Dale Matson
If you ask cardiologists what is
more dangerous, a heart attack or a GI Bleed, it goes without saying that they
will say that a heart attack is more dangerous. When I received two drug eluding
coronary stents at age 72 in 2016, I was prescribed dual antiplatelet “therapy”
to avoid clotting in the new stents. This consists of a drug known as Plavix combined
with low dose (81mg) aspirin. Unknown to me was the fact that I had three
ulcers which led to a serious G.I. bleed within two weeks. My hemoglobin
dropped to 7. I was now anemic. The gastroenterologist was able to cauterize
the ulcers and stop the bleeding but to reduce the chance of another bleed, I
was prescribed Carafate to coat the ulcers before meals and Protonix, a proton
pump inhibitor to keep my stomach acid from irritating my ulcers. The downside
of Protonix is that in lowering the stomach acid is that long term use can lead
to hypocalcemia, hypomagnesemia, Clostridium difficile infections, and
pneumonia. https://www.medscape.com/viewarticle/820136_1
I began to have blood in my urine
and in spite of a less than optimal duration of dual antiplatelet therapy (a
minimum of 18 months is recommended), my cardiologist consented to eliminating
the Plavix but for me remaining on the low dose aspirin. And here is the rub in
all of this. My ulcers did not heal
because I remained on aspirin.
This year, I developed high blood
pressure. I didn’t know it, so a month’s worth of severe headaches was
initially treated by a course of physical therapy. In reality, it was high blood
pressure. My high blood pressure was not evident in the doctor’s office. During
this time, in desperation, I took aspirin and ibuprofen for my headaches. And,
you guessed it, I had another GI bleed with a low hemoglobin of 6. I had an infusion
of 2 units of blood in the emergency room and another endoscopy to stop the
bleeding.
Aspirin has been touted as a wonder
drug that can lower the risk of heart attack, stroke and even cancer. At one
time, aspirin was recommended for reducing the risk of a heart attack even for younger
people not diagnosed as “at risk”. More recently the medical profession
has been backing away from this advocacy. https://www.youtube.com/watch?v=uweokPBaKwY
In fact,
those without ulcers who have been taking a daily low dose aspirin can develop
an ulcer. https://www.youtube.com/watch?v=JyWWixLpBf4
I admit that I overused (abused) aspirin and ibuprofen as an
endurance athlete to help with the aches and pains and that is probably what
created my ulcers. However, having to take a daily low dose aspirin for my
heart essentially means that my ulcers will never heal. Those medicines
intended to protect them like proton pump inhibitors (Protonix), H2 blockers
(Zantac) and Carafate have not led to healing but have side effects of their
own.
On a side
note. For those considering the possibility of an elective stent placement for coronary artery disease (CAD) I would
insist on an endoscopy first to determine that there are no preexistent ulcers.
I believe bleeding
from aspirin and other nsaids to be a very serious and underreported problem
especially for the elderly. Anemia is a devastating condition, damages the quality
of life, is hard to recover from and often a contributor to death from other
causes.
I am a lay
person, not a medical doctor and also do not recommend to anyone else what I have
decided to do. I am no longer going to take a daily low dose aspirin
for my heart. I will be increasing the possibility of a heart attack but
hopefully my ulcers will heal, my hemoglobin will normalize and I can go back
to taking aspirin for an occasional headache. If, God willing, my hemoglobin
increases to normal in the ensuing months (with the addition of iron and diet
supplements), I hope to be back in the Sierra Nevada Mountains again this summer.
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