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From: ((Steven B. Harris))
Subject: Re: PYCNOGENOL Most Potent Antioxidant
Date: 07 May 1995
Newsgroups: rec.running,alt.self-improve,,,,

In <3oh65v$> (Steve)

>    My question is, what did the study entail.  Is it comparison of how
>many in each group died over a ten year period, one group taking the
>substance and one taking a placebo?  Could you, in short, give us the
>main details of the study?  Now I am curious.  Thanks.
>                                                            Steve.

    The physicians health study was originally designed to randomize
22,000 Harvard physicians, aged 50 to 84, into three equal groups, to be
given, every other day, either 1 aspirin, 1 tablet containing 50 mg beta
carotene, or placebo.  The pills were all identical.  This was
originally supposed to be a cancer and heart disease study, but there
were so few cancer deaths in the first five years that this part was
extended, and is still ongoing now at something like 10 years.  The
aspirin arm was stopped by ethical monitors when heart attack
differences became statistically significant between the groups, but not
before death rates did (which is too bad, because aspirin decreased
heart attacks greatly, but slightly increased hemorragic stroke, and
it's not clear what the best tradeoff is).  In the beta carotene arm,
the most unexpected result was that for the 333 physicians who'd had
some evidence of atherosclerotic heart disease upon entering the study,
those taking the beta carotene had a 44% reduction in major coronary
events (MI, CABG, or death), and a 49% reduction in major vascular
events (stroke, MI, CABG, death).  This was after controlling for the
effects of aspirin use, age, and a number of coronary risk factors.
Apparently the beta carotene was doing it, though nobody knows how.
Only preliminary results have been published, so far as I know: at any
rate the only reference I have at hand right this moment is Gaziano et
al, Circulation, 82: 201, 1990.

   By the way, nearly all these physicians are now taking aspirin.  The
beta carotene vs placebo arm, as I said, is still running.

                                     Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: tooth extraction and my daily aspirin equal lots of blood.
Date: 16 Jul 1995

In <3u99ut$> (Jamell
Acree) writes:

>In <> "Duane
>J. Rigge" <> writes:
>>Yesterday I had a tooth pulled. I take one aspirin daily and as of
>>today (one day later) my gums are still bleeding. I've tried
>>the normal gauze method and also the tea bag method. I would
>>appreciate any suggestions.  Thanks.
>I once knew a fellow who worked in a hospital.  I told me that the
>hospital people would not allow a candidate for surgery to take aspirin
>for FIVE days prior to the surgery because of the blood thinning
>qualities of aspirin.
>The oral surgeon who did your extraction should have asked you a few
>questions before he/she began.
>Of course, that is of no help to you NOW, is it.

Actually, there have been studies of aspirin and surgery, and for
abdominal operations with modern techniques, no more blood is lost in
people on aspirin than not on it.  Aspirin mostly screws up procedures
in which there is a lot of raw, oozing tissue which isn't sutured or
cauterized.  Tooth extraction is (ironically) one of the few procedures
where aspirin use HAS been shown to make a difference in blood loss (as
you have just verified).

If you make platelets at the normal rate your bleeding time should
pretty much normalize after three days off aspirin (it really does not
take five), but not until then.  In the meantime you can only try some
of the capillary leak prevention agents, like citrus bioflavonoids,
pycnogenol, bilbery, etc.  And of course your vitamin C and CoQ10.  This
is a gamble since I know of no human studies with these agents in tooth
extraction bleeding (with the exception of vitamin C, which you probably
are taking already)-- but there ARE some few animal studies on wounds
and wound healing to suggest that all these things may do some good.  It
also seems to be a general truth that agents beneficial to collagen seem
to be beneficial in oral surgery studies of gum healing.

Good luck.  And don't worry about bleeding to death-- just keep pressure
on it.  As far as conventional medical treatments, if you're near an
Urgent Care or can get back to your dentist or see a surgeon, you can
get some Aventeen put in the socket.  This is a sterile cellulose stuff
which activates local thrombosis and helps a lot in bleeding control in
people with problems like yours.  It's expensive as heck, but for
certain cases, it's darn well worth it.

