Risks in taking and not taking aspirin with hydroxyruea, especially when older

[kitttycat]

I have been taking hydroxyurea since Nov 2020 when diagnosed with Essential thrombocytosis, my platlets are contained at 433 . I started to take coated aspirin 81mg with the hydroxyuria but had to stop due to severe stomach acid. Now oncologist says to take the aspirin and I realize its probably best to do this for condition I am concerned because of my age late 70's, and what might happen but I am also concerned if I dont. Can anyone give me any information.

[hunter5582]

There is mixed opinions on this. Most MPN Specialists support the use of anti-platelet treatment for people with ET who are considered high-risk due to age. Some do not. For people over the age of 60 there is an increased risk of hemorrhage with aspirin. Some docs have reservations about the use of aspirin in older patients. The bottom line is that it is a risk/benefit analysis you have to do based on your individual profile. Given that you have a prior adverse effect to aspirin that is in fact quite common, you might want to discuss other options, like DOACs (e.g. Warfarin) and NOACs (e.g. Eliquis). Do note that the NOACs have a significantly lower risk of hemorrhage.

FYI - I did go off the aspirin for a while at the recommendation of my MPN Specialist due to being over age 60. He specifically warned me about the risk of a brain bleed. Several weeks later I was diagnosed with a hemorrhagic brain tumor. The tumor is now resected and I have recovered well. Note that I also have GERD and a history of excess bleeding/bruising when platelets were elevated while on aspirin. Note that with 30 years with ET then PV, I have never had a single incident of thrombosis.

I later developed the burning/throbbing pain in my toes/feet that is a pretty common PV microvascular symptom. I elected to go back on the aspirin since I knew that was the first line treatment choice. I decided to try a 40.5mg dose (1/2 of a chewable tab). The microvascular symptom totally stopped after the first dose. Things changed. My needs changed. The benefit of not being in pain outweighs the risk of hemorrhage due to the aspirin. Choosing the lower dose worked out well for me. I have not had any issues with hemorrhage. I recently upped my dose to 405.mg 2x/day. Still no problems.

GI irritation is a common problem with aspirin. In the more severe reactions it can lead to GI ulcer or perforation. While most can tolerate aspirin and benefit, not everyone can. You also need to protect yourself from the intrinsic risks of ET, which include thrombosis, hemorrhage and microvascular issues. The best way to do this is based on your profile and how you react to the meds. You have a very reasonable concern. Suggest you review your options with a MPN Specialist and determine how best to proceed.

[kitttycat in reply to hunter5582]

Hunter thank you so much for sharing this with me and for sharing your experience. I really appreciate it. All of this has given me a lot of anxiety and is making me afraid . I am speaking to my family doctor this week to see if she can refer me to someone who can give me another opinion on all this. The risks and options were never brought up by the specialist and not knowing these unfortunately we don't always know the right questions to ask. Now that I am gaining insight this will help me a lot Thank you so much.

[hunter5582 in reply to kitttycat]

Fear and anxiety is not a place from which to make good decisions. The decisions about how to approach MPN treatment need to be based on an objective evaluation of what is in our best interests. This is best done in consultation with a MPN Specialist, not a regular hematologist. I expect you have seen this, but for convenience, here is the list again. mpnforum.com/list-hem./

For what it is worth, aspirin is certainly a reasonable risk for most people with MPNs. The benefits outweigh the risks for most. For those who cannot tolerate aspirin to prevent thrombosis. there are other options. Do bear in mind that hydroxyurea is not an anti-coagulant. That is what the aspirin or other types of thrombosis-preventing meds are for.

Others have spoken to using a proton pump inhibitor when on aspirin. I have been on one for decades (Nexium) for GERD. I could never tolerate aspirin without one. While there are potential adverse effects with PPIs, like all meds, it is another case of a risk/benefit analysis that you need to make.

You can certainly get this all sorted out in consultation with a MPN Specialist. Hope you get answers and can make a decision you are comfortable with soon.

[kitttycat in reply to hunter5582]

Thank you hunter I am certainly going to do my to best to get this straightened out. I value all this information . I hadn't seen the list but have now looked at it . I saw two specialists in my area and one is at Sunnybrook, which is an outstanding hospital and where I also have a history. My hope was to get a referral to this hospital- I appreciate all of this.

[SuET2017]

Hi, I also had GI issues taking asprin. I did stop taking it, but my consultant wanted me to go back on it for clot risk, and I now take omeprazole 20mg with it and have no GI issues at all.

[kitttycat in reply to SuET2017]

Hi Su, thanks for your response to my query. omeprazole is a PPI and I had to take one (a different kind) in the past a few times but haven't for a long time. Have you been taking this for a long time and can you stay on it indefinitely? I don't know a lot about this. Do you know if many people take this. Could you let me know. Thanks very much.

[SuET2017 in reply to kitttycat]

Ive been taking it for about a year, along with the aspirin. I haven’t had any apparent side effect with it. And it certainly helped being able to take the aspirin. Just a note, I haven’t had GI issues in the past so it was only the aspirin that caused upset! I don’t have answers to your other questions, not something I’d thought about. I would speak to you consultant or GP if you have concerns

Take care kitty

[BloodZero]

The only thing I would like to mention is not to take aspirin in empty stomach. You may be aware of already, but worth a mention.

I take aspirin mid meal for past 10 years. No problems so far 🤞🏻

[kitttycat in reply to BloodZero]

Hi thanks, it is worth a mention. In your experience is any meal better than another or is the largest meal of the day the best one to take it with .

[BloodZero]

Yes, good question . I take it with my largest meal. Which for me is lunch. I eat half my meal, take aspirin and hyproxy then finish meal. In fact on the rare occasion that I have forgotten to take meds and I don't want to eat anymore, I will skip that days dosage rather than have them on a empty stomach. My father is the same. Over 30 years taking aspirin, never on empty stomach, no issues.

[kitttycat in reply to BloodZero]

Thanks for this information. I am gathering that you cant just take a sandwich and take this, it has to be substantial food and that you can take the hydroxy and the aspirin together. Do you know if there is any adverse effect if you take supplements at the same meal or is it best to just have the aspirin and hydroxy alone?

[BloodZero]

My previous reply seemed like I take them together but actually I try to take them at seperate meals. I don't know of any adverse effects of taking them together but I dont chance it. The hydroxy I always want to take with a heavier meal. But aspirin I have no worries about having with a sandwich, even a piece of fruit if Im in a pinch. Just something to buffer the stomach against raw aspirin hitting it.

But for the majority of times a sandwich size meal would be the smallest I feel comfotable taking an aspirin with.

[kitttycat in reply to BloodZero]

hi, thanks for clarifying this, your way of taking sounds better than taking together thanks again for letting me know this.

[Gemms94]

Hi the same thing happened to me with asprin They transfered me to Clopidrogrel an alternative . They also prescribed Lanzoprazol to counter the side effect.

[kitttycat in reply to Gemms94]

Thanks for your note, This is great that I heard from you after my post a while ago.. The situation was resolved, I just didnt take it and I think I did the right thing.. My research told me it wasn't the right thing to do. I have read that some doctors are advsing not to take after a certain age, I did get atrial fibrillation and ended up taking blood thinners though and oddly enough read an article, which could be one persons opinion, that said this is the new way they do this now - replacing aspirin. Thanks again