What is Coumadin?
Coumadin is a Brand name for an anticoagulant (or blood thinner) drug that contains warfarin as an active ingredient. Warfarin prevents the formation of blood clots as well as their migration by inhibiting vitamin K-dependent coagulation factors. Coumadin is indicated for: treatment and prophylaxis of venous thrombosis and pulmonary embolism as its extension, treatment and prophylaxis of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement, reduction of recurrent myocardial infarction and thromboembolic events (such as stroke or systemic embolization) after myocardial infarction and therefore the reduction the risk of death.
Coumadin has no effects on an established thrombus, and can’t reverse ischemic tissue damage. The main targets of anticoagulant therapy are to prevent further extension of the formed blood clot and to prevent the risk of secondary thromboembolic complications that may result in serious and possibly fatal outcomes. Despite its effectiveness, warfarin therapy has several issues. Many drugs interact with warfarin, as well as some foods (such as leaf vegetable foods because they typically contain large amounts of vitamin K1) and its activity has to be monitored by blood testing for parameter INR – International Normalized Ratio to be ensured that adequate safe dose is taken. If INR value is high, patients are predisposed to an increased risk of bleeding, while low INR values indicates that the dose of warfarin is uneffective to protect against thromboembolic events.
Other Brand names for warfarin products on the market are: Jantoven, Farin, Marevan, Waran and Warfant.
Why should you take Aspirin every day?
Aspirin is a Brand name for a drug that contains acetylsalicylic acid as active ingredient. It works by lowering the substances in the body that can cause fever, pain and inflammation. Aspirin is indicated to treat pain, and reduce inflammation and fever. Aspirin in lower dose (75-325mg) is sometimes used for a long-term treatment and prevention of heart attacks, strokes, and angina (chest pain) because it can prevent blood clothing. Low doses of aspirin are usually given immediately after a heart attack to lower the risk of another heart attack or the death of heart tissue. For cardiovascular conditions, Aspirin should be used only under the supervision of a doctor. Aspirin may be also effective in preventing certain types of cancer, such as colorectal cancer.
Other Brand names for acetylsalicylic acid on the market are: Ascriptin, Arthritis Pain, Aspir-Low, Aspir 81, Bufferin Low Dose, Bayer Childrens Aspirin, Durlaza, Ecpirin, Ecotrin, Fasprin, Miniprin and Halfprin.
How does Coumadin and Asprin work in the body?
Warfarin works by inhibiting the enzyme activity of vitamin K reductase, which results in depletion of vitamin KH2 – the reduced form of vitamin K. Vitamin K is a cofactor for the carboxylation reactions of glutamate residues of vitamin K-dependent proteins, so this inhibition limits the gamma-carboxylation reactions and activation of the vitamin K-dependent coagulant proteins. Therefore, the synthesis of vitamin K-dependent coagulation factors II, VII, IX, and X and anticoagulant proteins S and C is inhibited. Decreased levels of 3 of the 4 vitamin K-dependent coagulation factors (II, VII, and X) results in decreased prothrombin levels in blood and a decrease in the amount of thrombin generated and bound to fibrin. This reduces the thrombogenicity of clots.
Aspirin manifest analgesic, anti-inflammatory and antipyretic poperties due to actions of both the acetyl and the salicylate portions of the molecule as well as by the active salicylate metabolite. Aspirin irreversibly and directly inhibits the activity of both cyclooxygenase (COX-1 and COX-2) which results in decrease of the formation of precursors of thromboxanes and prostaglandins from arachidonic acid. This makes acetylsalicylic acid different from other NSAIDS (such as ibuprofen, diclofenac or naproxen) which are reversible inhibitors. Aspirins antirheumatic actions are a result of its anti-inflammatory and analgesic. The platelet aggregation-inhibiting actions of aspirin specifically include aspirins ability to act as an acetyl functional group donor to cyclooxygenase enzyme. Irreversible acetylation renders cyclooxygenase enzyme inactive, thus preventing the formation of the aggregating agent thromboxane A2 in platelets. Since platelets lack can’t synthesize new proteins, the effects persist during the life of the exposed platelets (7-10 days). Acetylsalicylic acid may also inhibit production of prostaglandin I2 in blood vessel endothelial cells; however, inhibition of prostaglandin I2 is not permanent as endothelial cells can produce more cyclooxygenase to replace the non-functional enzyme.
Can patients take Coumadin and Aspirin together?