                                 Steve Harris, M.D.

From: B. Harris)
Subject: Re: Claritin put my wife in the EM
Date: 14 Jun 1997

In <5nok6n$> (Operator 7G) writes:

>In article <01bc76eb$1d0b4040$>, "Evan Franko"
<> wrote:
>>> children's aspirin? Is it still marketed as that in the US is it?
>>> Don't scare me like that please!
>>Children's aspirin is still marketed in Canada and the US. However, it
>>is used as adjunctive/ anticoagulant therapy for the prevention of
>>stroke in adults and not for fever/headache in children. In Canada, it
>>is kept behind the counter (in the pharmacy) so that we can warn against
>>use in children.
>nono, I'm aware of it's use as an antiplatelet, but my concern is
>*marketing* it as Childrens Aspirin, not it's use at that strength.

   Well, kids sometimes have pain from scrapes, bruises, sprains, and
teething problems, and an antiinflammatory like ibuprofen or aspirin
may work as well or better there as Tylenol.  Just so long as aspirin
isn't used willy nilly for febrile illnesses, and not during the first
24 hours of sprains and minor trauma (when there may still be some
bleeding), it should be fine for kids.  True, this requires a bit of
sophistication for parents.  But it's simple enough instruction that it
can be put on a bottle.

                         Steve Harris, M.D.

From: B. Harris)
Subject: Re: aspirin and surgery
Date: 2 Jan 1998 06:24:42 GMT

In <>
(MBRAFF) writes:

>Is it important to not take aspirin before
>minor surgery like a PEG insertion?

   It contributes to bleeding for surgeries in which bleeding is
expected to be controlled by means other than the usual tie and or
cautery.  A PEG insertion would be a good example.  Or a tooth
extraction.  Aspirin has been shown NOT to increase the amount of blood
loss is your typical surgery where all bleeding is directly visualized
and controlled.  Which is most surgery.

>If yes, how long before the surgery should
>aspirin be stopped?

   At least three days for someone making platelets at a normal rate.
This is how long aspirin effect lasts on bleeding time.  Three days is
not long enough to replace all the platelets, but it's enough time that
there are enough new platelets to normalize all parameters.

   A few people say 5 days to a week, based on how long it takes the
normal person to replace all platelets.  But replacing all of them
isn't necessary in practice.  Three days will generally do.

                                     Steve Harris, M.D.

From: B. Harris)
Subject: Re: Your Expensive Urine--- Ahem
Date: 26 Feb 1998 19:49:54 GMT

In <> (Alan Pollock)

>My doctor prescribed me 325mg Ecotrin enteric-coated asperin to be
>taken daily.  Now I'm wondering if I should take them every *other*
>day instead, as due to their coated nature one can't break them in
>half. Nex

    You can get coated "Halfprin" product which is only 1/4 of a 325 mg
tablet, or 81 mg (I know, they should have called it "Quarterprin").
The coating only lessens irritation to the stomach if a tablet should
land on the stomach wall and sit-- something that shouldn't happen if
you take aspirin with (after) a meal anyway.  But it never hurts to do
all you can.  The alternative is chewing a baby aspirin.  They taste
good, anyway, I always thought.

   The biggest heart studies was done at 325 every other day, but given
the way aspirin works, almost everyone thinks that 81 mg every other
day (as Halfprin) or 40 mg every day (as half a baby aspirin) would be
just as good.  Naturally, you should let your doc know you want to
change the regimen, and get his/her input.

                                             Steve Harris, M.D.

From: B. Harris)
Subject: Re: Your Expensive Urine--- Ahem
Date: 2 Mar 1998 04:47:49 GMT

In <6d8emv$qh8$> writes:

>Most everything I've read about aspirin, and of course what the
>aspirin manufacturers very carefully advertise, is that it may help
>those who've already suffered a prior heart attack, or heart
>Is it also preventative?

