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- Aspirin vs. warfarin (Coumadin, Jantoven)
- What is aspirin? What is warfarin (Coumadin, Jantoven)?
- What are the side effects of aspirin and warfarin?
- What is the dosage of aspirin vs. warfarin?
- What drugs interact with aspirin and warfarin?
- Are aspirin and warfarin safe to use while pregnant or breastfeeding?
Aspirin vs. warfarin (Coumadin, Jantoven)
- Aspirin and warfarin (Coumadin, Jantoven) are used to prevent blood clots.
- Aspirin is also used to treat fever, pain, and inflammation in the body.
- Aspirin and warfarin belong to different drug classes. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and warfarin is an anticoagulant.
- Brand names for aspirin include Bayer Aspirin, Ecotrin, and E.C. Prin.
- Aspirin is available over-the-counter (OTC) and as a generic.
- Side effects of aspirin and warfarin that are similar include rash.
- Side effects of aspirin that are different from warfarin include abdominal pain, abdominal burning, cramping, gastritis, stomach ulcers, nausea, ringing in the ears, dizziness, serious gastrointestinal bleeding, liver toxicity, kidney impairment, and spinning sensation (vertigo).
- Side effects of warfarin that are different from aspirin include bleeding, necrosis (gangrene) of the skin, purple painful toes, hair loss, bloating, diarrhea, and yellowing of eyes and skin (jaundice).
What is aspirin? What is warfarin (Coumadin, Jantoven)?
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat fever, pain, and inflammation. It is also used to prevent blood clots (antithrombotic). Other NSAIDs include ibuprofen (Motrin), nabumetone (Relafen), and indomethacin (Indocin). NSAIDs reduce levels of chemicals called prostaglandins that are released when there is inflammation. NSAIDs block cyclooxygenase, the enzyme that makes prostaglandins, resulting in lower concentrations of prostaglandins and reduction of inflammation, pain, and fever. Prostaglandin inhibition also reduces the blood’s clotting ability so aspirin is also used to reduce the risk of another stroke or heart attack in people who have already had a stroke or heart attack.
Warfarin (brand names Coumadin, Jantoven) is an oral anticoagulant that prevents the formation of blood clots by reducing the production of factors by the liver that promote clotting: factors II, VII, IX, and X, and the anticoagulant proteins C and S. The production of these factors by the liver depends on adequate amounts of vitamin K. Warfarin antagonizes vitamin K and reduces the production of these factors. Warfarin is used to treat deep vein thrombosis (DVT), to prevent further emboli in patients with pulmonary embolism, to reduce the risk of strokes and after a heart attack in patients with atrial fibrillation or artificial heart valves, to prevent blood clots from forming in certain orthopedic surgeries, and to prevent closure of coronary artery stents due to clotting.
What are the side effects of aspirin and warfarin?
Most patients benefit from aspirin and other NSAIDs with few side effects. However, serious side effects can occur and generally tend to be dose-related. Therefore, it is advisable to use the lowest effective dose to minimize side effects.
The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears.
Gastrointestinal side effects are
- abdominal burning,
- gastritis, and
- even serious gastrointestinal bleeding and
- liver toxicity.
Ringing in the ears
- Should ringing in the ears occur, the daily dose should be reduced.
Other side effects include:
Other side effects and adverse reactions
- Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.
- Aspirin may exacerbate asthma.
- Aspirin can raise the blood uric acid level and is avoided in patients with hyperuricemia and gout.
- Children and teenagers should avoid aspirin for symptoms of the flu or chickenpox because of the associated risk of Reye's Syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
- Aspirin can increase the effect of medicines used to treat diabetes mellitus, resulting in abnormally low blood sugars if blood sugar levels are not monitored.
- NSAIDs should be discontinued prior to elective surgery because of a mild tendency to interfere with blood clotting. Aspirin, because of its prolonged effect on platelets, is best discontinued at least ten to fourteen days in advance of the procedure.
The two most serious side effects of warfarin are:
- Necrosis (gangrene) of the skin
Bleeding can occur in any organ or tissue. Bleeding around the brain can cause severe headache and paralysis. Bleeding in the joints can cause joint pain and swelling. Bleeding in the stomach or intestines can cause weakness, fainting spells, black tarry stools, vomiting of blood, or coffee ground material. Bleeding in the kidneys can cause back pain and blood in urine.
Other side effects include:
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What is the dosage of aspirin vs. warfarin?
- Aspirin should be taken with food. Doses range from 50 mg to 6000 mg daily depending on the use.
- Usual doses for mild to moderate pain are 350 or 650 mg every 4 hours or 500 mg every 6 hours.
- Doses for rheumatoid arthritis include 500 mg every 4-6 hours; 650 mg every 4 hours; 1000 mg every 4-6 hours; 1950 mg twice daily.
