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We Are Relatively Fine, Thanks For Asking. But I Have

Posted on Wed, 11 Sep 2019

Question: We are relatively fine, thanks for asking. But I have another question unrelated to the others. My wife's PTINR man who is a pharmacist told her not to take aspirin because of the risk of bleeding. Also her PC DR said the same thing. She has had severe bleeding problems. But her Cardiologist told her to take aspirin, daily, baby aspirin. SO who is right? Should she take a daily 81 mg aspirin or not? This may be outside of your usual questions but we will respect your answer. I presume you have access to my dashboard but just in case, she is taking Coumadin and her INR is under control. XXXXXXX Demint

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
aspirin intake needs evaluation among various factors.

Detailed Answer:
Hi XXXXXXX
Welcome to Ask A Doctor services.
I have read your query and here is my advise.

* There are vigilant controls needed over the PT INR for a patient who is on
blood thinner, because alteration of the same proves very dangerous in
terms of uncontrollable hemorrhage.

* When PT INR range is altered , one has to avoid taking blood thinner as
aspirin for sake of avoiding bleeding issues possibility.

* Intake of aspirin has to be evaluated between the advantages and
disadvantages of the same with existing clinical condition.

Kindly provide me further details to proceed with your query.

1. Attach latest lab results as an attachment.
2. Details of current doses of all medicines consumed.

Awaiting for your response.
Regards.

Dr Bhagyesh

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Bhagyesh V. Patel (5 hours later)

Thanks for your prompt reply. You asked for a list of her meds but it is available on her dashboard. And she doesn't have a recent lab results. Do you mean her PTINR results or a complete run down including GFR, HDL, LDL etc? I can send again her meds if necessary. XXXXXXX

Answered by Dr. Bhagyesh V. Patel (2 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Welcome for follow up XXXXXXX

* I do not have access to her dashboard dear and so I need list of medicines
with dosage for primary information.

* Even if the latest PT INR result is not available, the recent last result will
do There is no need of complete run down for aspirin purpose.

* Grossly I would suggest that both of your personnel including pharmacist
and consultant are right on their own way, but the way is to merge both of
their opinions and the ultimate answer depends upon the co relation of
data with pros and cons of the consumption of aspirin in a given situation.

* It is the job of a consultant in more sound way over pharmacist to co
relate the same and give professional opinion in the perfect direction,
because pharmacist will not have that expertise for the same to comment
so far as patient systemic need is concerned.

* But if the consultant is over looking the lab data and insisting to continue
certain medications, there must be strong reasons for the same against
doing so.

Hope this will make you understand the issue more precisely.
Thank you.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (40 hours later)

My wife is taking the following meds. Coumadin 1 mg as directed; Cilostazol 100 mg 2/day; Amiodarone 200 mg1/day; Norvasc 10 mg 1/day; Crestor 20 mg 1/; Lopressor 50 mg1 a.m, &11/2 p.m; Synthroid 88 mcd 1/day; Calcitriol .25mcg 1/day; Xalatan 1/day; Cephalexin 500 mg 2X/day; Tylenol 50 mg 3X/day; Oxycodone/acetamin 5-325 mg 1Xfourhours; Aspirin 81 mg 1/day?? CBD oil 100mcd,??; CBD cream 2000mg??;
Re PTINR, last three readings were a month ago, 1.8, two weeks ago 2.5, last reading on 8/13 was 1.7. Now she is taking 1 mg M and W, .5 mg other days, She sees a specialist regularly. One main concern is whether any of the above meds affects her kidneys as her GFR is 18 with CKD.

Answered by Dr. Bhagyesh V. Patel (43 minutes later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Thanks for the relevant detailed information of drug dosage and molecules.

* As far as GFR of 18 is concerned, current medications are safer to be
consumed without any problems in case of chronic kidney disease.

* Be sure to confirm the days of cephalexin consumption as it is an antibiotic
and that must be prescribed for certain days, not regularly as other
medicines.

* Taking both of oxycodone/acetaminophen and tylenol is not mandatory if
there is not significant pain,distress or fever as tylenol is version of
acetaminophen only.

Wish granny best health.
Regards.

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Above answer was peer-reviewed by : Dr. Prasad