   It's definitely preventive of a first heart attack, as the
Physician's Health Study (PHS) showed.  Whether or not preventing a
first heart attack wins out over your increased risk of GI bleed and
hemorrhagic stroke, is the question.  This probably depends on how
large your prior heart attack risk is.  Nobody has a good answer,
because they didn't run the PHS study long enough to find out.  Duh.
You'd think the NIH would have been smarter. Or maybe not.

                                     Steve Harris, M.D.

From: B. Harris)
Subject: Re: Curing Heart Disease and Cancer
Date: 14 Jun 1998 22:15:28 GMT

In <>
(Alf Christophersen) writes:

>No, the intention with 50-80 mg is that when the aspirin reach the liver
>(the first place it reach) it should be used by the platelet so that
>enough platelets are damaged, but not so much that you are threatening
>your life.


   Your statements are garbled.

   The intention is to acetylate the cyclooxygenase of all your
platelets, which 50 to 80 mg will certainly do.  You do not get any
increase in bleeding time with 1000 mg, although higher doses of
aspirin do slightly effect things like how well platelets are activated
by damaged collagen, so it's not perfectly true that there's no extra
effect above 40 mg.  But there isn't much.

    However, aspirin at very low doses is taken out by the liver before
it reaches your systemic circulation, and so small doses will indeed
keep any aspirin from reaching your systemic circulation.  Your
platelets will still all get acetylated in your portal system as they
all eventually pass through those vessels (from gut to liver) but your
endothelium only in that region is affected.  In the rest of your
vessels, the cyclooxygenase is fine.  And that which is affected, is
capable of quick regeneration.  Your platelets cannot make new
cyclooxygenase, so you have to wait after a dose of aspirin for new
ones to be made.  It takes 3 days for enough to be made to normalize
your bleeding time after a dose of aspirin (halflife of platelets is 5
days, but you don't need to replace them all for the anti-clotting
effect to go away, just half of them).

   Anyway, that's the theory behind low dose aspirin.  It's not yet
been proven that 80 mg of aspirin is as good as 325 mg or 650 mg per
day for preventing strokes or heart attacks, however.

                                        Steve Harris, M.D.

From: B. Harris)
Subject: Re: Women, Men and Heart Attacks
Date: 6 Nov 1998 22:41:33 GMT

In <>
(Blair Zajac) writes:

>When you are on such a program, you should take *enteric* asprin,
>available in any drug store as an over-the-counter product. This enteric
>asprin disolves in your intestines over an extended period of time,
>avoiding the impact of asprin on your stomach. So, all of objections of
>taking asprin is avoided.

   No.  Alas, the danger of low dose aspirin in causing GI bleeds is
due mainly to its effect on platelets.  Enteric aspirin does not change
this.  At larger aspirin doses (therapeutic NSAID doses) the effect on
the stomach is due to prostaglandin manufacture inhibition, and again
is not effected by coating the tablets.  Again, no relief.

From: B. Harris)
Newsgroups: sci.physics,
Subject: Re: Research Funding: (was jets and propellers)
Date: 18 Jul 1999 11:30:48 GMT

< (chelp) writes:

>Does the fact that aspirin is itself a weak acid play any role in ulcer
>formation. An older chemistry text suggested that, since aspirin is a
>weak acid it would not be ionized in the low pH environment of the
>stomach but could diffuse into the lining of the stomach where, at a more
>neutral pH it would ionize and destroy tissue. Is that at all a plausible
>   Lisa

   It's plausable, but turned out to be wrong.  Buffered aspirin didn't
do any better.  Dispite all the money people still pay out for
'Bufferin' and other buffered aspirin products.  One of the great fads
and lasting fads of the 20th century.

