Aspirin which type and when to take

[DougyW]

I had assumed that Entric asprin would be better for me in the longterm than dispersable. I asked my GP abut this who disagreed. A quick bit of research latter and it would appear dispersible is more effective at thinning the blood and if taken with food may not be anymore impactful on the stomach.I have also read that taking at night may be be more effective. Is there any wisdom/ advice on this please

[mhos61]

You will find the majority on the forum take enteric coated. I am fortunate that I do not have any stomach issues.

I take the dispersible form precisely for the reasons your GP discussed with you. My GP had the same discussion with me, explaining the bioavailability of dispersible aspirin was better.

I used to take aspirin in the morning, but I changed in the last year to late evening after evening meal.

[hunter5582]

I have taken the enteric, dispersible, and the newest form - Vazalore. I found no difference in tolerance between the three forms. I would not take any form of aspirin on an empty stomach since it can be a GI irritant and I have GERD.

This is really more of an issue of your preference than one form being better than the other. The dispersible may be more effective/rapid deploying but would have higher risk of GI adverse effects. The enteric or Vazalore forms amy take loner to take effect and perhaps not be as strong in the same dose for antiplatelet effect. The question is which choice is your preference.

[DougyW in reply to hunter5582]

Thanks. Would have thought this sort of advice would have been given out by the haematologist. I've changed this weekend to taking with my last meal. Still asking myself about entric vs dispersible. At the moment I switch every 57 days in an attempt to reduce the build up of reaction to either. No idea if that makes any sense or not.

[hunter5582 in reply to DougyW]

I doubt that it matters much which form you take regarding something building up over time. The active ingredient is the same. It is the inert ingredients that are different. I would just go whichever or both if that is your preference.

The reason for the efficacy of taking the aspirin twice per day likely has more to do the the short half-life of aspirin than the total amount. Your care team can do the best job of explaining the rationale for 2x/day.

Excretion: urine; Half-life: 0.25h (aspirin), 2-6h (salicylate); Info: dose-dependent half-life, amount excreted unchanged pH-dependent online.epocrates.com/drugs/...

All the best.

[PhysAssist in reply to hunter5582]

For what it's worth, I was originally writing to explain that although GI side-effects are the purported reasons for having enteric-coated aspirin in the first place, the real concern is for bleeding- specifically GI bleeding , and regardless of whether or not you experience GI upset or GERD, or whatever other GI symptoms you may or may not have, the risk of GI bleeding will still exist.

BUT, then it occurred to me that in forming that response I had an inherently assumed that there was actually a difference in the rates of GI bleeding between the 2 [enteric -coated, and non-enteric-coated aspirin], but that I hadn't seen any specific evidence of a difference- but was relying on what the GI MD's [and general medical literature] purported to be the case.

Thus I took a relatively shallow dive into that rabbit hole, and found this:

Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric-coated formulations

Abstract

The use of low-dose aspirin has been reported to be associated with an increased risk of upper gastrointestinal complications (UGIC). The coating of aspirin has been proposed as an approach to reduce such a risk. To test this hypothesis, we carried out a population based case-control study.

Conclusions

Low-dose aspirin increases by twofold the risk of UGIC in the general population and its coating does not modify the effect. Concomitant use of low-dose aspirin and NSAIDs at high doses put patients at a specially high risk of UGIC.

Source: ncbi.nlm.nih.gov/pmc/articl...

What they suggest is that the reason that the risk of GI bleeding is essentially the same for both formulations is that the risk isn't typically from local effects of the aspirin, as seems to have been assumed, but is instead a systemic effect from the therapeutic effects of the medication on the clotting pathways mediated by platelets.

Given that assumption, their findings also can be seen to have ruled out any difference in effect of any of the immediate-release, enteric-coated, [or most likely whatever other formulations of aspirin exist], because if the GI bleeding risk is the same between them- they are all equally therapeutic.

Granted, I am assuming that the newer forms will likely have the same risk, but if they don't- are they really better systemic anti-thrombotic agents?

Best,

PA

[hunter5582 in reply to PhysAssist]

Excellent fact based assessment.

The bottom line is that like everything else we take, aspirin has a risk-benefit profile. There is an intrinsic risk of GI bleeds. There is also other increased risk of hemorrhage. That is an assumed risk with any medication that has antiplatelet or anticoagulation effects. Inhibiting the coagulation cascade at any point both protects us from thrombosis and puts us at risk for hemorrhage. Long-term aspirin use also has other risks. For most of us, the benefits outweigh the risks.

It is true that the American Heart Association no longer recommends daily aspirin for most adults age > 60. We respond more strongly to aspirin as we age, increasing our risk of hemorrhage. My former MPN Specialist took me off aspirin for this reason. I was, in fact, experiencing excessive bleeding/bruising, particularly when my PLTs were higher. I went back on aspirin when I started experiencing erythromelalgia. Once again, risk/benefit analysis favored aspirin use for me.

