Comments
raptorbluez t1_j7vw278 wrote
The big question is an aspirin regiment as effective as Eliquis?
Eliquis has the most total cost the U.S. government, nearly $10 billion in 2020, not to mention its extreme cost for patients.
If low dose aspirin is as effective it will save a boatload of cash for both the government and for patients.
rdizzy1223 t1_j7w010v wrote
Why does everyone only talk about low dose aspirin regiments rather than just normal/higher dose aspirin for more serious cases?
Hapgam t1_j7w07a3 wrote
Glancing at the abstract as I don't access to the full article, but this study's population was very specific - "patients with extremity fractures that had been treated operatively or with any pelvic or acetabular fracture".
It would be interesting to see if aspirin continued to be noninferior in patients with conditions that were even more procoagulable, such as sepsis or covid. Does anyone happen to know if this is an active area of research being investigated in another conditions?
odoroustobacco t1_j7w594a wrote
What about side effect profiles, organ toxicity, etc.?
pokey1984 t1_j7w5akn wrote
Because "more aspirin" doesn't thin the blood any more than a low dose.
After 81 mgs, you don't see any increase in the amount it thins the blood and higher doses over extended periods can be hard on the stomach and kidneys.
Pro-Karyote t1_j7w5lvw wrote
Largely because there isn’t an increase in efficacy for higher doses of aspirin for prevention of cardiac or stroke events, but there is an increased risk of bleeding events with increasing doses according to several studies.
Yoshi_87 t1_j7w6bo5 wrote
I am taking it for over 25 years for that reason, thought this wasn't something new...?
TinFoilHeadphones t1_j7w6nom wrote
81mg for what body weight?
Pandoras_Cockss t1_j7w795o wrote
Ig it depends on how big the regiment is and how well they are equipped
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Pro-Karyote t1_j7w865m wrote
For daily prophylactic use, it’s 81mg for all body weights (though the actual definition of low-dose aspirin is anything less than 100mg per day - 81mg is traditionally the dose for historical reasons).
pokey1984 t1_j7w9zb8 wrote
It's pretty universal. I'm sure some adjustments meed to be made for people who weigh like 600lbs, but for pretty much everyone else 81mgs is sufficient.
My mom is on Aspirin, Elliquis, and Warfarin for her heart problems because simply adding more aspirin or increasing either of the other drugs doesn't do enough. Most drugs reach a maximum effective level and after that more of the drug doesn't have any more effect. That's why people with serious problems will be on so many different medications instead of just taking a huge dose of one drug.
And in most cases, body weight is irrelevant. Certain drugs, yes, body weight matters. That's true of anesthetics and a few other types of drugs. But for most of them weight doesn't matter.
pokey1984 t1_j7wares wrote
Warfarin is a different type of blood thinner from aspirin and works in different ways.
This study was researching what, if any, difference there was for patients with a specific ailment. "Is one better than the other and, if so, why?"
They found out that for this particular ailment, no, warfarin wasn't better. That was something they didn't know before.
But for some ailments warfarin is better. And studies like this one are why we know that.
Edit: I said warfarin when I mean to say heparin. My bad. I have a problem with mixing up words when I speak or write. I usually proofread better. Apologies.
Jsum2003 t1_j7wbpxa wrote
This study was not comparing warfarin and aspirin. It was comparing low molecular weight heparin (lwmh) and aspirin. Lwmh is not the same thing as warfarin.
pokey1984 t1_j7wc6nu wrote
My apologies, I used the wrong word. I have that problem. I meant heparin.
Will edit to correct.
Edges8 t1_j7wep7y wrote
eliquis isn't typically used for DVT prophylaxis, but rather in those who have a known DVT/PE or in those with risk of stroke for AF, as two common examples.
a better question would be if asa could prevent DVTs in the general hospital population, and not simply young healthy trauma patients
sciolycaptain t1_j7wh7qj wrote
This study is in line with previous studies comparing aspirin to LMWH in this specific population of orthopedic trauma.
This was a larger number enrolled and showed low dose aspirin is non-inferior to LMWH for all cause mortality. But LMWH had lower instances of DVT and PE.
sciolycaptain t1_j7whrwo wrote
You've had continuous lower extremity fractures for 25 years?
[deleted] t1_j7wi7lu wrote
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Redditcommentorsrdum t1_j7wk87o wrote
Sponsored by aspirin manufacturers
tjeulink t1_j7wl80m wrote
Historical reasons on medicine dosages? Now im interested haha
HenryKrinkle t1_j7wm3la wrote
Boneitis strikes again
AnnexBlaster t1_j7wmgtr wrote
Yes I do research on the effects of anticoagulant drugs for sepsis, but I haven’t investigated aspirin yet, I suspect though that the toxins in sepsis cause far too much platelet activation for aspirin to handle, ticagrelor on the other hand looks very promising for increasing platelet killing efficiency and host survival.
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aedes t1_j7wnkhn wrote
Non-inferior is not “just as effective.” That would require an equivalence study to conclude, rather than a non-inferiority study.
