internal bleeding whilst taking Ticagrelor, Bisoprolol & Aspirin.

[Medmuncher]

hi, I’m 9 weeks post inferior Stemi/PPCI RCA and started on the above meds, I’m also a 50+ year crohns sufferer. I suffered an internal bleed episode 7 weeks in which when investigated via end/colonoscopy procedures did not reveal a likely source. Evidence suggested a high up bleed as blood passed was of a black tar consistency, been through the digestive process with occasional fresh blood passed. The scopes revealed nothing in the stomach as a likely cause. Anyone else have experience of internal bleeds.

[Lowerfield_no_more]

Yes. I had an internal bleed caused by ibuprofen taken within the dose guidance. Consequently I now never touch the stuff. It is possible that one or more of the medication types you are taking is causing you problems, especially aspirin and/or ticagrelor which are known to be a potential cause of internal bleeding, so I suggest you discuss that with your GP or your pharmacist to consider your options.

[Medmuncher in reply to Lowerfield_no_more]

thanks for your reply. I have just spent 5 days in hospital trying to identify the likely culprit and bleed source. We did a stop start on my meds and there has been no recurrence of the bleed for a week.

[Naana16]

please may I know if you were also prescribed with another medication like lansoprazole - what we call for gastroprotection? Usually recommended if at higher risk of stomach bleeding when on high risk medication which can cause stomach bleeding ( ticagrelor and aspirin )

[Medmuncher in reply to Naana16]

I have been on omeprazol for some years due to acid reflux issues.

[Mlinde]

Are you taking anything to neutralise the Aspirin as without an acid neutraliser (I take Famitodine as I won't take Omeprazole), the aspirin can cause bleeding.

[Medmuncher in reply to Mlinde]

Yes I also take Famitodine

[Mlinde in reply to Medmuncher]

Well then the Aspirin is unlikely to be the cause but have you tried stopping the Ibuprofin, you might be overloading your system?

[Medmuncher in reply to Mlinde]

Thanks for replying again. I don’t take ibuprofen. The bleeds have stopped but I’m now left with shortness of breath and fatigue. I am back at the hospital again tomorrow for further blood tests.

[Mlinde in reply to Medmuncher]

Whoops, my mistake, I thought I read that you took it. Well, I hope you get it sorted.

[Naana16 in reply to Medmuncher]

Wow, so you were on both famotidine and Omeprazole whilst on ticagrelor and aspirin and still got a stomach bleed

Is that my understanding?

[Medmuncher in reply to Naana16]

No stomach bleed was detected on endoscopy and yet there was strong evidence of the bleed coming from high up in the gut as the blood had passed through the digestive system, black and tar like in appearance.

[Naana16 in reply to Medmuncher]

Thanks for the clarification

[Jaybbb]

I have been on Tricagrelor ( Brilinta) since November 2024, 4 months. Plus aspirin 81 mg. The first week that I was on the medication I had bleeding, once moderate, than 2 days of minor. After that no issue. I have taken aspirin (325 MG x 2) for many years before this and never had a problem with bleeding. BUT since I know that bleeding can be a potential issue, I never take medication on an empty stomach. I have my doubts if the small dosage of 81 or 75 mg aspirin in itself will cause bleeding. Why not take it on a full stomach as I do. I am assuming you are NOT consuming alcohol with the medication.

[Medmuncher in reply to Jaybbb]

Thanks for the reply. No alcohol full stop. I’ve been shuffling my meds as there is a timing issue around one of my LDL cholesterol meds which rather gets in the way of taking meds with food. Have you experienced breathing difficulties whilst taking Ticagrelor?