- Heart attacks are prevented with 75, 81, 162 or 325 mg daily.
- 160 to 325 mg of non-enteric coated aspirin should be chewed immediately when experiencing symptoms of a heart attack.
- The dose for preventing another stroke is 75 to 100 mg daily.
- Warfarin may be taken with or without food.
- Since warfarin is metabolized (inactivated) by the liver and then excreted by the kidneys, dosages need to be lowered in patients with liver and kidney dysfunction.
- Frequent blood tests (INR test) are performed to measure the effect of warfarin and to adjust dosing.
- There are published INR ranges for the various uses of warfarin.
- Treatment usually is started at 2 to 5 mg once daily and the dose is adjusted based in INR tests.
- Patients typically require 2 to 10 mg of warfarin daily.
What drugs interact with aspirin and warfarin?
- Aspirin is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common of the suspected interactions.
- NSAIDs may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
- Aspirin may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation of blood pressure.
- When aspirin is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
- Individuals taking oral blood thinners or anticoagulants, for example, warfarin, (Coumadin) should avoid aspirin because aspirin also thins the blood, and excessive blood thinning may lead to serious bleeding.
- Many drugs, both prescription and nonprescription (OTC), can affect the anticoagulant action of warfarin or increase the risk of bleeding. Patients on warfarin should regularly consult their doctor before instituting any medications on their own.
- It also is advisable for patients on warfarin to carry identification such as bracelets to alert other health professionals to the presence of anticoagulation.
- A few examples of drugs that interact with warfarin are:
- Drugs that increase the effect of warfarin by reducing the breakdown of warfarin include amiodarone (Cordarone), trimethoprim/sulfamethoxazole (Bactrim), fluconazole (Diflucan), itraconazole (Sporanox), fluvastatin, fluvoxamine, metronidazole miconazole, voriconazole (Vfend), zafirlukast (Accolate), ciprofloxacin (Cipro), cimetidine, atorvastatin (Lipitor), clarithromycin (Biaxin), fluoxetine (Prozac), indinavir (Crixivan), and ritonavir (Norvir).
- Drugs that may reduce the effect of warfarin by increasing its breakdown include St. John's wort, carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), rifampin, bosentan (Tracleer), and prednisone.
- Bleeding is increased by other anticoagulants such as heparin, argatroban (Acova), dabigatran (Pradaxa), and others; antiplatelet drugs such as aspirin and other nonsteroidal anti-inflammatory drugs (for example, ibuprofen [Motrin], naproxen [Alleve]), clopidogrel (Plavix), and prasugrel (Effient); serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and paroxetine (Paxil). Garlic and ginkgo also increase the risk of bleeding because they cause bleeding when taken alone.
- Foods with high vitamin K content (for example, green leafy vegetables) reduce the effect of warfarin. Maintenance of a consistent intake of vitamin K containing foods is important to avoid fluctuations in the effect of warfarin.
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Are aspirin and warfarin safe to use while pregnant or breastfeeding?
- Aspirin is generally avoided during pregnancy because it may adversely affect the fetus. However, low aspirin doses have been safely used for the prevention of complications of pregnancy.
- Aspirin is excreted into breast milk and may cause adverse effects in the infant.
Aspirin and warfarin (Coumadin, Jantoven) are used to prevent blood clots. Aspirin is also used to treat fever, pain, and inflammation in the body. Aspirin and warfarin belong to different drug classes. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and warfarin is an anticoagulant.
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Deep Vein Thrombosis (DVT, Blood Clot in the Legs)
Deep vein thrombosis (DVT) is a blood clot in the deep veins, and can be caused by broken bones, trauma to a limb, immobility, medications, smoking, cancer, genetic predisposition, and cancer. Symptoms of a deep vein thrombosis in a leg are swelling, tenderness, redness, warmth, and pain. Treatments for DVT include medications and surgery.
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic). Symptoms of a stroke may include: weakness, numbness, double vision or vision loss, confusion, vertigo, difficulty speaking or understanding speech. A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.
Blood Clots (in the Leg)
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for causes of blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Heat Stroke (A Very Serious Condition)
Heat stroke (heatstroke or sun stroke) is a form of hyperthermia. Heat stroke is a true medical emergency that can be fatal if not promptly and properly treated. Symptoms of heat stroke include high body temperature, absence of sweating, hot red or flushed dry skin, rapid pulse, difficulty breathing, strange behavior, hallucinations, confusion, agitation, disorientation, seizure, and coma. A victim of heat stroke must receive immediate treatment to avoid permanent organ damage.
