- People may take aspirin for a number of reasons, such as to help prevent heart attacks. Some people take warfarin to help prevent blood clots.
- However, some people who take warfarin also take aspirin. Because aspirin is available without a prescription, some people may take it without a recommendation from their doctor.
- Results of a new study show that for some people taking warfarin, stopping aspirin use can help prevent negative bleeding.
A recent study was published in
The results suggest that some people may have a lower bleeding risk if they stop taking aspirin while taking warfarin.
The statements serve as an important reminder for people to discuss medication use with their doctors.
warfarin (also known as Jantoven or Coumadin) is an anticoagulant medicine, known as a blood thinner. It helps prevent blood clots and reduces the risk of heart attack or stroke in people at risk of developing blood clots. The following individuals can take warfarin:
- People with mechanical heart valves
- People who have had a heart attack
- People with atrial fibrillation (A-fib), which is an irregular heartbeat
Aspirin is an anti-inflammatory drug. It has multiple uses, including relieving pain and reducing inflammation. Some people take aspirin to help reduce the risk of developing it Heart attack or stroke.
In some cases, people may take both warfarin and aspirin. However, this is not always medically indicated. Because both drugs carry risks of serious bleeding, it is essential that people discuss the medications they are taking with their doctors, including over-the-counter medications such as aspirin.
study author, Dr. Jeffrey Barnesa cardiologist at the University of Michigan’s Frankel Cardiovascular Center explained to MNT:
“Aspirin is not a benign drug, even if it is available without a prescription. Be sure to discuss with your doctor the potential benefits and harms of aspirin and decide whether or not you should take aspirin. This is especially true if you are taking another blood-thinning drug.”
The study examined the effect of reducing aspirin use among people taking warfarin. It specifically included participants on warfarin who also had no clear indication for taking aspirin.
For example, researchers sought to review aspirin use for people with no prior history of coronary artery disease or heart attack.
The observational study involved more than 6,000 adult participants who took warfarin for either A-fib or blood clots. Working with primary care professionals, participants were assessed for whether or not they needed to take aspirin and warfarin.
Aspirin was discontinued when it was deemed medically unnecessary.
The researchers found that stopping aspirin was associated with a lower risk of bleeding among the participants.
This included the risk of major bleeding episodes and emergency room visits related to bleeding. They further found that discontinuation of aspirin was not associated with increased coagulopathy events.
Dr. Barnes noted the highlights of the following study:
“First, we were able to demonstrate that among patients taking anticoagulants, such as warfarin, and also taking aspirin without clear indication, stopping aspirin can reduce bleeding risk. Second, we were able to demonstrate that a structured approach to assessing the need for aspirin and helping patients On stopping aspirin when it is not indicated can be very effective. This is an excellent example of anticoagulation supervision.”
The researchers acknowledge that their study has several limitations.
First, they note limits based on the methods used to collect data and study participants. They note that the study could not determine the cause, some data could be missed, and the results could not be generalized.
Aspirin use has also been reported, increasing the risk of data collection errors.
The study only included participants from one state, and the researchers were not able to collect as accurately information about myocardial infarctions as they would have liked. Participants would have received medical attention for events that the study could not capture. The number of events that occurred was low, which limits some data analysis. The study also lacked a control group.
Overall, the study is an important reminder of the careful use of medications and how some medications, such as aspirin, are not always necessary. Because indications vary from person to person, some people will still need to use aspirin in addition to warfarin or aspirin as well as a newer type of blood thinner such as Eliquis or Xarelto.
People should work carefully with their doctors to take medications appropriately.
author on the study, Dr.. Navid Saqiba vascular surgeon at UTHealth Houston Heart & Vascular and Memorial Hermann, explained to MNT:
“This study has important findings that will help clinicians identify patients at high risk on combination therapy for bleeding and aspirin elimination. This should also be studied in patients taking new oral anticoagulants. Currently, patients with recent heart attacks, heart valves and , coronary and carotid stents, peripheral stents, and those requiring anticoagulation require combination therapy of aspirin/clopidogrel plus warfarin/Eliquis/Xarelto.”
d p. Barnes further noted the following components of future research:
“While we were able to show a reduction in bleeding when we stopped taking aspirin among patients taking warfarin, we need to understand how best to implement this same approach for patients taking direct oral anticoagulants, including apixaban and rivaroxaban. Patients using these drugs are not being followed up. in the anticoagulation clinic. So we need to develop new ways to systematically review their medications and eliminate unnecessary prescribing.”