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Dr. Roach: Is OK to take a blood thinner and aspirin?

Keith Roach
To Your Health

Dear Dr. Roach: I take Xarelto, which is a blood thinner. My doctor says it is OK to also take a baby aspirin (81 milligrams). Do you agree?

D.C.

Dear D.C.: Rivaroxaban (Xarelto) is one of a new class of anticoagulants (medications that reduce the blood’s ability to clot). Like warfarin (Coumadin), these new drugs affect the clotting factors, produced mostly in the liver. These are needed to form a dense, stable clot. Xarelto is used for people with atrial fibrillation (with normal heart valves), and to prevent or treat deep vein blood clots and blood clots in the lungs.

Aspirin also is an anticoagulant, but it works on the platelets, the circulating blood cells that begin a blood clot. Aspirin is used for many conditions, especially to prevent a heart attack in people at moderate to high risk. Aspirin appears to be most effective when taken at night.

Since many people have reasons to take both these medicines, they often are prescribed together. All anticoagulants increase risk of bleeding. Combined use does increase bleeding risk beyond either separately. Although Xarelto has a similar bleeding risk to warfarin (lower in some studies), if bleeding occurs there is no generally accepted or safe way to stop it. Therefore, Xarelto, and especially the combination of Xarelto and aspirin, should be reserved for people in whom benefits clearly outweigh risks. I am sure your doctor has considered this before recommending the combination.

Dear Dr. Roach: I am a 63-year-old male who did have chickenpox as a child. I asked my doctor if I should get the shingles vaccination. He said no, for two reasons: It is not effective all the time, and it has been proven to cause shingles in many cases. I would like a second opinion. What would you recommend?

J.A.B.

Dear J.A.B.: It is true that the shingles vaccine is not effective all the time, but even some protection is better than none. However, I disagree with the statement that shingles vaccination causes shingles; the data are quite clear that it does not. I recommend the shingles vaccine for everyone over 60 who is able to take it (excluding those with severe allergy to gelatin or neomycin, weakened immune system due to illness or medication, or pregnancy. I don’t think there are too many women over 60 who are pregnant, though).

Email questions to ToYourGoodHealth@med.cornell.edu