Rather, a positive non-inferiority like this best interpreted as “aspirin is tolerably close to low-molecular weight heparin.”
Where the researchers have defined what “tolerably close” means. It could very well be 10% worse than low-molecular weight heparin. But if the non-inferiority margin was set to 15%, the study would conclude that aspirin was non-inferior.
You can’t interpret non-inferiority study results without knowing the non-inferiority margin and how it was derived and if it seems to be a reasonable amount or not.
Jigglysquare t1_j7wnuc6 wrote
"Heparin" and "low molecular weight heparin" are also different.
[deleted] t1_j7wo390 wrote
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AnnexBlaster t1_j7wo9p3 wrote
Bro its aspirin at 1/3 dose twice a say
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Pro-Karyote t1_j7wp06j wrote
It has to do with a unit of measurement we don’t currently use for dosing medications, called a grain. The full dose of aspirin was 5 grains, which is about 325mg. The low dose was a quarter of the full dose, so 1.25 grains (which is roughly 81mg). That was the dose that was on formulary, and since it falls within the low-dose range and it was the dose available, it stuck.
SodaRayne t1_j7wpb7g wrote
> DVT and PE.
Deep Vein Thrombosis and Pulmonary Edema?
edit: That's what I get for reading the comments before the article. Deep venous thromboembolism (DVT) is listed in the first sentence.
Km2930 t1_j7wrudv wrote
No, the question is, which one leads to more bleeding.
robm111 t1_j7wt81o wrote
Interested in this also. I was diagnosed with a genetic blood clotting disorder right when I turned 40, being told I have to be on a very expensive blood thinner for the rest of my life was... not great to hear. (Though obviously better than dead.)
ThreeBlindRice t1_j7wtpzq wrote
Pulmonary embolism*.
Venous thromboembolism (VTE) is the better umbrella term.
SodaRayne t1_j7wwbwp wrote
Thank you. Yeah, not sure why my brain jumped to edema, given the topic. Crossed wires I guess, but then that's also why I like to confirm initialisms.
Listenstothesnow t1_j7wz3wl wrote
Interesting read on Aspirin vs blood thinners - where AFib patients are concerned or hi risk stroke.
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Listenstothesnow t1_j7wzwye wrote
https://pubmed.ncbi.nlm.nih.gov/22195279/
Grabbed another article from pubmed re Aspirin
Lawdoc1 t1_j7x04ar wrote
Came here to ask this very question.
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Majorjim_ksp t1_j7x1eiw wrote
What’s the aspirin dosage recommended?
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pspahn t1_j7x6iax wrote
They say heparin, but is enoxaparin/lovenox the more specific name?
So instead of daily injections you could take low dose aspirin instead?
My wife is not going to be happy about the timing of this news (pregnant and taking lovenox.)
memetunis t1_j7x7838 wrote
I go to a clinic to have my port flushed, which is done with heparin. Each room has a sign stating they don't store large amounts of heparin on site, similar to what you see with opioids. Do you know why this would be? I have asked the nurses but they weren't aware.
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80Lashes t1_j7xdr1y wrote
No, heparin is different from Lovenox (enoxaparin) which is called low molecular weight heparin. But heparin is still given subcutaneously (shot) or intravenously (IV).
lalapine t1_j7xecob wrote
Heparin is a bit different than lovenox. I was having a weird reaction to lovenox but did fine with heparin. Heparin is shorter acting so usually is taken more often than lovenox (twice daily instead of once daily).
TinFoilHeadphones t1_j7xgrnp wrote
Oh, that explains. I thought he said such a specific number as 81mg because of some calculations. I couldn't understand why such a weird number.
(I don't live in the USA, so measurements here are different)
pspahn t1_j7xh24p wrote
Right, the title says LMWH and I'm wondering if they should have just said enoxaparin. Is LMWH and enoxaparin the same thing?
Substance___P t1_j7xl5gg wrote
Enoxaparin is a drug in the sub-class of drugs known as low-molecular weight heparins.
KanyeMidwest t1_j7xlvrv wrote
Maybe because you can reverse heparin with protamine but youd have to do a platelet infusion to reverse aspirin which can take much longer to procure than just dialing up a bolus of protamine.
This has strong clinical importance in real life where youd want to prevent clotting intraprocedurally and then reverse it immediately to prevent hemmorhaging and hematomas.
[deleted] t1_j7xm656 wrote
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braindrain_94 t1_j7xnbkk wrote
So the two categories of “blood thinners” are anti platelets, and anticoagulants. Aspirin is in the former group, while drugs the article is talking about known as novel oral anticoagulants or NOACs include drugs like apixiban, dabigatran etc. in the latter.
If you have a fib something called a CHADS VAS score is used to determine your risk for a thromboembolic event and wether this outweighs bleed risk. If you have a CHADS VASC >2 in men or >3 in women then NOACs are superior to aspirin in preventing thromboembolism, although aspirin may still be used in addition to NOACs if you have say coronary artery disease.
However, at the moment standard of care for prevention of a recurrent stroke, is using dual anti plalet therapy (DAPT) clopidogrel + Asprin- see SAMPRIS trial.
