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Aspirin and Coumadin

Determining the interaction of Aspirin and Coumadin and the possibility of their joint administration.

Check result:

Aspirin <> Coumadin

Relevance: 09.04.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using warfarin together with aspirin may cause you to bleed more easily. You may need a dose adjustment based on your prothrombin time or International Normalized Ratio (INR). Call your doctor promptly if you have any unusual bleeding or bruising, vomiting, blood in your urine or stools, headache, dizziness, or weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Aspirin, even in small doses, may increase the risk of bleeding in patients on oral anticoagulants by inhibiting platelet aggregation, prolonging bleeding time, and inducing gastrointestinal lesions. Analgesic/antipyretic doses of aspirin increase the risk of major bleeding more than low-dose aspirin; however bleeding has also occurred with low-dose aspirin.

MANAGEMENT: This combination, especially with analgesic/antipyretic aspirin doses, should generally be avoided unless the potential benefit outweighs the risk of bleeding. If concomitant therapy is used for additive anticoagulant effects, monitoring for excessive anticoagulation and overt and occult bleeding is recommended. The INR should be checked frequently and the dosage adjusted accordingly when aspirin is added to an anticoagulant regimen. Be cognizant that bleeding may occur without INR or prothrombin time increases. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bruising, red or brown urine, or red or black stools. Patients should also be counseled to avoid any other over-the-counter oral or topical salicylate products.

References

Hirsch J, Dalen J, Guyatt G, American College of Chest Physicians "The sixth (2000) ACCP guidelines for antithrombotic therapy for prevention and treatment of thrombosis. American College of Physicians." Chest 119(1 Suppl) (2001): 1S-2S
Barrow MV, Quick DT, Cunningham RW "Salicylate hypoprothrombinemia in rheumatoid arthritis with liver disease. Report of two cases." Arch Intern Med 120 (1967): 620-4
Penning-van Beest F, Erkens J, Petersen KU, Koelz HR, Herings R "Main comedications associated with major bleeding during anticoagulant therapy with coumarins." Eur J Clin Pharmacol 61 (2005): 439-44
Hurlen M, Erikssen J, Smith P, Arnesen H, Rollag A "Comparison of bleeding complications of warfarin and warfarin plus acetylsalicylic acid: a study in 3166 outpatients." J Intern Med 236 (1994): 299-304
Wells PS, Holbrook AM, Crowther NR, Hirsh J "Interactions of warfarin with drugs and food." Ann Intern Med 121 (1994): 676-83
Koch-Weser J, Sellers EM "Drug interactions with coumarin anticoagulants (first of two parts)." N Engl J Med 285 (1971): 487-98
Fausa O "Salicylate-induced hypoprothrombinemia: a report of four cases." Acta Med Scand 188 (1970): 403-8
Koch-Weser J, Sellers EM "Drug interactions with coumarin anticoagulants (second of two parts)." N Engl J Med 285 (1971): 547-58
Massel D, Little SH "Risks and benefits of adding anti-platelet therapy to warfarin among patients with prosthetic heart valves: A meta-analysis." J Am Coll Cardiol 37 (2001): 569-78
Watson RM, Pierson RN "Effect of anticoagulant therapy upon aspirin-induced gastrointestinal bleeding." Circulation 24 (1961): 613-6
Chesebro JH, Fuster V, Elveback LR, et al "Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole." Am J Cardiol 51 (1983): 1537-41
Weiss HJ, Aledort LM, Kochwa S "The effect of salicylates on the hemostatic properties of platelets in man." J Clin Invest 47 (1968): 2169-80
Bates ER, Mukherjee D, Lau WC "Drug-drug interactions involving antiplatelet agents." Eur Heart J 24 (2003): 1707-9
"Product Information. Coumadin (warfarin)." DuPont Pharmaceuticals, Wilmington, DE.
Donaldson DR, Sreeharan N, Crow MJ, Rajah SM "Assessment of the interaction of warfarin with aspirin and dipyridamole." Thromb Haemost 47 (1982): 77

Aspirin

Generic Name: aspirin

Brand name: Arthritis Pain, Aspir 81, Aspir-Low, Bayer Childrens Aspirin, Durlaza, Ecotrin, Ecpirin, Fasprin, Halfprin, Miniprin, Aspiritab, Bayer, Bayer Low Strength, Bayer Children's, St. Joseph 81 mg Adult

Synonyms: n.a.

What is Aspirin?

Coumadin

Generic Name: warfarin

Brand name: Coumadin, Jantoven

Synonyms: n.a.

What is Coumadin?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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