[Jaybbb in reply to Medmuncher]

YES. Breathing problems with Ticagrelor. In the first few weeks it was a significant problem---in the middle of the night I would wake up from a sound sleep gasping for breath as if I was not breathing. Only at night, but this went away in the first month. Since my research and the fine print says SOB (shortness of breath) is common and it goes away after a while (a few weeks??) I tolerated it and the gasping (SOB) in middle of night completely disappeared. My doctor offered me the option of going on Clopidogrel (Plavix) and I told him that I wanted to stay with Ticagrelor (Brilinta)---that was based on all my reach that it is the more effective rx. And I had no assurances that changing to Plavix would not have its side affects that I would have to deal with. It is now just past 4 months on Ticagrelor, and no problem with it affecting me during sleep. BUT in month 2 and 3 I was getting SOB, very minor, during the day--maybe once every 3 days. But annoying. In the last few weeks the SOB (daytime only) has gotten a little worse but tolerable--perhaps once or twice a day lasting for a minute or so. I keep reminding myself that I could go on Plavix, which apparently does not have SOB like Ticagrelor. But other issues may confront me with change of medication. And again, it is my understanding and confirmed with my cardiologist that Ticagrelor is the better and perferred RX. So unless SOB becomes unbearable, I am staying with Ticagrelor. In addition to SOB (daytime only) I do have chest discomfort, slight pain every 5 or 6 days and take Nitro pills (.4mg) for it that gives me instant relief. I also have had a TEE test as a follow-up for this, and about to take a CTA Heart w Cardiac Structure test

[Medmuncher in reply to Jaybbb]

Wow, many thanks for the detailed reply. I am seeing my Dr tomorrow and will be discussing this matter with him. Nice to know there are alternatives but like you I’m reluctant to change provided the SOB issue does not get any more out of hand. To-date I have days without issue and then I have a day when I cannot bend over or walk 10 metres without being SOB.

[Jaybbb in reply to Medmuncher]

Your comment that SOB occurs when walking is NOT the same as me. Big difference. The Shortness of Breath (SOB) for me is at rest. For example— sitting in a chair, watching TV, reading a book. I can walk several blocks at a normal pace and no SOB. But walking up more than 2 flights of stairs presents a problem of just overall weakness, and not so much SOB. I re-started Cardiac Rehabilitation (36 sessions) and thinking that will help correct that—hopefully.

[Medmuncher in reply to Jaybbb]

I also get SOB just sitting down. An example of SOB walking, one day I do a 40 minute round trip on foot with a 30 minute stop for coffee with no SOB at any stage during or after. The next day I do the same walk, get to the coffee shop and have call my wife to come and get me due to SOB which then lasts for the next 8 hours, great discomfort. Today no walk as woke up SOB which lasted another 5 hours. It then just went away. On all 3 days I took my meds as prescribed and at the same time!!!

[Jaybbb in reply to Medmuncher]

Well, I can feel for you when you say SOB lasts for 5 hours or 8 hours. My discomfort with SOB is that it last maybe a minute or two, never never over 5 minutes. But next week may be different for me based on what you are experiencing. We are all different as you know, and I am not saying that your situation is worse than mine. I see you also take a Statin (Zetia). Years ago I was on that, and most other Statins before doctors declared me Statin Intolerant and no more Statins. Caused extreme pain of the muscles and tiredness (among other things). I am glad that I do not have that as an issue today complicating what rx causes what. I am now on Repatha sure-click that is amazing with results that could not be more favorable in just 2 weeks. What I have learned from people posting on this forum is that after I end ticagrelor (in 12 months?) --and the side effects (ie SOB) are gone. Something I look forward to. As i mentioned, like you I am on Amlodipine but at 5mg dose. Cardiologist originally designated 10 mg for me but I had that changed to 5 mg--and I knew I could have the dose increased if needed---not needed 5mg is doing a great job. I do understand that 10 mg is quite normal dose for many. Good luck at your doctor's appt.

[Naana16 in reply to Jaybbb]

thanks for sharing

[Naana16 in reply to Jaybbb]

Absolutely should be taken with food for additional protection

Though for some people may still not provide full protection

[Jaybbb in reply to Naana16]

I DO READ all the fine printouts with a RX. And also do a search on Dr Google. Do not recall seeing any of my medications that says: do not take with food. When I say i take with food, I am not looking for a full stomach, a full meal. I do make sure I have something, perhaps light, in my stomach. Maybe some toast. Maybe a banana with fat free cottage cheese (if you like that).

