Medical Forum / General / Pharmacy / March 2005
aspirin and surgery
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nospam@pacbell.net - 26 Jan 2005 04:08 GMT I recently had minor surgery and the doctor instructed me not to use any medications containing salicylates for two weeks before the surgery - I suppose to prevent excess bleeding. They gave me a long list of medications to stay away from.
What I am wondering is why the medical profession recommends that people take a baby aspirin every day to prevent whatever they prevent (strokes?). Why not just take one regular aspirin every week or so?
Ora
Bryan - 26 Jan 2005 15:40 GMT Using the minimun dose reduces the chance of developing stomach problems down the road. Taking a 325mg of ASA once a week won't give you the protection you need. It doesn't last that long. You could take 325mg once a day, or even every other day and get the same protection as 80mg once daily, but over time you have a higher risk of developing stomach ulcers.
Bryan
> I recently had minor surgery and the doctor instructed me not to use any > medications containing salicylates for two weeks before the surgery - I suppose [quoted text clipped - 6 lines] > > Ora nospam@pacbell.net - 27 Jan 2005 00:57 GMT >Using the minimun dose reduces the chance of developing stomach problems >down the road. Taking a 325mg of ASA once a week won't give you the [quoted text clipped - 3 lines] > >Bryan If it doesn't last that long, why the two weeks without aspirin before surgery?
Ora
Repeating Rifle - 27 Jan 2005 05:25 GMT > If it doesn't last that long, why the two weeks without aspirin before > surgery? Malpractice problems?
Bill
Jake - 28 Jan 2005 14:29 GMT I think it was probably a round figure. Aspirin inactivates your blood platelets (which cause blood coagulation) for about 4-7 days. I think he just added the extra week just to be on the same side.
> in article e1fgv0thbo6a9is9q3hi826vc5qh2p2bsh@4ax.com, nospam@pacbell.net > at [quoted text clipped - 6 lines] > > Bill Jake - 28 Jan 2005 14:30 GMT I ment "safe side" not "same side"
>I think it was probably a round figure. Aspirin inactivates your blood >platelets (which cause blood coagulation) for about 4-7 days. I think he [quoted text clipped - 10 lines] >> >> Bill Dee Randall - 20 Mar 2005 17:42 GMT > in article e1fgv0thbo6a9is9q3hi826vc5qh2p2bsh@4ax.com, nospam@pacbell.net > at [quoted text clipped - 6 lines] > > Bill When I have my yearly physical which includes taking a stool sample, and they say not to take aspirin for SEVEN days before I take the sample, I have been under the impression that aspirin can cause bleeding in the stomach, or if you have an ulcer it can cause bleeding in the stomach.
Also my physician said that instead of a baby aspirin every day that it is ok to take a full aspirin every other or third day and that would do just as well. What I do is take a half-aspirin every day and sometimes skip a day. Dee
Glenn Gilbreath Jr. - 01 Jan 2002 05:00 GMT In article <jason-2003050919150001@pm1-broad-70.snlo.dialup.fix.net> jason@nospam.com (Jason) writes:
>Date: Sun, 20 Mar 2005 09:19:15 -0800 >From: jason@nospam.com (Jason) >Subject: Re: aspirin and surgery
>In article <113r9vutgrrrf09@corp.supernews.com>, "Dee Randall" ><deedoveyatshenteldotnet> wrote:
>> > in article e1fgv0thbo6a9is9q3hi826vc5qh2p2bsh@4ax.com, nospam@pacbell.net >> > at [quoted text clipped - 16 lines] >> well. What I do is take a half-aspirin every day and sometimes skip a day. >> Dee
>They now have special aspiren tablets designed for people that are over >50. For example--Bayer makes a product called "Bayer enteric safety coated >low strength Aspiren Regiment" I take one pill a day. Actually, Bayer's 81 mg low dose "Asprin Regimen" has been available for a few years...not to mention Ecotrin also has an enteric coated low dose 81mg version. To answer the original question, regarding not taking aspirin for at least 2 weeks prior to surgery or other invasive technique... aspirin deactivates platelets permanently from binding to each other. Platelet binding is one of the first steps in blood clotting. The "turnover rate" for platelet production is roughly 4 weeks. By not taking aspirin products for minimum of 2 weeks prior to a surgical procedure, it allows the platelets to be replaced to a level that promotes blood clotting, and this prevents the patient from bleeding to death. As far as "effective dose" for aspirin's effect on platelets, the 81 mg strength is usually plenty, and can be taken daily. Alternatively, it is perfectly allright for a patient to take a regular 325mg ("5 grain") aspririn tablet daily to prevent blood clotting, as long as some monitoring of the patient's GI tract is performed to prevent bleeding of the stomach wall, or ulcer irritation.
