4 ms·

As for the internal bleeding risks, I was wondering what the actual numbers were. This is based on one low dose aspirin a day. http://onlinelibrary.wiley.com/d

by aantix 10y ago

As for the internal bleeding risks, I was wondering what the actual numbers were. This is based on one low dose aspirin a day. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2006.03077.x/full http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2006.... "These results translate into an absolute rate increase with aspirin above placebo (the incidence of cases of major GI bleeding attributable to low-dose aspirin) of 0.12% per year (95% CI: 0.070.19% per year).[20] Based on this value, 833 patients (95% CI: 5261429 patients) would need to be treated with low-dose aspirin instead of placebo to cause one major GI bleeding episode during a 1-year period (i.e. the NNH is 833)"

mtgx 10y ago
Does that mean the risks are very low? What about compared to aspirin alternatives such as ibuprofen or acetaminophen (in terms of how much damage they can each cause to the body, and which is safer)?
- matt4077 10y ago
  Acetaminophen in particular is somewhat scary. Just 2.5x the recommended maximal daily dose of 4g can lead to complete liver failure. With alcohol, other medication, or existing damage, much less could be enough.
  - nostromo 10y ago
    A friend of mine swears that the reason acetaminophen is added to opioids (like hydrocodone) is so that you cant abuse the opioid without being poisoned by the acetaminophen. If true, it's alarming that the way to "prevent abuse" is to poison the patient.
    - snerbles 10y ago
      A more extreme example of this concept is denatured alcohol, which is ethanol adulterated to deter consumption. https://en.wikipedia.org/wiki/Denatured_alcohol https://en.wikipedia.org/wiki/Denatured_alcohol
    - jaggederest 10y ago
      That is completely correct. It also has synergistic effects as a pain reliever, but it's mainly there to deter abuse. Of course, addicts have found ways to extract the opiates from the adulterants, so it's not even effective.
      - joshgel 10y ago
        Source? Adding it for synergism makes sense and is what I was taught in medical school. I doubt they add it to deter abusers, but I could be wrong...
        icantdrive55 10y ago
        I think what you were taught in med school was correct. I was told by an emergency room nurse that Vicodin is not killing patients/abusers; it the liver damage that results from the acetaminophen. A few years ago, I heard they were talking about removing it, but lost track of the outcome.
        jaggederest 10y ago
        Just look at the simple fact that they were schedule 3 instead of schedule 2 until 2014, even though the base hydrocodone was schedule 2 without adulterants. Here's an interesting discussion from 2010, before they were rescheduled https://painmedicine.oxfordjournals.org/content/11/3/379.full.pdf https://painmedicine.oxfordjournals.org/content/11/3/379.ful...
    - maccard 10y ago
      You can buy codeine over the counter in the UK, in doses of 8mg with 500mg acetaminophen(paracetamol to us). If you get a prescription, they happily bump it to 30/500
    - matt4077 10y ago
      Isn't their anything that is uncomfortable in higher doses, but not deadly? Or have I misunderstood what I read about acetaminophen and/or liver failure–i. e. is there a meaningful dosage range where it's uncomfortable without causing irreparable harm?
  - ghaff 10y ago
    It's arguable that Acetaminophen shouldn't be an OTC drug. And that, had its liver toxicity been fully understood, it probably wouldn't be. At the time, it apparently seemed a good alternative to aspirin which does cause some number of people to have stomach problems. (As well as having a particularly extensive repertoire of only somewhat understood physiological effects, for better or worse.)
    - nommm-nommm 10y ago
      And aspirin should never be used in children because its use in children is associated with Reye syndrome.
- smeyer 10y ago
  Are those really alternatives in this context? The linked study highlights >Low-dose aspirin, commonly defined as 75–325 mg daily, is used for primary and secondary prevention of cardiovascular events such as myocardial infarction (MI). The whole purpose of aspirin here is its blood-thinning properties and the effect this has on cardiovascular events. Do ibuprofen and acetaminophen have those same properties, or are you just calling them alternatives in terms of pain relief or other applications?
fauigerzigerk 10y ago
GI bleeding is just one issue though. The other perhaps more scary one is hermorrhagic stroke. I used to take low dose aspirin for 9 months a couple of years ago, but I stopped taking it after a blood vessel in my mouth suddenly bulged hugely and my (unrelated) nose bleeds became difficult to stop.

