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What are the side effects of aspirin with history of HEART DISEASE?

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Hi there,

Due to a family history of heart disease, I take several supplements daily (with my doctor's approval) that really helped me get my blood pressure to good levels but also to mildly thin the blood. These include daily doses of:
- fish oil (~2,000 mg EPA + DHA)
- garlic (1200 mg)
- celery seed (150 mg)
- L-Arginine (250 mg)
- L-Carnitine (250 mg)
- CoQ10 (200 mg)
- Grape Seed Extract (300 mg)
- moderate doses of papain, bromelain, quercetin, cayenne, and ginger
- mushroom complex (considering this one)

My doctor also mentioned I could take a baby aspirin daily, but with the other supplements, and at the age of 34, I'd prefer to stick to that as I've read about certain risks of aspirin that make me uncomfortable, and I don't want too much blood thinning either...

Anyway, onto my question. I've read that aspirin can increase the chance of cerebral microbleeds, whereas other drugs like heparin don't necessarily. Would the supplements I list above also likely increase the chance of cerebral microbleeds, or is that likely something aspirin-specific?

Also, is there anything to watch for to make sure my blood doesn't get too thin? A lot of these (even my multivitamin) say not to use before surgery, but I haven't noticed any excess bleeding/bruising. Anything I've noticed has been fairly positive...ie. reduced blood pressure. Cuts still heal fine, and while they bleed, not excessively or anything, no bleeding gums, no bruises. Once in a while I have blood when I blow my nose, but I've always had that, and it's never a lot.

Thanks!


Category: Internal Medicine Specialist

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello.

Thank you for your query at DoctorSpring.com.

I understand your concern.

Its true that aspirin can increase the risk of cerebral micro-bleeds in individuals in whom such a risk exists. As long as you are maintaining a healthy lifestyle and you do not have other significant risk factors for heart disease or stroke necessitating Aspirin prophylaxis, you do not have to take Aspirin.

Omega-3 fatty acids from fish oils can increase the risk of bleeding from anywhere in the body, particularly at doses of three grams daily or greater. Since you only take about 2 grams and you do not have any bleeding disorders, you do not have to worry. Garlic too has a theoretical bleeding risk.

Celery seed, grape seed extract, Coenzyme Q10 and the others; when taken in conjunction with other anticoagulant drugs or in individuals with pre-existing bleeding disorders raises the bleeding risk. However, you are only on other supplements, not anticoagulant drugs.

High doses of a specific mushroom, the reishi mushroom might increase the risk of bleeding in people with thrombocytopenia(decreased platelet count).

Arginine and Carnitine taken orally have not shown any risk of bleeding.

All in all, no research exists about any of these supplements cause bleeding when taken together. Most of their benefit in lowering blood pressure is not supported by good quality clinical trials. 

Personally I would not recommend these supplements. Mild to moderate hypertension can be controlled by dietary changes and regular exercise and higher grades with medication, thus obviating the need for these supplements.

However, since you haven't experienced any adverse effects by taking them, you can continue to do so. Blood thinning can be monitored by simple tests such as Bleeding and Clotting Times or more complex ones such PT(Prothrombin Time), APTT(Activated Partial Thromboplastin Time) and INR ratio which are done for patients on anti-coagulation therapy.

I hope that addresses your concern.

Feel free to ask queries.

Thank you.



Patient replied :

Thanks very much for your detailed answer!
So in your opinion, as long as my doctor approves, I shouldn't have any increased risk for things like cerebral microbleed, etc., on these supplements alone?
I'm relieved to hear you don't feel I need to use aspirin at this point. Does aspirin increase the microbleed risks by a different mechanism than some of the blood-thinning effects of these supplements?
Given my success with lowering my borderline blood pressure to healthy levels (and yes, I am exercising, trying to eat better in general, etc. as well), I'm fairly happy with my regimen, so I'd like to continue if possible (but I will revisit with my doctor next I see her as well).
Thanks again!


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Thanks for writing to us again. We are happy to help you in whatever possible way.



The supplements mentioned by your doctor, and the dosage that he has given doesn't predispose you to any micro-bleeding. Aspirin is an unique drug in itself, and some doctors still firmly believe in its effects and some have disapproved its usage. Aspirin indeed, acts in a different way, by blocking the action of a compound in our body called Thromboxane, which is responsible for platelet accumulation in sites of bleeding. Since aspirin blocks this effect, it can lead to micro-bleeds as you correctly specified. So my advise would be to continue wroking out,bring your weight and BMI down, and continue taking the other supplements. Then you will stay in good shape. At this point, since you're only 34 avoid aspirin.



Hope that answers your query,



Do post additional queries,



Regards



Patient replied :

Excellent! Thanks for the information and the difference cited between aspirin and the other supplements I listed. I'm a bit relieved by the fact that you don't think I need the low-dose aspirin at my age. The microbleed risk as well as some early evidence it might boost macular degeneration risk worried me a bit.
One final followup (last one) if you don't mind - the same logic would apply to (low-moderate doses) of cinnamon and mushroom [reishi, shitake, and maitake...less than 500 mg total combined] as well, correct? Of course I would get doctor's approval of any supplement changes. I just want to make sure nothing I'm taking/considering taking has that same mechanism of action as the aspirin.
Thanks again for all the help, and I will continue working on a healthy lifestyle!


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello.

Yes, my opinion on these supplements too remains the same. As long as you are taking your treating doctor's approval for these, there should not be any problems.

The mechanism of action of most herbs? is not fully elucidated and research is on-going in this field. The Reishi mushroom for example, seems to have anti-coagulant action due to its inhibition of platelets from aggregating and forming a clot. However, the exact chemical process is still unknown. Aspirin too inhibits platelet aggregation. Even then, it is unlikely that any of the active compounds from these herbs have the same chemical pathway and risks as Aspirin.

I hope that answers your question. Let me know if you have any queries

Thank you.



Patient replied :

Thanks much. My chief worry was risks of cerebral microbleeds, and it seems like aspirin is unique in this regard most likely (even though not everything is understood re herbs). I'm just a bit more comfy using lower dose whole food type products than a drug at this point as long as I have no negative symptoms. Thank you very much for your help!



Dr. Deepu Sebin Sebastian
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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