more so since starting on the Amiodarone I feel so much better that I forget I need to take the other 5 pills. LOL


God bless                      Ally

[Momto3]

Hi often,

Thanks!!  I've researched quite a bit, but mostly come up with 81mg....any idea why some doctors prefer a larger dose?  My cardio started to say a baby aspirin, then changed his mind.......You should see my "favorites"....LOL.  Pretty soon,  I'm gonna need a separate computer to store them....... : )

[often]

I have been taking 325 mg for about a year....there is good information on both Mayo clinic and webmd.  you really should put them in your favorites.

[Momto3]

JKJ, kenkeith, Sirenet, penney4

Thanks for your input!  OK, so what's the deal with taking 325mg?  Hmmmm......Anyone else on aspirin therapy?  Any ideas as to why I might be on a higher dose?  I'm not getting the impression that it is any more effective.  Any ideas?  Hmmmmm

[penney44]

Doctor put me on asprin regiment about 4 years ago, 81 mg, saved me from my heart having damage, had triple bypass, no heart attack. It does what it is suppose to do.

[Sirenet]

Hi, I am also taking the ecotrin 81mg

[Momto3]

I was so happy to hear when the AHA and the ACC said some of us no longer needed antiobiotics!  I took them for over 25 years!!  I don't miss that at all!

I had that weird eye thing (partial loss of vision) and that led to taking the aspirin. Hmmmm.....My doctor started to say,a baby aspirin then changed his mind to the 325mg.  I'm going in for an echo bubble test and a carotid art. ultrasound in a couple of weeks so I'm going to ask about that.  Do you happen to know anything about the bubble test?  I haven't come across anyone that's had one (yet) : )

Thanks for your help!

[kenkeith]

According to American College of Cardiology/American Heart Association guidelines for the management of patients with valvular heart disease, when using current echocardiographic criteria for diagnosing MVP, the prevalence is 1 percent to 2.5 percent of the population. Even this estimate means millions of people have been taking antibiotics prior to dental procedures.

Patients at the greatest danger of bad outcomes from IE and for whom preventive antibiotics prior to a dental procedure are worth the risks include those with:

artificial heart valves
a history of having had IE
certain specific, serious congenital (present from birth) heart conditions, including
unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
a cardiac transplant which develops a problem in a heart valve.
"Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of congenital heart disease,¡¨ the statement said.

[kenkeith]

My research on the effective dose for heart patients is 81 mg daily.  That dosage is effective in preventing clots which is the concern for most heart patients.

Also, after many years of doctors' advising taking an antibiotic for valve disorders prior to dental procedures, has recently been aknowledged by the medical community to be no longer necessary.  But there are exceptions such as non-biological valve prosthesis, but for heart murmurs, regurg it is not necessary.

[JKJ]

I've never heard of taking that much asprin for daily asprin therapy.  Seems like a lot; but then again, I'm no doc.