More than one-third of patients risk major bleeding by doubling up on blood thinners Aspirin,Warfarin etc : JAMA

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The study, just published in JAMA Internal Medicine, reveals a significant increase in adverse outcomes for people taking both aspirin and warfarin, a long-popular anticoagulant often prescribed for stroke prevention in patients with atrial fibrillation and venous thromboembolic (VTE) disease. Both groups of people need to avoid developing blood clots that could lead to stroke or pulmonary embolism.              "Nearly 2,500 patients who were prescribed warfarin were taking aspirin, without any clear reason, over a 7-year period," says senior author Geoffrey Barnes, MD, MSc, a vascular cardiologist at the University of Michigan (U-M) Frankel Cardiovascular Center and an assistant professor of internal medicine at the U-M Medical School. "No doctors really own the prescribing of aspirin, so it's possible it got overlooked."               Some patients could have been taking aspirin already when they began anticoagulation with warfarin for a new issue like atrial fibrillation or VTE, and they didn't stop the aspirin. Others may have started aspirin for other reasons while already taking warfarin, which is easy to do because it's over the counter, researchers say.             In this study, 5.7% of those using combination therapy experienced major bleeding events after 1 year, compared to 3.3% of those on warfarin only. The combination group that was using aspirin without a clear indication also visited the emergency department and/or were hospitalized for bleeding significantly more often.               Yet, there wasn't a difference in stroke or heart attack outcomes that are typical uses for aspirin, Barnes says. The mortality rates at 1 year were similar between both groups, and 2.3% of those on both medications had a thrombotic event at 1 year compared to 2.7% of those on warfarin alone. The study cohort included 6,539 patients who were enrolled at six anticoagulation clinics in Michigan between 2010 and 2017.