    Aspirin (like many drugs) is locally irritating if a pill sits
right on the stomach (which can be prevented by taking it with
food/milk, or a lot of water).  But its main action to cause bleeding
is inhibition of platelet function (even at tiny doses), and (at much
higher doses) the inhibition of synthesis of prostaglandins which are
necessary to direct the stomach to make protective mucin so as not be a
a victim of its own acid.  Both of these latter effects would happen
even if the aspirin were given directly into the intestine, or even
into the blood.  Both happen with many other NSAIDs (non steroidal anti
inflammatory drugs), though there are a few, like Celexa, which are
easier on the stomach.  Several non-aspirin salicylates, as well as
Celexa, don't affect platelets.  Aspirin's effect there is uniquely
potent and long lasting for the dose (the effect of 1/8th of an
aspirin, or 40 mg, lasts for days).

From: B. Harris)
Subject: Re: Aspirin vs. Ibuprofen
Date: 5 Feb 2000 08:21:37 GMT

In <>
(Bruce) writes:
> B. Harris) wrote:
>>benefits. The physician's health study looked only at Harvard male
>>doctors over 40, and even then was not run for long enough for an effect
>>on mortality to show up.  That was dumb.  The money spent on it was
>>mostly wasted.
>There have been over 25 studies on the efficacy of asprin in reducing
>heart attacks.  They were even presented as an example of how to perform
>meta analysis in the journal Science in 1990.
>Incidentally, the results of the meta analysis showed a ratio of .75
>where 1.0 represented no benefit, with a 99% confidence interval of
>around 74 to .76.

   I've no question that aspirin reduces heart attacks by 25% in the
entire population it was studied in, in all those studies.  And so what
makes you think that study population represents everybody over 65?
Which is how this thread got started?  Most of these are secondary
prevention trials as you know (our should know).  Such the primary
prevention trials as exist (the PHS study is an example) are in at-risk
populations.  If you know of the prospective aspirin heart attack
prevention trial in 65 year old women with no heart disease risk
factors other than age, perhaps you'd post it. I can't seem to find it
on medline.

   Finally, none of the data on heart attacks really addresses the
question of who lives longer on aspirin.  In the PHS study the number
of people hospitalized for GI bleed was significantly greater in the
aspirin group (325 mg every other day), and the number of extra
hemorrhagic strokes (which tend to be rather devistating) just missed
significance.  Life span got nowhere near significance.  Nobody
attempted to look at the difference in quality of life tradeoff in
whether you want to decrease your heart attacks by 25%, if your life
span doesn't change, and you know you're trading a lot of MIs which
probably aren't crippling, for a few hemorrhagic strokes which
certainly will be.  And that's if you're a middle-aged male physician.

   Have a little skepticism about single outcome studies, why don't
you?  If you randomize middle-aged men to corn oil supplmentation, they
have fewer heart attacks.  Alas, they also have more colon cancer,
which is one reason why we don't have this group just drink corn oil to
lower their heart attack risk and cholesterol levels.  Life span, if
you check the VA corn oil study, wasn't changed.  Wups.  The same is
more or less true of cholesterol binders and fibrates. There's a very
good reason why HMG-CoA reductase inhibitors are drugs-of-choice for
heart attack prevention.  Heed it when it comes to aspirin.

Subject: Re: Expired Aspirin
From: (Steve Dyer)
Date: Sun, 09 Jul 2000 23:13:30 GMT

In article <>,
Kuklinski  <> wrote:
>> I have a bottle of aspirin with hundreds of pills left.  It expired in 1998.
>> Is there any reason I shouldn't use this, or has it lost any effectiveness?
>> Thanks for any help.

>There is a reason why the manufacturer places expiration dates on

So that they can donate soon-to-expire drugs to the UN and foreign
social service agencies for humanitarian relief and still take a
tax writeoff for the donation at the full price? :-)

>I advise you to properly discard of the old aspirin and purchase new aspirin
>within proper date.
>Do NOT take the expired aspirin.

Aspirin decomposes into salicylic acid and acetic acid.  A bottle
of aspirin past its prime will smell strongly of vinegar from the
acetic acid.  Salicylic acid is still an effective analgesic/antipyretic
(it's sold as the salt, sodium salicylate).  However, unlike aspirin,
salicylate doesn't irreversibly inhibit platelet cyclooxygenase, so it has
much less of an effect on platelet aggregation and bleeding.  Someone
taking aspirin well past its expiration date to help prevent a heart
attack could be taking a sub-therapeutic dose.