by aantix 10y ago

mtgx 10y ago

Does that mean the risks are very low? What about compared to aspirin alternatives such as ibuprofen or acetaminophen (in terms of how much damage they can each cause to the body, and which is safer)?

matt4077 10y ago
Acetaminophen in particular is somewhat scary. Just 2.5x the recommended maximal daily dose of 4g can lead to complete liver failure. With alcohol, other medication, or existing damage, much less could be enough.
- nostromo 10y ago
  A friend of mine swears that the reason acetaminophen is added to opioids (like hydrocodone) is so that you cant abuse the opioid without being poisoned by the acetaminophen. If true, it's alarming that the way to "prevent abuse" is to poison the patient.
  - snerbles 10y ago
    A more extreme example of this concept is denatured alcohol, which is ethanol adulterated to deter consumption. https://en.wikipedia.org/wiki/Denatured_alcohol https://en.wikipedia.org/wiki/Denatured_alcohol
  - jaggederest 10y ago
    That is completely correct. It also has synergistic effects as a pain reliever, but it's mainly there to deter abuse. Of course, addicts have found ways to extract the opiates from the adulterants, so it's not even effective.
    - joshgel 10y ago
      Source? Adding it for synergism makes sense and is what I was taught in medical school. I doubt they add it to deter abusers, but I could be wrong...
      - icantdrive55 10y ago
        I think what you were taught in med school was correct. I was told by an emergency room nurse that Vicodin is not killing patients/abusers; it the liver damage that results from the acetaminophen. A few years ago, I heard they were talking about removing it, but lost track of the outcome.
      - jaggederest 10y ago
        Just look at the simple fact that they were schedule 3 instead of schedule 2 until 2014, even though the base hydrocodone was schedule 2 without adulterants. Here's an interesting discussion from 2010, before they were rescheduled https://painmedicine.oxfordjournals.org/content/11/3/379.full.pdf https://painmedicine.oxfordjournals.org/content/11/3/379.ful...
  - maccard 10y ago
    You can buy codeine over the counter in the UK, in doses of 8mg with 500mg acetaminophen(paracetamol to us). If you get a prescription, they happily bump it to 30/500
  - matt4077 10y ago
    Isn't their anything that is uncomfortable in higher doses, but not deadly? Or have I misunderstood what I read about acetaminophen and/or liver failure–i. e. is there a meaningful dosage range where it's uncomfortable without causing irreparable harm?
- ghaff 10y ago
  It's arguable that Acetaminophen shouldn't be an OTC drug. And that, had its liver toxicity been fully understood, it probably wouldn't be. At the time, it apparently seemed a good alternative to aspirin which does cause some number of people to have stomach problems. (As well as having a particularly extensive repertoire of only somewhat understood physiological effects, for better or worse.)
  - nommm-nommm 10y ago
    And aspirin should never be used in children because its use in children is associated with Reye syndrome.
smeyer 10y ago
Are those really alternatives in this context? The linked study highlights >Low-dose aspirin, commonly defined as 75–325 mg daily, is used for primary and secondary prevention of cardiovascular events such as myocardial infarction (MI). The whole purpose of aspirin here is its blood-thinning properties and the effect this has on cardiovascular events. Do ibuprofen and acetaminophen have those same properties, or are you just calling them alternatives in terms of pain relief or other applications?

fauigerzigerk 10y ago

GI bleeding is just one issue though. The other perhaps more scary one is hermorrhagic stroke. I used to take low dose aspirin for 9 months a couple of years ago, but I stopped taking it after a blood vessel in my mouth suddenly bulged hugely and my (unrelated) nose bleeds became difficult to stop.