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Medical Forum / General / Pharmacy / March 2005

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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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