Still, as other have pointed it, aspirin is so cheap that it doesn't
make sense to use it past its expiration date.
Steve Dyer

From: "Steve Harris" <>
Subject: Re: Oxidation/polymerization of polyunsaturates (was Re: alpha lipoic 
	acid eliminates wrinkles?)
Date: Fri, 8 Mar 2002 10:13:29 -0800
Message-ID: <a6auup$b06$>

DB wrote in message <0a6i8.1450$>...
Uncle Al wrote:

> Ed McBride wrote:
>> > > Uncle Al wrote:
>> > >
>> > > > Take your 500 mg of Vitamin C, 400 IU of Vitamin E, and a
>> > > > multivitamin after dinner
>> Except my sister, a VERY good internal-medicine doc, suggests 800-1000 IU
>> of E and one aspirin, anywhere from the 81 mg dosage to the 325 mg
>> standard one.
>> Ed
> Oil-soluble vitamins are inefficiently excreted.  OD on Vitamin E
> leads to blood clotting disorders and visual impairment (competition
> with Vitamin A).  Aspirin causes gastric bleeding no matter how
> administered, including IV.

>Not at those dosages.


Yes, even that these dosages.  It's the antiplatelet effect on GI ulcers
that you wouldn't ordinarily otherwise notice. In the Physician's Health
Study (PHS) where the aspirin dose was 325 mg every other day, they had
siginicantly more admissions to the hospital for GI bleed in the aspirin
group. So it's not a benign drug, even at only anti-platelet doses. I think
the good effects outweigh risks in many groups (all smokers, and probably
most men over 40 and women over 50), but you really need to know your blood
picture and family history and medical history to take a good guess at this.
We don't know for sure, because no study (not even the PHS, which was the
biggest) has looked at aspirin long enough to assess its effect on all-cause
mortality.  The only drugs we know those answers for are the statins (they
do extend life in people with high LDLs, even if they've not had a previous
MI or known cardiovascular event).  We don't know the life extending effect
(if any) for aspirin, nor vitamin C, nor vitamin E, nor niacin in the
general population, or even for high LDL people.  We know precious little
about any of these last set of substances, even as secondary preventives.

So a bit of humility is in order. The statins are presently the best-tested
"life-extension drugs" known. We know far more about their long term health
effects that we do megadose vitamins. You may rightly complain about that,
but do it to your congressman. The science is as I've reported.  The drug
companies have the 100's of millions to find stuff like this out, and no
vitamin C maker does.

>Chronic megadosing is no more
> clever than eating just enough to avoid deficiency disease.  You want
> your auto engine oil level to be topped off, not overfilled or
> bottomed out.

>>I feel pretty clever, though. Must be all the supplements.

Nah, probably just narcissism. The cure is medline.  Go thou and read.


From: "Steve Harris" <>
Subject: Re: Aspirin for atherosclerosis, prostate cancer prevention and colon 
	cancer cure, etc.
Date: Mon, 18 Mar 2002 14:20:42 -0700
Message-ID: <a75m6q$ve1$>

"hilite" <> wrote in message
> Whay won't doctors comment on aspirin usage?

Because we don't know. They stopped the Physician's Health Study, the only
one that would have answered the question, before the life span results were

So all we know is that low dose aspirin decreases stroke and heart attack at
low doses, but increases GI bleeding. Probably it's a good bet for anyone
with any serious atherosclerotic risk factors (over 50, hypertension, LDL >
160, smoker, male, obese, family history).  But don't take it if you have an
ulcer history, without care to use acid blockade treatment, and under MD
supervision. It might be better if routine acid blockade (Zantac) and a
multivitamin was used by everyone who considers therapeutic low-dose
aspirin. I certainly put all my low-dose aspirin patients on Zantac, and
they get something more powerful if they've had any ulcer history. I can't
prove that any of this is the right thing to do, prevention-wise, since the
crucial studies aren't there.