C U L8R! Wiz <{;-) Wizard57M Glenn Gilbreath Jr. Registered Pharmacist http://members.surfbest.net/wizard57m@surfbest.net/index.htm -- DOS Internet, Close Windows and Keep the Internet Open! --
nospam@pacbell.net - 23 Mar 2005 20:46 GMT Thanks for answering my question. Now another one - if aspirin deactivates platelets permanently, and new platelets (I presume) are produced daily to replace those that expire, it seems to me that it would be more logical to take an aspirin about once a week so that we will have SOME useful platelets which will permit clotting but not so many that they might stick to the artery walls.
I take an aspirin about once a week which I have heard is useful for preventing strokes and other bad stuff, but I still have clotting ability which I think we need.
Ora
>To answer the original question, regarding not taking aspirin for >at least 2 weeks prior to surgery or other invasive technique... [quoted text clipped - 20 lines] >http://members.surfbest.net/wizard57m@surfbest.net/index.htm >-- DOS Internet, Close Windows and Keep the Internet Open! -- Jason - 24 Mar 2005 01:22 GMT Hello, I am not a medical expert. It's my guess that studies have been done that show that older people should take one aspirin per day--not one per week. If your theory was true--the medical experts would tell us to take one asperin per week instead of one per day. A medical expert might respond and explain why we need one asperin per day instead of one per week.
> Thanks for answering my question. Now another one - if aspirin deactivates > platelets permanently, and new platelets (I presume) are produced daily to [quoted text clipped - 34 lines] > >http://members.surfbest.net/wizard57m@surfbest.net/index.htm > >-- DOS Internet, Close Windows and Keep the Internet Open! --
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nospam@aol.com - 24 Mar 2005 01:44 GMT Actually I believe that studies have been done showing that taking 80 mg. aspirin daily is likely to prevent strokes. So 80 mg. aspirin has become big business and is widely available at higher cost than 325 mg. aspirin, and used by older folks all over the place.
I wonder if anyone ever did a study to detemine whether taking a 325 mg. aspirin once a week would have the same effect. Probably no one will because such a study would not be cost effective and would not produce the profits gleaned by sales of 80 mg. aspirin which was formerly available for use by children and is now being taken regularly by millions of people who are not children.
Ora
>Hello, >I am not a medical expert. It's my guess that studies have been done that [quoted text clipped - 45 lines] >> >http://members.surfbest.net/wizard57m@surfbest.net/index.htm >> >-- DOS Internet, Close Windows and Keep the Internet Open! -- Jason - 24 Mar 2005 17:31 GMT You might be right. I believe that your original theory was based upon your belief that an aspirin effects a human body for a full day--I don't think that is true. It's my guess that a aspirin tablet is digested and is out of the body in the urine or fecal material within about 2 or 3 hours. That's probably why you have to take an aspiren pill every day instead of once per week. Another poster recently said that Ginkgo Biloba is like aspirin in the sense that it keeps the blood from clotting. It's my guess that you could take Ginkgo Biloba each day instead of an aspiren--but I'm just guessing. You would have to talk to your doctor or a medical expert to detemine if my guess is correct. You might also do a google search on Ginkgo Biloba to find out if I am right. I do know that there is warning on my bottle of Ginkgo Biloba--warning me NOT to take aspirins during the same day that I take a Ginkgo pill.
> Actually I believe that studies have been done showing that taking 80 mg. > aspirin daily is likely to prevent strokes. So 80 mg. aspirin has become big [quoted text clipped - 58 lines] > >> >http://members.surfbest.net/wizard57m@surfbest.net/index.htm > >> >-- DOS Internet, Close Windows and Keep the Internet Open! --
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Jason - 20 Mar 2005 18:15 GMT > > in article e1fgv0thbo6a9is9q3hi826vc5qh2p2bsh@4ax.com, nospam@pacbell.net > > at [quoted text clipped - 16 lines] > well. What I do is take a half-aspirin every day and sometimes skip a day. > Dee They now have special aspiren tablets designed for people that are over 50. For example--Bayer makes a product called "Bayer enteric safety coated low strength Aspiren Regiment" I take one pill a day.
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RWP - 20 Mar 2005 19:21 GMT > They now have special aspiren tablets designed for people that are over > 50. For example--Bayer makes a product called "Bayer enteric safety coated > low strength Aspiren Regiment" I take one pill a day. But how much of a premium do they attract?
In the UK it is possible to buy 100x75mg Aspirin 75mf for aproximately ?1.
