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How Does Aspirin Compare to Pricey Anticoagulants?

Researchers analyzed 13 studies to find out how well can aspirin compare to standard anticoagulants for preventing post-surgical blood clots.
Single baby aspirin may be helpful to cardiac health

When people have knee or hip replacement surgery, they may face the danger of blood clot formation. Such clots can form in the large veins of the legs, break loose and end up in the lungs as pulmonary embolisms. If this happens, it is a life-threatening complication. That’s why doctors often prescribe anticoagulants following surgery. How does aspirin compare to other anticoagulants in this situation?

Aspirin vs Pricey Anticoagulants:

A new study compared pricey anticoagulants such as rivaroxaban or dabigatran to inexpensive aspirin (JAMA Internal Medicine, online Feb. 3, 2020). There were 13 randomized controlled trials in this meta-analysis and systematic review. More than 6,000 people participated in these trials.

The investigators analyzed the data for evidence of any deep vein thrombosis after surgery. Abbreviated DVT, deep vein thrombosis is the medical term for a dangerous blood clot. How well did aspirin compare in effectiveness and safety?

They found that:

“The effectiveness and safety of aspirin did not appear to have been statistically significantly different from other anticoagulants used for venous thromboembolism prophylaxis after total hip and knee replacement and hence remains an option for use.”

The authors call for larger studies to determine whether more expensive anticoagulants sold as Pradaxa or Xarelto are any safer or more effective than aspirin. What we know for sure is that they are more expensive.

Other Studies Compare Aspirin to Anticoagulants After Surgery:

In summary, this is not the first study to compare aspirin to other anticoagulants for preventing post-operative blood clots. Unfortunately, researchers have not devoted enough attention to the question of whether discontinuing low-dose aspirin before surgery increases risk. This is truly a serious dilemma, since staying on aspirin through surgery might increase the chance of excessive bleeding. 

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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  • Matharu GS et al, "Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip and knee replacement: A systematic review and meta-analysis of randomized clinical trials." JAMA Internal Medicine, online Feb. 3, 2020. doi:10.1001/jamainternmed.2019.6108
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This is certainly a very important question, especially as it is very common and affects so many people. Sad that this research has not already been thoroughly established. I would be interested to know where turmeric fits in this picture?

Turmeric has not been studied in this context.

Would aspirin have the same effect on ectopic heartbeats and paroxysmal Afib?

We don’t know. Lack of research

You got that “pricey” part correct. Eliquis retails for over $500/month! Since omega 3 fatty acids have essentially the same anti-coagulant effect as aspirin, the question becomes whether fish oil would be an even safer pre and/or post-op anticoagulant prophylaxis. Curious as to what your thoughts on that would be.

We can’t answer that question because we don’t have the data.

I have been told to stop taking my anticoagulant by my dentist, prior to colonoscopies and for numerous other minor (or major) procedures. My personal physician says that I am a lot less likely to die from a little extra bleeding than I am from a stroke if I stop the anti-coag. (I am taking it for an afib condition.)

In fact I did have a stroke four years or so ago, and it was the fact that I had been taking large amounts of aspirin (for pain) for years prior to the stroke that minimized the stroke’s effect.

For those who have not started using aspirin on a daily basis, you need to be aware of serious side effects. I used low dose aspirin on a daily basis twenty years ago because a doctor wrongly thought doing so would prevent a heart attack or stroke (my heart rate was normal). I stopped after a year after I noticed red splotches on my hands. The aspirin caused bleeding under the skin and this left permanent large splotches that a later doctor called “rust” from oxidation of iron in the blood. These cannot be treated. My vision also deteriorated from advancing macular degeneration which the aspirin no doubt worsened. I stopped after I noticed the splotches, and I regret I ever used it.

Seems we keep flogging this dead horse. It is about the money, PERIOD!

I have had both knees replaced, one at a time. The first time I was placed on Coumadin to prevent blood clots. After the second surgery, 8 months later, I was placed on aspirin to prevent blood clots. All went well both times, and my blood tests were nearly identical. I was less constipated (a common problem following surgery) the second time.

Have any similar studies been done in regards to Atrial Fib.? Aspirin vs the expensive anti coagulants?

A few. This one found the oral anticoagulants are better: https://www.ncbi.nlm.nih.gov/pubmed/16765759
According to this recent meta-analysis, it is complicated: https://www.ncbi.nlm.nih.gov/pubmed/31924397 Doctors and patients are urged to consider individual situations in assessing trade-offs.

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