> On Sat, 16 Mar 2002 18:36:56 GMT, hilite <> wrote:
> >What is the opinion on the best aspirin dosage for a 'healthy' male
> >with a 5% chance of a heart attack in the next year?
> >
> >Since aspirin is also able to prevent prostate cancer, and that is
> >another concern of mine, do you think 80mg or 160mg per day would be
> >best?
> >
> >Since long term use of aspirin is a little risky, do you think it
> >would be sensible to take aspirin daily for two months and then skip
> >it for a month to give the body a chance to recover, and then continue
> >this regimen indefinitely?
> >
> >How much aspirin do you think is required to kill colon cancer?
> >
> >Since aspirin is beneficial in the treatment and prevention of 2 types
> >of cancer, don't you think it's reasonable to think it will also help
> >prevent and cure other types as well?

From: "Steve Harris" <>
Subject: Re: Aspirin for atherosclerosis, prostate cancer prevention and colon 
	cancer cure, etc.
Date: Tue, 19 Mar 2002 09:34:45 -0800
Message-ID: <a77sph$1ls$>

Somewhat Useful Trainer wrote in message ...
>On Mon, 18 Mar 2002 14:20:42 -0700, "Steve Harris"
><> wrote:
>> It might be better if routine acid blockade (Zantac) and a
>>multivitamin was used by everyone who considers therapeutic low-dose
>Why the multi and is the aspirin creating additional acid output?

The multivitamin for the B12 which you'll need in a non-protein bound form,
if you suppress gastric acid production.  The aspirin does NOT create
additional acid output, but it does make ulcers bleed. If you have no acid
or less acid it's much easier to avoid ulcers in the first place.

I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <>
Subject: Re: Aspirin for atherosclerosis, prostate cancer prevention and colon 
	cancer cure, etc.
Date: Mon, 25 Mar 2002 18:18:48 -0800
Message-ID: <a7olt4$9il$>

Alf Christophersen wrote in message <>...
>On Mon, 25 Mar 2002 12:09:05 -0800, "Steve Harris"
><> wrote:
>>You can get by on as little as 40 mg aspirin (1/2 baby aspirin) every
>>other day (if you can remember to dose it that way). At these doses,
>>what brand of aspirin you take is irrelevent (just take it with food so
>>it doesn't sit up against the stomach wall and cause irritation).

BTW, I should note that this is only if you're swallowing them. If you're
chewing the nice orange flavor baby aspirin till it disolves, then no

>One early study reported good effects with 25 mg daily. That should
>have almost none sideeffects.

Yeah, 25 mg daily is pretty close to 40 mg every other day. Okay, half a
chewable baby aspirin a day.

Again, this has nearly as much effect on platelets as 10 full aspirin a day.
Yes it can have side effects.  It can give you bloody noses if you're prone
to them, and all kinds of odd things.

> But here in Norway the lowest doses in
>pills are 125 mg and most are 300 mg and more, which means lot of
>trouble in dosing such small quanta :-(

They don't have children's aspirin in Norway?  Surely you jest.

>(And now you need a prescription with such doses if you want more than
>25 tablets)

State nannyism.  Don't you just love being treated like a child?  I'm
surprised all adults aren't given children's aspirin in Norway-- it would go
right along with the philosophy.

I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <>
Subject: Re: Aspirin for atherosclerosis, prostate cancer prevention and colon 
	cancer cure, etc.
Date: Mon, 25 Mar 2002 11:37:41 -0800
Message-ID: <a7nu80$ld4$>

hilite wrote in message <>...

>Interesting. However....
>The number of people who experience GI bleeding while on a daily
>aspirin regimen is very small - 1 per 1000 per year and......

This is not trivial. It's on the same order of risk that you'll be
hospitalized for a traffic accident this year.  Would you willynilly double
your risk of being hospitalized for a car wreck?