[ianstrat]

So sad to hear.. Bisoprolol 7.5mg daily was a life saver and stopped my chest pains and brought my Blood pressure down. Are you on apixaban a blood thinner. You must discuss this now with your Doctor

[Medmuncher in reply to ianstrat]

Thanks for the reply. No to apixaban and yes seeing my doctors tomorrow and Thursday.

[Jaybbb]

Again, I will not take these Rx without eating first. I know aspirin is tough on the stomach, but I solved that issue with eating first. However, I have doubts that the tiny dose of aspirin (81 or 75 mg) will have any stomach problems, it is tiny amounts. Not sure about the other drugs I am on (metroprolol 25 mg, Amlodipine 5 mg, brilinta 90 mg, 81mg aspirin) , and if they affect the stomach--but I eat first. Note that the cardiologist initially put me on 10 mg of amlodipine--but I told him I wanted to go on 5 mg and lab test show that level is just fine. I cut out ALL alcohol (social) --do not want any complications. It appears to me that in UK Clopidogrel (Plavix) is the more commonly prescribed rx over Ticagrelor. Not sure why, perhaps because it is much cheaper to take Plavix.

[LesleyJ59]

Do you take the coated aspirin? That's better for the stomach than the dispersible.

[Medmuncher in reply to LesleyJ59]

Dispersible, as given to me in Hospital.

[LesleyJ59 in reply to Medmuncher]

I don't know about hospitals, but GPs only prescribe dispersible, presumably as it's cheaper. I take the enteric/coated aspirin with breakfast. It's less likely to upset your stomach and presumably a little better regarding internal bleeding. I would check with your GP, pharmacist or consultant.

[Medmuncher in reply to LesleyJ59]

Thanks for your reply. I’m still on the Aspirin given to me by the hospital. It will be interesting to see what I am given when I renew my scrip this week.

[LesleyJ59 in reply to Medmuncher]

I didn't start taking the coated aspirin until I was off the ticagrelor, so it might not apply to you just yet.

[Jaybbb in reply to LesleyJ59]

I never took COATED aspirin. Not sure what that does with the drug intentional interaction needed with ticagrelor (brilinta) rx when it slows that interaction. My cardiologist has never prescribed COATED. But I never had, or reported, a problem with aspirin to my MD.. My slight knowledge of COATED is from this forum where someone said the result of Coated is that it is dissolved, dispersed, not in the stomach--but later in the intestine--which results in other (minor?) organ interaction (kidney?). I am not sure but I would look into this before using Coated---just do not know. A slice of toast is my answer that serves me well. However, I have read that ticagrelor rx does want up to a max of 100 mg of aspirin taken at the same time. Not sure if COATED meets that ideal need for ticagrelor--or if it weakens or otherwise affects the benefit of ticagrelor.

[LesleyJ59 in reply to Jaybbb]

Thanks for your reply. My switch to coated came further down the line after I'd stopped taking ticagrelor. My GP wanted me to take Lansaprol (sp?) to protect my stomach from long term use of aspirin, but I chose not to. My pharmacist agreed that taking the coated tablets with food was sufficient.

[Jaybbb in reply to LesleyJ59]

thank you for your clarification. BUT is the issue that when on ticagrelor one is taking a tiny dose (81mg or 75mg) of aspirin as required by ticagrelor---and when you stopped taking ticagrelor and were on aspirin and that small dose was increased to maybe 325mg or 325mg x2. My normal dose for years before using ticagrelor, was 325mg x2--with food, never on an empty stomach. I can see under these circumstances the use of COATED may be appropriate for some people. I do not know, but if one is taking COATED are they accepting the delay in having aspirin as a whole body relief. I also suspect that COATING on some medications is intentional to provide a time release of the medication. This is a separate discussion aside from the use and need of 81/75mg with ticagrelor. Would you not agree

[Pundit999]

I developed ulcers in my stomach after I took aspirin for several months 20 years ago. At the time I was not careful and was taking aspirin with or without food . Also I was using a generic brand

It took several months of nexium to cure the ulcers

Now I take aspirin very carefully. I never take it without a full meal and I always use an enteric aspirin from Bayer