Avoid aspirin if you take warfarin, researchers say

Share on Pinterest
According to a new study, some people taking warfarin should stop using aspirin to avoid adverse bleeding events. Aitor Diago/Getty Images
  • People may take aspirin for several 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. Since aspirin is available without a prescription, some people may take it without their doctor’s advice.
  • The results of a new study show that for some people on warfarin, stopping aspirin use may help prevent adverse bleeding events.

A recent study published inJAMA looked at how stopping aspirin can benefit some people who are already taking warfarin.

The results indicate that some people may have a reduced risk of bleeding if they stop taking aspirin while taking warfarin.

The data is an important reminder for people to discuss their medication use with their doctor.

Warfarin (also known as Jantoven or Coumadin) is a blood-thinning medication, commonly referred to as a blood thinner. It helps prevent blood clots and reduces the risk of heart attack or stroke in people at high risk of developing blood clots. The following people can take warfarin:

  • people with mechanical heart valves
  • people who have had a heart attack
  • people with atrial fibrillation (A-fib), an abnormal heart rhythm

Aspirin is a nonsteroidal anti-inflammatory drug. It has multiple uses, including pain relief and inflammation reduction. Some people take aspirin to help reduce their risk of heart attack or stroke.

In some cases, people can take both warfarin and aspirin. However, it is not always medically indicated. Since both medications carry risks of serious bleeding, it is essential that people discuss their medications with their doctor, including over-the-counter medications like aspirin.

Study author Dr. Geoffrey Barnes, a cardiology specialist at the University of Michigan Frankel Cardiovascular Center, told MNT:

“Aspirin is not a benign drug, even though it is available over the counter. Be sure to discuss the potential benefits and harms of aspirin with your doctor and whether or not you should take aspirin. This is especially true if you are taking another blood thinner.

The study looked at the impact of reducing aspirin intake in people taking warfarin. It specifically included participants on warfarin who also had no clear indicator for taking aspirin.

For example, researchers sought to examine the use of aspirin in people who had no history of coronary artery disease or heart attack.

The observational study included more than 6,000 adult participants taking warfarin for fib A or blood clots. Working with primary care professionals, participants were assessed whether or not they needed to take aspirin and warfarin.

Aspirin was discontinued when deemed medically unnecessary.

Researchers found that stopping aspirin was associated with a decreased risk of bleeding in participants.

This included the risk of major bleeding episodes and bleeding-related emergency room visits. They further found that stopping aspirin was not associated with an increase in blood clot events.

Dr. Barnes noted the following highlights from the study:

“First, we were able to show that in patients who are taking an anticoagulant, such as warfarin, and who are also taking aspirin without a clear indication, stopping aspirin can reduce the risk of bleeding. Second, we were able to show that a systematic approach to assessing the need for aspirin and helping patients to stop aspirin when it is not indicated can be very effective. This is an excellent example of anticoagulation management.

The researchers acknowledged that their study had several limitations.

First, they note limitations based on data collection methods and study participants. They note that the study could not determine the cause, some data may be missed, and the results cannot be generalized.

Aspirin use was also reported by participants, increasing the risk of data collection errors.

The study only included participants from one state, and the researchers were not able to accurately gather information about incidents of myocardial infarction as well as they would have liked. Participants could have received medical attention for events that the study could not capture. The number of events that occurred was low, which limits some of the data analysis. The study also lacked a control group.

Overall, the study serves as an important reminder for careful drug use and how some drugs, like aspirin, aren’t always necessary. As the indications are different for everyone, some people will still need to use aspirin plus warfarin, or aspirin plus a new type of blood thinner like Eliquis or Xarelto.

People should work carefully with their doctors to take their medications appropriately.

Study author Dr. Naveed Saqib, a vascular surgeon at UTHealth Houston Heart & Vascular and Memorial Hermann, explained to MNT:

“This study has significant results that will help physicians identify high-risk patients on combination therapy for bleeding and remove them from aspirin. This also needs to be investigated in patients on newer oral anticoagulants. For now , patients with recent heart attacks, heart valves, coronary and carotid stents, and peripheral stents who require anticoagulation will still require combination therapy of aspirin/clopidogrel plus warfarin/Eliquis/Xarelto.

Dr. Barnes further noted the following for future research:

“Although we were able to show a reduction in bleeding when we stopped aspirin in patients on warfarin, we need to understand how to best implement this same approach for patients taking direct oral anticoagulants, including apixaban and rivaroxaban. Patients using these medications are generally not monitored in an anticoagulation clinic. So we need to develop new ways to systematically review their medications and deprescribe unnecessary medications.

Leave a Reply