Why pay any more than that for a premium produce with negligible, if any, benefits over the original?
Aspirin causes GI problems via its systemic effect, rather than simply local irritation. So, enteric-coating isn't going to have a benefit1,2.
Rob
1 Am J Gastroenterol. 2000 Sep;95(9):2218-24.
Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin.
Sorensen HT, Mellemkjaer L, Blot WJ, Nielsen GL, Steffensen FH, McLaughlin JK, Olsen JH.
Department of Clinical Epidemiology, Aarhus University and Aalborg Hospitals, Denmark.
OBJECTIVE: Aspirin products are known to cause irritation and injury to the gastric mucosa. We examined the risk of hospitalization for upper gastrointestinal bleeding with use of low-dose aspirin. METHODS: This was a cohort study based on record linkage between a population-based prescription database and a hospital discharge registry in North Jutland County, Denmark, from January 1, 1991, to December 31, 1995. Incidence rates of upper gastrointestinal bleeding in 27,694 users of low-dose aspirin were compared with the incidence rates in the general population in the county. RESULTS: A total of 207 exclusive users of low-dose aspirin experienced a first episode of upper gastrointestinal bleeding with admission to the hospital during the study period. The standardized incidence rate ratio was 2.6 (95% confidence interval, 2.2-2.9), 2.3 in women and 2.8 in men. The standardized incidence rate ratio for combined use of low-dose aspirin and other nonsteroidal anti-inflammatory drugs was 5.6 (95% confidence interval, 4.4-7.0). The risk was similar among users of noncoated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 1.8-3.5) and coated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 2.2-3.0). CONCLUSIONS: Use of low-dose aspirin was associated with an increased risk of upper gastrointestinal bleeding, with still higher risks when combined with other nonsteroidal anti-inflammatory drugs. Enteric coating did not seem to reduce the risk. The findings from this observational study raise the possibility that prophylactic use of low-dose aspirin may convey an increased risk of gastrointestinal bleeding, which may offset some of its benefits.
2 . Which prophylactic aspirin? Drug and Therapeutics Bulletin 1997.Vol35 No.1. (R)
halo2 guy - 20 Mar 2005 19:43 GMT There is no logical reason to purchase an expensive name brand item such as aspirin that has been around forever and costs just a few cents a bottle to make. Purchase a generic.
Bayer has a brilliant marketing department as does Tylenol.
Aspirin is aspirin and it doesn't know if it is in a 6 year old or a 50 year old. There are generics all over that have enteric coated aspirin even the 81 mg 1/4 strength baby aspirin.
>> They now have special aspiren tablets designed for people that are over >> 50. For example--Bayer makes a product called "Bayer enteric safety [quoted text clipped - 52 lines] > 2 . Which prophylactic aspirin? Drug and Therapeutics Bulletin 1997.Vol35 > No.1. (R) Jason - 20 Mar 2005 21:27 GMT halo2 guy, Great point. The grocery store where I shop only has the Bayer enteric low dose aspirins. If they had a generic brand next to it on the shelf--I would buy it.
> There is no logical reason to purchase an expensive name brand item such as > aspirin that has been around forever and costs just a few cents a bottle to [quoted text clipped - 62 lines] > > 2 . Which prophylactic aspirin? Drug and Therapeutics Bulletin 1997.Vol35 > > No.1. (R)
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halo2 guy - 20 Mar 2005 23:17 GMT you have got to be kidding me... Wow..you must be shopping at a small store... The profits are so much greater on generics also. I am surprised the store doesn't carry them.
> halo2 guy, > Great point. The grocery store where I shop only has the Bayer enteric low [quoted text clipped - 87 lines] >> > 1997.Vol35 >> > No.1. (R) Hawki63@sbcglobal.net - 21 Mar 2005 02:56 GMT read what you quoted...
"irritation and injury to the gastric mucosa"....means the aspirin is exhibiting a LOCAL effect...
prior to surgery...etc...one DOES want to reduce the systemic effects...ie on the platelets...
apples and bananas
>> They now have special aspiren tablets designed for people that are over >> 50. For example--Bayer makes a product called "Bayer enteric safety [quoted text clipped - 52 lines] > 2 . Which prophylactic aspirin? Drug and Therapeutics Bulletin 1997.Vol35 > No.1. (R) Rob - 21 Mar 2005 11:50 GMT > read what you quoted... > [quoted text clipped - 5 lines] > > apples and bananas I agree with your last comment about the systemic effects Hawk.
However, I don't think RWP was answering the OP's question. He was trying to dissuade one of the latter posters from buying e/c tablets, at ten times regular aspirin cost, when it has no evidence base for its use.