Stroke vs. Mini-Stroke (TIA) Differences
A stroke or "brain attack" occurs when a blood clot or artery ruptures within the brain. The rupture or clot causes brain cell damage or death. A mini-stroke (TIA, transient ischemic attack) is caused by brain cells that dysfunctional over a short period. Stroke and mini-stroke warning signs of stroke and mini stroke are the same, and include, speech problems, weakness, numbness, and facial droop. Side effects of stroke may be permanent and you may never regain full function of the parts of the body affected. Mini-stroke side effects usually resolve within minutes to a couple of days. A transient ischemic attack (mini-stroke) is a precursor for stroke because 40% of individuals who have a mini-stroke will have a stroke within a year. Treatment of stroke depends upon the type and parts of the body affected.
Early Warning Signs and Symptoms of Stroke (FAST)
Stroke is a serious medical condition. If you think you or someone you know is having a stroke call 911 immediately. There are two main types of strokes, hemorrhagic and ischemic (the most common type). A hemorrhagic stroke occurs due to a blood vessel rupture in the brain. An ischemic stroke occurs when a blood clot becomes lodged in a blood vessel in the brain, which causes a loss of blood supply to the brain, possibly causing brain tissue death. FAST is an acronym that helps people identify stroke signs and symptoms so they can act fast and call 911. Face drooping, Arm weakness, and Speech difficulty are indicators that a person may be having a stroke and it is Time to seek emergency medical treatment. Additional signs and symptoms of stroke may include weakness, difficulty walking, blurred vision, dizziness, headache, confusion, difficulty speaking, and loss of sensation. Stroke is a major cause of death and disability in the U.S. Early identification and treatment of stroke helps reduce the risk of morbidity and mortality.
Pulmonary Embolism (Blood Clot in the Lung)
A pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Pulmonary embolism can cause death if not treated promptly.
Transient Ischemic Attack (TIA, Mini-Stroke)
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Migraine and Stroke
Migraine headache is a type of headache in which the exact cause is not known; however, they may be inherited, and certain foods and environmental factors can trigger and may contribute them. A stroke (brain attack) happens when a blood vessel in the brain leaks, bursts, or becomes blocked, which can be caused by many other health problems. Both migraines and strokes can can cause severe head pain (migraine pain usually is only on one side of the head). Migraine aura symptoms may mimic or feel like a stroke or mini-stroke (transient ischemic attack, TIA) because they have similar symptoms and signs like severe headache, numbness in the legs, feet, arms, hands, or face, nausea, vomiting, and dizziness. Other migraine aura symptoms include vision problems like flashing lights or blind spots in one eye. The main difference between migraine headache and stroke symptoms and signs is that a migraine headaches usually come on gradually while a stroke symptoms come on suddenly and unexpectedly.
Heart Attack vs. Stroke Symptoms, Differences, and Similarities
Heart attack usually is caused by a clot that stops blood flow supplying oxygen to an area of heart muscle, which results in heart muscle death. Stroke or "brain attack" is caused by a loss of blood supply to the brain (usually a blood clot) or by hemorrhagic stroke (bleeding within the brain), which results in brain tissue death. Both heart attack and stroke usually come on suddenly, produce similar symptoms, can be disabling, and can be fatal. The classic symptoms and warning signs of heart attack are different. Classic heart attack warning signs are chest pain or discomfort, shortness of breath, pain that radiates to the shoulders, back, arms, belly, jaw, or teeth, sweating, fainting, and nausea and vomiting. Moreover, woman having a heart attack may have additional symptoms like abdominal pain or discomfort, dizziness, clammy skin, and moderate to severe fatigue. The classic symptoms and warning signs that a person is having a stroke are confusion or loss of consciousness, sudden severe headache, speech problems, problems seeing out of one or both eyes, and numbness or weakness of only one side of the body. Moreover, a woman having a stroke may have additional warning symptom and signs like shortness of breath, disorientation, agitation, behavioral changes, weakness, nausea, vomiting, seizures, and hiccups. Recognition of stroke symptoms is vital for emergency treatment. The acronym "FAST" stands for recognition of Facial drooping, Arm weakness, Speech difficulty, and a Time for action. If you experience the symptoms heart attack or stroke (FAST) or see them develop in another person, then contact 911 immediately.
Stroke vs Aneurysm (Differences and Similarities)
A stroke or "brain attack" is caused because blood flow to an area of the brain has been cut off by a blood clot or by a weakened or damaged blood vessel (for example, head trauma). The damaged area of the brain dies, which results in loss of function like speech capabilities, muscle movement, or muscles of an extremity like an arm or leg is reduced or lost completely. An aneurysm is a weakness in an artery wall. This weakness in the wall causes the artery to widen or balloon out, and then they rupture or break open.
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble seeing with one or both eyes, dizziness, loss of balance, and more. Stroke prevention and reatable risk factors for stroke include lowering high blood pressure, quit smoking, heart disease, diabetes control and prevention.
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