So aspirin still can have its place but there’s a lot of nuance in deciding the medication regimen for someone.
braindrain_94 t1_j7xnxn9 wrote
Enoxparin is one a several formulations of LMWH. But I think it’s the most widely used.
Also unless your wife has lower extremity fractures this article doesn’t apply to her so she can rest easy.
sciolycaptain t1_j7xp26m wrote
Please read beyond the headline. This paper was studying clot prevention in a very specific patient population, those who had bone fractures in the lower extremity. It excluded pregnant patients, because almost all studies exclude pregnant patients.
Your wife taking LMWH is probably for a very different reason. Aspirin should be avoided in later pregnancy unless advised by your physician.
rabb1thole t1_j7xt7hs wrote
I was on Lovenox for a over a year. It ended up causing significant bone loss. My primary doctor never mentioned this risk to me; it was disclosed when I went in for lab work. I have always been a clotter though. I now take only aspirin. I'm just sharing MY experience with it; not trying to dispense medical advice or cause fear. I urge your wife to talk to her doctor and perhaps have bone density before / after tests.
slickhedstrong t1_j7y1200 wrote
time to invest in bayer
Medical_Bartender t1_j7y3ywq wrote
Aspirin does lower stroke risk its just not as effective as anticoagulation. For people with increasing risk, anticoagulation is recommended (chads2vasc of 2 or more)
BuggerMyElbow t1_j7y68tl wrote
What are the toxins involved in sepsis and where do they come from?
I'd imagine they come from the bacteria, so lipopolysaccharides/endotoxin? Are these responsible for platelet malfunction?
Also how does sepsis vary depending on the species and strain of bacteria?
AnnexBlaster t1_j7yevf3 wrote
Theres proteins in Staph aureus called clumping factors which active platelets, and pore forming exotoxins called alpha hemolysins which cause major damage.
Sepeis varies a great deal between bacteria, the toxins from different pathogens determine whether your immune system will win, or how fast and painful your death will be
YepYep123 t1_j7yfg7i wrote
It’s important to look at what they define as their primary outcome.
Aspirin was non-inferior to LMWH when it came to death from any cause. However, the rates of venous thrombosis (which is what ASA and LMWH are trying to prevent) was higher in the aspirin group. It was only 0.8% higher, though in a study of over 12 000 patients that equates to an extra 1000 people getting a blood clot and this was statistically significant.
While these blood clots may not have increased mortality, that doesn’t mean they have no morbidity. Patients can get chronic symptoms of swelling and pain after a DVT (called post thrombotic syndrome). This is reported in around 20-50% of patients with DVT, so conservitavely 200 people on the study are likely to have long term symptoms (often lifelong) as a result of being randomized to aspirin. While more rare, there is also risk of cardiac and lung complications after a pulmonary embolism (such as pulmonary hypertension) which can be quite severe.
At my hospital, nearly all patients are on LMWH for VTE prevention and complications from this are exceedingly rare. If it were me in hospital with a fracture, I’d take LMWH over ASA any day.
Source: Hematologist who sees people on blood thinners every working day.
Sgt_Munkey t1_j7yq5vp wrote
Just recovering from a smashed ankle and have to inject dalteparin daily. I hate needles, and wish this was prescribed instead... Perhaps it may be useful for a period of time when my lmwh course ends if I'm still stuck in bed elevating my leg...
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Lunaranalog t1_j7z6df9 wrote
Warfarin and Eliquis? Her cardio trying to make her bleed to death? That’s some serious dual therapy. I’ve never seen that. She must be a case study if that’s true.
SippyTurtle t1_j7zv9iz wrote
It lowers the risk but it's not specifically because of AF. It's more targeting atherosclerosis rather than the clots formed in AF.
norbertyeahbert t1_j808axg wrote
I read that it might depend on body weight?
pokey1984 t1_j81b0qv wrote
Not a case study, just bad heart/blood pressure issues. She's already had one stroke and two stents. She has A-fib and damage to one of her ventricles from an "undiagnosed" heart attack. (It wasn't diagnosed as a heart attack and she didn't have any symptoms of a heart attack, but she has damage that's evidence of a heart attack.) So they're trying to keep her heart from over working itself, trying to keep her arteries from clogging any worse, while trying to keep the stents from throwing any more clots while also not overwhelming her kidneys and liver.
So she's on a low dose of three blood thinners for the time being to try and protect her heart and lungs and eyes from further damage without destroying her kidneys.
mwebster745 t1_j86pk5s wrote
Gotta say working on an anticoagulation clinic I'm really hoping my patients I need to bridge off warfarin with a LMWH don't think this applies to them. The title is a bit overgeneralized, like you said, very specific population
Balthasar_Loscha t1_j8syjub wrote
Aspirin as a preventative for COVID-related clotting in a male? Not your area, but maybe you heard something?
AnnexBlaster t1_j8t1s90 wrote
Yes theres studies about this, I think its better than not taking a preventative drug. I want to see a paper about it preventing long covid
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