Aspirin and ET

[Cokopops]

Hi. I have E T and I’ve been on hydroxy and aspirin for 4 years.

Saw the haematologist last week. She said that my spleen was a little enlarged but nothing to worry about. I questioned the aspirin that might giving me problems and wondered why I couldn’t take apixaban instead . She said that it didn’t work in the same way… She suggested that I doubled opeprazole.

Anyone have problems with aspirin and if so were you given something else?

Thank you

[Cat_lady52]

hi Cokopops, I'm getting switched to Clopidogrel instead of Aspirin and Lansoprazole instead of Omeprazole, but i'm not sure how they all work, i think Aspirin thins the blood and Clopidogrel does something to stop platelets from sticking together.

[Spanelmad]

Are you having any symptoms with the spleen size?

[Cokopops in reply to Spanelmad]

when having a meal, I feel full after a few bites..feel uncomfortable more than pain.

[Spanelmad]

Thanks for the reply, I was wondering if what I was feeling might be the spleen.I'm uncomfortable after eating ,no pain so not sure it's anything really will bring add to.Thursday's list of questions.

[Scaredy_cat in reply to Spanelmad]

Spleen: I had a very large Spleen before my sct. I occasionally got sharpish pains from it (in abdomen just under left ribs) not particularly related to eating. It was palpable by the doctor, ie feelable . I got her to show me how to feel it but if your's is only slightly enlarged it just needs to be monitored and is something I didn't worry about

[Spanelmad in reply to Scaredy_cat]

Ok thanks, seeing Heam tomorrow so will get them to check

[hunter5582]

Spleen enlargement is quite common with MPNs due to the alliteration in spleen function caused by the MPN. Provided there is not too much enlargement, it should not be a problem. Your hematologist will regularly monitor your for splenomegaly. If you become symptomatic (e.g., early satiety, pain) then you would be sent for imaging to further assess the issue.

Aspirin and apixaban (Eliquis) do similar things (prevent clots) in two different ways. Aspirin is an antiplatelet medication that inhibits platelet aggregation. Apixaban is an anticoagulant, inhibiting the process of coagulation. Coagulation and platelet aggregation are both part of the process of hemostasis in which a thrombus is formed. Apixaban is generally considered to have a lower bleeding risk than some of the other anticoagulants (e.g., warfarin). Apixaban does have this Black Box warning.

Premature Tx Discontinuation incr. thrombotic event risk when D/C apixaban for reasons other than pathological bleeding or completion of therapy course; if must D/C apixaban, consider administering another anticoagulant. epocrates.com/online/drugs/...

Whether you should be taking an anticoagulant rather than an antiplatelet medication is an issue to review with your MPN care team for a more detailed explanation. It is worth noting that there are other antiplatelet medications to consider such as clopidogrel, which some with MPNs use as an alternative to aspirin.

If you are unable to tolerate aspirin due to the GI effects, then your MPN care team can review other options. Note that each of these options come with their own risks and contraindications/cautions. You need a case-specific review to determine appropriate options.

Regarding the proton pump inhibitor, there are other options than omeprazole. When omeprazole was not working well enough for me, the GI-doc switched me to esomeprazole (Nexium) 40mg. The prescription-strength version of this PPI did work better for me. Suggest you consult with a gastroenterologist about your treatment options.

You may find these trainings of interest. It helps to inform our decisions when we understand more about how our bodies work and what the meditations are supposed to do.

Hemostasis

youtube.com/watch?v=SGzp9wq...(Not working as expected?)

Antiplatelet medications

youtube.com/watch?v=1L5ztli...(Not working as expected?)

[Cokopops in reply to hunter5582]

Thank you Hunter for your reply. I really appreciate you taking the time. Do you think enlarge spleen may cause an excess of wind in tummy? Or the aspirin? My diet is good ( checked by my daughter who’s a registered dietitian). It is so very uncomfortable.

Kind regards