>people who use low-dose aspirin daily are most likely to experience GI
>bleeding during the first 60 days. This leads me to conclude that not
>many ulcers are formed after people begin a daily aspirin regimen.
>Otherwise the bleeding would be more common and more evenly
>distributed over time.

Agreed, and it is for this reason I infer that low-dose aspirin mainly is
responsible for making pre-existing ulcers bleed.  At these doses, the
effect is purely a platelet problem, not a COX inhibition problem.  There
isn't enough aspirin in a baby aspirin to permanently inhibit COX-1 except
in your platelets (which can't regenerate it).

>Even if the aspirin regimen creates more ulcers, ulcers are quite easy
>to cure.

Not when they bleed enough to put you in the hospital.  By that time it's
serious business.

>And the aspirin can prevent heart attacks, strokes, colon
>cancer and prostate cancer, all of which are difficult or impossible
>to cure. Furthermore, it seems likely that aspirin will prevent and
>cure other kinds of cancer as well.

There's no good prospective evidence for aspirin and cancer yet. And even if
it does work, it will be at doses higher than necessary for stroke and heart
attack.  Again, the tradeoff may not be a good one unless you know more
about your stomach.

I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <>
Subject: Re: Aspirin for atherosclerosis, prostate cancer prevention and colon 
	cancer cure, etc.
Date: Mon, 25 Mar 2002 18:28:57 -0800
Message-ID: <a7omb4$2r9$>

Somewhat Useful Trainer wrote in message
>On Mon, 25 Mar 2002 12:06:34 -0800, "Steve Harris"
><> wrote:
>>>When you say "know about stomach" are you referring to a specific
>>>gastrointestinal exam/test or a previously diagnosed medical issue?

Or endoscopy.  Anything that gives you some idea of what your stomach looks
like.  If you have risk factors (previous ulcers, you smoke, you're a young
male) you might want to consider seeing your doc for a stool blood test
before you just willy nilly put yourself on aspirin.  Even if that's
negative, I still think the Zantac's a good idea for anybody with ulcer risk
factors who's going on aspirin for no particular reason other than
cardiovascular risk factors.  Understand that I'm giving you my intuitive
guess there, though. There are NO studies to directly add up all the risks,
and prove that Zantac is cost effective, or effective at all, at lowering
your risk of GI bleed from going on low dose aspirin.


I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <>
Subject: Re: Aspirin for atherosclerosis, prostate cancer prevention and colon 
	cancer cure, etc.
Date: Wed, 3 Apr 2002 21:48:50 -0700
Message-ID: <a8gmea$5d2$>

"Keith F. Lynch" <> wrote in message
> Steve Harris <> wrote:
> > They don't have children's aspirin in Norway?  Surely you jest.
> I thought they got rid of children's aspirin everywhere, because of
> Reye's syndrome.

You're not supposed to use it for flu or chickenpox.  Otherwise, however,
it's still useful and still sold.

From: "Steve Harris" <>
Subject: Re: Aspirin inactivates cox-2 inhibitors?
Message-ID: <sFcD9.2803$>
Date: Thu, 21 Nov 2002 21:57:44 GMT

John Adams wrote in message ...

>More about why a doctor will be very careful when using ASA and COX-2
>inhibitors at the same time. ASA is proven to decrease the risk of
>heart attacks and strokes. A low dose will suffice. ASA makes the
>platelets in the blood less "sticky" and thus less likely to form
>clots, especially in those narrowed arteries feeding the heart muscle
>and the brain cells. The anti-platelet effect makes it valuable in
>prevention of clot formation, but there's a down side to that very
>same property: it slows clotting time. In the stomach, it ASA can
>irritate the lining to the point that it bleeds.

If you take a lot of it. If you're just taking anti-clotting doses of
aspirin (40-80 mg a day) any extra bleeding you get in the stomach is from
ulcers you already had from some other cause, and is due to the aspirin's
anti-platelet activity. These doses are far too small to directly irritate
the stomach or do anything for the stomach's production of protective mucus
(which is blocked by large doses of COX-1 inhibitors). COX-2 inhibitors also
inhibit healing of ulcers, largely because COX-2 is expressed only in
inflammation (healing) in the stomach. Small doses of aspirin don't do that.