Hawki63@sbcglobal.net - 21 Mar 2005 20:13 GMT sorry about the attribution problem
but RWP stated "aspirin causes GI problems via its systemic effect,,,rather than simple local irritation,,,so enteric coating isn't going to have a benefit"
both of these statements are incorrect...
GI problems are a LOCAL,,,not systemic effect
Thus...enteric coating WILL/SHOULD have a protective benefit....
I agree...don't need the higher priced stuff....
also..hubby having surgery this week...surgeon said one week off aspirin prior was fine...
>> read what you quoted... >> [quoted text clipped - 14 lines] > at ten times regular aspirin cost, when it has no evidence base for its > use. RWP - 21 Mar 2005 21:14 GMT > Thus...enteric coating WILL/SHOULD have a protective benefit.... That's just it, it doesn't.
http://www.biomedcentral.com/1472-6904/1/1
Part of the discussion says:-
"The enteric-coated formulations appear not to protect from the aspirin-induced risk of upper gastrointestinal bleeding, irrespective of the dose, neither for gastric nor for duodenal lesions. This observation adds up to previous results from other investigators [4]. Assuming that the coating of aspirin effectively spares the stomach from its topical adverse effect, such results cast doubts on the overall contribution of the local effect in serious bleeding lesions observed among aspirin users. Instead, our findings support the hypothesis that the effect of aspirin, both plain and enteric-coated, on upper gastrointestinal bleeding is mainly systemic mediated through inhibition of platelet thromboxane A2 synthesis [19] and/or inhibition of protective prostaglandin synthesis in the gastroduodenal mucosa [20]. A local effect, however, cannot be ruled out as a relevant contributor for aspirin-induced perforation, as most cases were located in duodenum, and no difference or, perhaps, a slightly greater risk was found with the coated formulation. A preferential prescription of enteric-coated aspirin to patients with antecedents of gastrointestinal disorders does not explain our results, since enteric-coated aspirin users with no such antecedents present a risk similar to the one associated with plain aspirin."
Lancet. 1996 Nov 23;348(9039):1413-6. BACKGROUND: Aspirin products are known to cause irritation and injury to the gastric mucosa. The belief that enteric-coated and buffered varieties are less likely to occasion major upper-gastrointestinal bleeding (UGIB) than plain aspirin was tested in data from a multicentre case-control study. METHODS: 550 incident cases of UGIB admitted to hospital with melaena or haematemesis and confirmed by endoscopy, and 1202 controls identified from population census lists, were interviewed about use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) during the 7 days before the onset of bleeding (cases) or interview (controls). Relative risks of UGIB for each type of aspirin used regularly (at least every other day) were calculated overall, and according to dose, by multiple logistic regression, with control for age, sex, marital status, date, education, cigarette smoking, alcohol use, and use of NSAIDs. FINDINGS: The relative risks of UGIB for plain, enteric-coated, and buffered aspirin at average daily doses of 325 mg or less were 2.6, 2.7, and 3.1, respectively. At doses greater than 325 mg, the relative risk was 5.8 for plain and 7.0 for buffered aspirin; there were insufficient data to evaluate enteric-coated aspirin at this dose level. There were no important differences in risk attributable to the three aspirin forms according to bleeding site (gastric vs duodenal), or when users of NSAIDs were excluded. INTERPRETATION: Use of low doses of enteric-coated or buffered aspirin carries a three-fold increase in the risk of major UGIB. The assumption that these formulations are less harmful than plain aspirin may be mistaken.
chidi - 21 Mar 2005 15:41 GMT Repeating Rifle - 20 Mar 2005 19:33 GMT > They now have special aspiren tablets designed for people that are over > 50. For example--Bayer makes a product called "Bayer enteric safety coated > low strength Aspiren Regiment" I take one pill a day. Such 81mg doses are also available from Costco. Probably various drug chains have their equivalent house brands. It amazes how Bayer drums up demand for their brand by marketing. There is an old Barnum saying.
Bill
Jason - 26 Jan 2005 20:09 GMT > I recently had minor surgery and the doctor instructed me not to use any > medications containing salicylates for two weeks before the surgery - I suppose [quoted text clipped - 6 lines] > > Ora You are right--the doctor told you not to take certain medication since it causes excessive bleeding.
Regarding aspirin- Buy the new type of aspirins that are now located in almost all grocery stores and grocery stores. It's called things like low dose aspirin--It has an ENTERIC safety coating which means that it does NOT desolve in the stomach which means that you are less likely to get an ulcer as a result of taking regular aspirins every day.
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