Theoretically, with the pharma companies theorizing anyway, the newer forms of aspirin like Vazalore are supposed to be easier on the GI system. Low dose Vazalore cost = $30 for 30 caps. Compare that to generic low dose enteric aspirin = $2 for 120 tabs. The risk/benefit analysis here is to our wallets. Is Vazalore really that much better? I decided not.

Thanks for the additional facts. It really comes down to fully informed consent when it comes to aspirin or any other medication. The better the information, the better the capacity to choose the best treatment.

All the best.

[DougyW in reply to hunter5582]

Agreed I did find a Mayo report for cardiology that indicated taking dispersible and evenings was more effective at reducing blood pressure. Given that and PhysAssys findings above I think I'll stick with the dispersible and take with my last meal. The meal bid us the really important thing and I wasn't even advised on that. I do dispare at the Pharma industry sometimes. So much good work then you see things like this and remember profit is their main concern

[hunter5582 in reply to DougyW]

That sounds like a sensible plan. I expect the dispersible aspirin will work fine. For a while I cut one in half and took it AM/PM. That worked fine too.

Big pharma is what it is. Money underlies the practice of medicine at all levels and in all systems. Earning more and/or spending less underlies how systems work. We simply have to navigate the process the best way possible. We are fortunate that despite the issues we have, there is better treatment available now than there was in the past. It is just a matter of how to access it when needed.

All the best.

[Bill209]

Taking enteric coated 81 mg aspirin is probably better to reduce the probability of having gastrointestinal issues when taking aspirin on a daily basis over the long term.

There is also at least one study that shows that taking 81 mg aspirin twice per day is significantly more effective in suppressing platelet activity than taking it once per day to help reduce the probability of having a thrombotic event, so that is what I am doing and my hemotologist/oncologist is okay with me doing that.

ashclinicalnews.org/news/fr...

[PhysAssist in reply to Bill209]

That's my regimen, as recommended by both my general Heme/Onc MD and my MPN-specialist, and for me, the enteric-coated causes less break-through GERD, so that's why I take it.

I was initially surprised that once daily was insufficient because the effects of aspirin on platelet function are thought to be both permanent and significant, but given the proliferation of stem cell products, which define MPN's, and particularly in reviewing the study cited above, it is clear that twice-daily dosing of even low-dose aspirin is the best regimen.

In addition to the study I added, there was this related article:

Aspirin in ET: will twice a day keep thrombosis away?

In Summary: "The evidence in support of multiple daily doses of aspirin to suppress TX synthesis within 2 weeks of therapy in ET is compelling. Future results from the ARES trial will hopefully provide definitive guidance on whether overcoming biochemical evidence of aspirin resistance improves clinical outcomes. If the results are positive, they have the potential to replace the empiric, one-size-fits-all approach to antithrombotic therapy in ET."

Source: ashpublications.org/blood/a...

FYI, despite the information about the ARES trial having been posted in 2018, I could not find any evidence of results.

ncbi.nlm.nih.gov/pmc/articl...

Best,

PA

[Amethist]

I have tried both. Enteric didn’t do anything for my erythromyalgia in my toes, but regular aspirin does. With the blessing of an MPN specialist, I take ½ a regular aspirin every 3rd day which leaves me 100% symptom free . As my platelets are rather high, and I choose not to take any other medication , I don’t want my blood overly thinned anyway, as I would then bruise easily.

[Orangeboykitty]

I can't tolerate enteric coated aspirin because of the colors in the coating, so I take plain white aspirin with nothing added. They only come in full strength so I use a pill cutter and divide them in quarters and take in the morning with breakfast. Since I eat a full breakfast, that's the meal with which I chose to take it.

[Hopetohelp]

I am reading your replies with interest. I asked a question about aspirin a while ago for which you might like to see the answers if you have a look at my previous posts. I have tried to research the same questions you are asking but came up with mixed answers. Decided to keep taking mine in the morning with breakfast as didn’t fancy taking it at night if I had a glass or two of wine at the weekends and I think it’s probably important to stick to same time of day if possible. I do however take the enteric coated one a minute before breakfast whilst downing a glass of water now instead of just after breakfast due to the research comments. Honestly I don’t think it really matters as long as food is involved in the process but I totally get the need for wanting the answers

[Mishie14]

I take one vazelore liquid caplet specifically at the same time at night a couple hours after meal upon advice of cardio and approved by hematology. I was told vazelore caps are easily absorbed beyond the stomach so avoids the stomach distress that the coated pills caused. I was taking hydroxyurea at the time that caused bad side effects that the coated pill seemed to only aggravate. Switching to Vazelore was a good move for me. Even when hydroxy was stopped, I continued with vazelore. I have not had any discomfort from vazelore nor side issues like bleeds or clots along my ET JAK2 journey.