Patients on a Coumadin anticoagulant therapy should be very careful before taking any drugs for aches and pains. Taking NSAID (non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, diclofenac, ketorolac, aspirin or any other NSAID for pain relief together with Coumadin can increase the risk of serious bleeding. However, pain relievers that contain acetaminophen can be the best choice, and many doctors will recommend it. So, patients should never take Coumadin and Aspirin together without medical advice. Aspirin will impair the function of platelets which are important for blood clotting, while Couamdin impairs blood clotting in a different way, by impacting the INR level. If these are taken together at the same time, they will attack the body’s ability to do blood clotting in two separate ways. This could greatly increase the risk of having significant bleeding.
However, in some cases under doctor supervision these drugs combination can make sense. Coumadin takes care of cardioembolic “red clot” that occurs in blood low-flow states such as venous thromboembolism and atrial fibrillation, and the antiplatelet drug such as Aspirin treats the “white clot” associated with atherosclerosis. Prothrombin time or INR should be monitored closely in patients on Coumadin therapy, and in many cases therapy need dose adjustment. Patients should be advised to contact their doctor if they develop signs and symptoms of excessive anticoagulation, such as: bruising, vomiting, unusual or prolonged bleeding, headache, dizziness, change in stool or urine color, or weakness.
The table below shows the incidence of side effects after Coumadin and Aspirin administration in recommendable doses. The incidence can be increased if these drugs are taken together or overdosed.
|Frequency not defined||Cholesterol embolus syndrome, Abdominal pain, Intraocular hemorrhage, Alopecia, Rash, Pruritus, Headache, Lethargy, Taste disturbance, Tissue necrosis, Hematuria, Anemia, Hepatitis, Respiratory tract bleeding, Hypersensitivity reaction, Hemorrhage, “Purple toe” syndrome, Increased fracture risk with long-term usage, Dizziness, Angioedema, Bronchospasm, GI pain, ulceration, bleeding, Dermatologic problems, Premature hemolysis, Platelet aggregation inhibition, Pulmonary edema (salicylate-induced, noncardiogenic), Renal damage, Rash, Urticaria, Tinnitus, Vomiting|
Special precautions and warnings during Coumadin and Aspirin administration:
- Patients should tell their doctor and pharmacist if they are allergic to Coumadin or Aspirin, or any other medications, or any of the ingredients in these products.
- Patients should tell their doctor and pharmacist what prescription and nonprescription medicines, nutritional supplements, vitamins and herbal preparations they are taking or plan to take. There are many drugs that have interactions with warfarin and those interactions can cause serious side effects.
- Patients should tell their doctor and pharmacist if they have or have ever had diseases such as: atherosclerosis, diabetes, some liver or kidney disease, bleeding problems, porphyria, cardiovascular disease such as chest pain (angina), arrhythmias, high blood pressure or heart attack; an underactive adrenal or pituitary gland, or any condition that makes swallow difficult.
- Patients using Coumadin should tell their doctor and pharmacist what herbal or botanical products they are taking, especially if they are using coenzyme Q10 prparation, Echinacea, Ginkgo biloba, garlic, goldenseal, ginseng, and St. John’s wort. There are also many other herbal or botanical products which might affect body’s response to Coumadin.
- Patients should tell their doctor if they have or have ever had diabetes. Also they should tell their doctor if they have an infection, a gastrointestinal illness such as diarrhea, or sprue or an indwelling catheter.
- Patients should also tell their doctor if they are pregnant or plan to become pregnant or if they are breast-feeding. If they become pregnant while using these drugs they should call their doctor immediately. Pregnant women should not take warfarin unless they have a mechanical heart valve, but only with medical supervision. Coumadin may harm the fetus.
- If patients should have surgery, including dental surgery, they should tell their doctor or dentist that they are using these drugs. Doctor may tell to stop taking warfarin before the surgery or procedure or change your dosage of warfarin before the surgery or procedure.
- Cigarette smoking may decrease the effectiveness of Coumadin.
- Patient using aspirin should tell their doctor if they have or have ever had asthma, frequent stuffed or runny nose, or nasal polyps. If they have these conditions, there is a high risk that they will have an allergic reaction to aspirin.
- Patient using aspirin should also tell their doctor if they often have heartburn, stomach pain and if you have or have ever had ulcers, anemia, bleeding problems such as hemophilia, or liver or kidney disease.
- Children and teenagers should not use Aspirin for flu or chicken pox symptoms before a doctor is consulted about Reye’s syndrome, a rare but very serious disease that is associated with Aspirin.