>With an increase in
>the amount of time it takes to form a clot to stop that bleed in the
>stomach, yeah, you guessed it: bleeding ulcers are more common in
>those who uses ASA regularly. (One more reason for a low dose of

Yes. But a bigger reason to do something about what's causing the ulcer in
the first place.

>The other NSAIDS, older ones and the newer ones, demonstrate
>the increased risk for bleeding, especially in the stomach, that may
>last longer than is good. The new COX-2 inhibitors are less bad about
>the GI bleeding, but they still demonstrate longer bleeding times.

The old Vioxx didn't increase bleeding time, and for that matter, neither do
some NSAIDs like salsalate. But COX-2 drugs still increase stomach bleeding,
probably due to the healing inhibition thing. GI bleeding risk after a year
of use is not much different in non-selective NSAIDs vs the new COX-2
selective ones. It's only short term use in which COX-2 agents shine.

> Now let's think about the possibility of a slow bleed in the stomach
>caused by ASA and NSAID use. This scenario can become very very
>serious. Let's say the person fell and got some bruises. These issues
>can be more pertinent and quite serious in the older person. Prudence
>when using these meds is appropriate.

Don't I wish!  About the only prudent thing you can do is not take aspirin
if you're bleeding already (even by occult stool blood test). But it's not
obvious that you shouldn't use low dose aspirin if you're taking another
NSAID, or even if you had bleeding ulcers in the past, but were treated for
H. pylori. Probably most people over 40 should use low dose aspirin, though
this has yet to be proven (they keep stopping the studies early, before
mortality results are in, so I'm not sure it will EVER be proven). However,
though a GI bleed is bad, a stroke or MI is worse. One of the ways NSAIDs
may harm people is by keeping them from taking their baby aspirin, when they
really should still be taking it.

I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: Steve Harris <>
Subject: Re: Aspirin for over 70s in question
Date: 20 May 2005 17:56:31 -0700
Message-ID: <>

>Doctors already recommend aspirin for patients who have a higher than
>normal chance of having a heart attack or stroke, as long as there are
>no other medical reasons not to prescribe the drug, such as unwanted
>side effects.
>Aspirin has been linked to an increased chance of bleeding in both the
>stomach and brain.
>The figures thrown up by the model used by the researchers at the
>University of Tasmania indicated that the overall balance of harm and
>benefit for taking aspirin could tip either way.


For the brain, the benefit in not clotting easly trumps any increase in
bleeding. That's known from many stroke prevention trials. And since
few people bleed into their heart, aspirin is pure gain there.

As for the stomach, I'm of the opinion that anybody over 65 on asprin
ought to consider stomach acid blocker therapy (with a B12 supplement)
at the same time anyway. The risks of that are low, and the expense is
getting to be modest. We're slowly coming around to this view on
NSAIDS, and I see no reason why low dose aspirin won't be the same.


From: Steve Harris <>
Subject: Re: Asprin and 81 mg baby asprin .
Date: 28 Sep 2005 14:46:14 -0700
Message-ID: <>

Jim Chinnis wrote:
> "Kamalakar Pasupuleti" <> wrote in part:
> >Can someone educate me if I can split the regular Asprin - 325 mg
> >into quarter and take instead of 81 mg baby asprin which is expensive .
> Sure.

Indeed "sure."  But most of the studies have been done at doses of 1
full aspirin a day, so if you want to duplicate them, you need that.
And some fraction of (40%?) people are aspirin-resistant. That fraction
drops, the more aspirin you take in a single dose. 2 tablets might be
even better than one. But whatever you take, do it on a full stomach.
Also, effects on platelets last 2 days at least, so you can do it every
other day (or Mon-Wed-Fri if that helps you remember). The longer
between doses, the longer your stomach has to recover.

Lab tests for aspirin insensitivity are not yet common or cheap.
Eventually, we'll all know how much aspirin it takes for us. Right now,
we don't.


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