Using pain relievers

I do not take pain meds as I haven't really found that anything other than prdnisone takes care of the pain.  I am concerned about all of the comments however of not taking an NSAID with Prednisone.   My cardiologist insists that I take a low dose 81 mg aspirin each day.  I certainly do not want to take Warfarin and so far the low dose aspirin has been working for me.  I have had A-Fib, no reoccurrneces, but this is why I take the aspirin.   If this is dangerous with Prednisone, I would like to know why.  Thanks,  Donna

The problem with both pred and aspirin is that both are hard on the stomach lining. Also if you are taking pred it can make the aspirin less effective. You can always take a PPI to protect the stomach.

I do take a prescriiption to protect my stomach.   I just kept reading on here that there was an interaction with Prednisone which led me to believe that one would make the other inefective.  I do not take painkillers at all as I feel they are totally ineffective with Prednisone, so no point in them at all.  Also the low dose aspirin that I take is a coated tablet, along with my prescriptin for Zantac, I think I am protected.  Thanks, Donna

Why don't you want to take warfarin? I also have a-fib and was on a warfarin-type drug for over 3 years with no problems at all. Then I had a pred dose change and it messed up the INR so I was switched to one of the new generation anticoagulants - again, no problems at all. My husband has been on warfarin for years and will stay on it for life, his INR is rock steady.

However, particularly in the context of this discussion, NICE said in 2015:

"Aspirin has been used for years to help protect patients from strokes, but the risks of taking aspirin – which can cause stomach bleeds – now outweigh any benefits of taking the drug.

NICE’s latest quality standard, which sets out advice on the treatment and management of AF,  recommends that people with AF who have a CHA2DS2-VASC stroke risk score of 2 or above are offered newer anticoagulants, such as apixaban, dabigatran etexilate, rivaroxaban or a vitamin K antagonist like warfarin.

However, it is important to note that many adults with AF may already be taking aspirin for other conditions. If so, this may result in the patient taking aspirin as well as anticoagulants. If a patient chooses not to take anticoagulants, this decision and the reason for it should be documented by their doctor.

The quality standard, which is based on NICE’s AF guideline, also recommends that patients with AF who are prescribed anticoagulants discuss their options with their doctor at least once a year in order to improve adherence to treatment."

It was recommended previously that aspirin should be given alongside pred in GCA but the newest recommendations will change this advice since they have decided that the increase in risk due to combining aspirin and corticosteroids outweighs the benefits gained from using it.

And I should have added

"Professor Beverley Hunt, Medical Director of Thrombosis UK and specialist member of the committee that developed the standard, added: “The NICE AF quality standard provides a minimum standard of care expected within NHS England. It demands that patients at high risk of stroke without a bleeding risk are offered blood thinners - either warfarin or the newer oral anticoagulants - but not aspirin.

“Every patient needs to decide with their health care professional which is most suitable for them and they should be reviewed annually. Those who self-monitor their warfarin with a home coagulometer should be supported. Lastly if treatment fails to control symptoms, then patients should be referred for specialist management within 4 weeks.

“These Quality Standards are important because without adequate blood thinners many patients would have a preventable stroke, and stroke can have a devastating impact on lives causing loss of movement, independent living and even death.” "

Aspirin isn't as good protection against stroke in a/f - so that is a primary argument anyway.

I am terrified of Warfarin.  I know of two cases where it caused brain bleeds that were followed by death.   My A-fib is very controlled.  I have not had a bout of A-Fib in over ten years.   With Warfarin there is the need of the montly blood tests, the dietary restrictions, along with the bleeding.  I have an eye disease that has caused me to lose my peripheral vision.  I bump into things ALL the time.  I carry bandaids with me everywhere I go.  I cannot even imagine my life on Warfarin.   Both my cardiologist and my rheumatologist are well aware of my medications.  As I said I do take prescription Zantac.  I only take the coated 81 mg aspirin.  I only take the prednisone with full meals, never with just a snack.  My primary reason for asking the question was that some of these posts led me to believe that the interaction of aspirin and prednison was something that made one or the other in effective.  Once I knew that it wasn't really an interaction just the added possibliy of the bleeding, I understood.  As I have said, both of my doctors understand this.  My case of my vision and the possibility that I would be bleeding on a daily basis is too scary for me to even consider.  I appreciate all that you wrote on here.  I hope you understand why I would be so very fearful of the Warfarin.  I also had mentinoned in another post that I never take aspirin as a pain reliever, as a matter of fact, I do not take pain meds at all.  

Oh yes - I do understand and some people do have problems. I have to say - I do like the new generation stuff! No blood tests, no dietary restrictions. Not that I bothered much about what I ate. They don't make a fuss here, just tell you to not binge on anything, just keep a steady diet. Everyhting in moderation.

Some of the dietary things are myths - the cranberry one for example. There was a guy who had a mega bigh INR and was asked about his diet - he drank cranberry juice so they fixed on that and decided it must be dangerous. What they didn't know at the time was that he was a cranberry farmer and drank gallons of the stuff every day! What most of us drink wouldn't matter.

Donna for what it's worth I had a stroke about five years ago and because of that I was on 325 mg of aspirin. I was on such a high dose of aspirin because I had also had a blood clot one year earlier. Anyway I was on prednisone and aspirin for three months from September thru December with absolutely no problems. And I have acid reflux even so you would think I would have stomach upset taking both but I did not. In December I had a TIA so I had to stop my aspirin and get on Plavix. But I just wanted you to know that for the time that I was on both it was no problem for me

Thank you so much, Amkoffee.  I appreciate your response.  I am a very big believer that not all fits intot he category of "one size fits all."  I definitely trust my two doctors and my primary.  They are all on top of all of this.   I am so very careful.  Yes, you were on a large dose.  Have a good day.  

I love the story of the cranberry farmer.  Yes, I know that if a person has a leafy green salad eveyday that it is the consistancy that counts.  I will continue to be very careful and always take the Zantac.   I wish that could be gtaken anytime, but the directions are a half hour before a meal.  Sometimes wtih travel that gets to be difficult.  I am taking a cruise in July and will need to really make sure that I get the Zantac down at a proper time.  I do hope to be down a bit more on the Prednisone by then.  I am at 6 mg now. Thanks for your expertise, Eileen.