Aspirin vs. Warfarin for Rheumatoid Arthritis and Atrial Fibrillation: Important Differences and Potential Risks.

Key takeaways

Warfarin (Coumadin) and aspirin are both used to manage blood-related conditions, but they work differently and have distinct uses. Aspirin is an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever. At low doses (81 mg), it acts as a blood thinner to help prevent heart attacks and strokes. Warfarin, on the other hand, is a prescription-only blood thinner that prevents and treats blood clots by blocking vitamin K, which is necessary for blood clotting. While aspirin can be used in people 12 years and older, warfarin is specifically used in adults to prevent blood clots for conditions like deep vein thrombosis and atrial fibrillation. Aspirin is available in various forms, including chewable tablets and suppositories, whereas warfarin is only available in tablet form. Warfarin also requires regular blood tests and has a higher risk of severe bleeding than aspirin.

Aspirin

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Warfarin

(Coumadin)

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Summary for Aspirin

Over-the-counter

Aspirin is an over-the-counter NSAID (nonsteroidal anti-inflammatory drug) that helps lessens inflammation. It's used to help lower fevers and relieve pain from minor injuries in people 12 years of age and older. A lower dose of aspirin is also commonly used for heart protection in certain adults who are at risk of having a heart attack or stroke. This medication most often comes as pills that are taken by mouth. Aspirin side effects include heartburn and stomach upset.

Indications for Aspirin

Pain relief from minor aches and pains, such as from headaches, muscle pain, toothache, menstrual cramps, and arthritis
Fever
Heart protection (lower the risk for heart attack or stroke) in certain adults - low-dose aspirin (81 mg per day) only

Pros and Cons for Aspirin

Pros

Doesn't raise risk for heart attacks like other NSAIDs
Can help protect the heart in certain adults with or at risk for heart disease when taken at low doses (81 mg per day)
Available as a chewable tablet for people who have trouble swallowing pills
Available over the counter in a lower-cost, generic form

Cons

Has risk for stomach ulcers and bleeding
Might worsen asthma symptoms
Not recommended for relieving pain or breaking fevers for children 18 years or younger with the flu because of risk of Reye's syndrome
Can't be used in children 12 years or younger

Common Side Effects for Aspirin

Stomach irritation (e.g., heartburn, stomach upset)

Warnings for Aspirin

Stomach irritation, stomach bleeding, and stomach ulcers
Kidney problems
Reye's syndrome in children
Harm to an unborn baby
Severe allergic reactions and skin reactions
Different aspirin strengths available

Summary for Warfarin

Prescription only

Warfarin (Coumadin) is a blood thinner (anticoagulant). It's used to prevent and treat blood clots in adults and children with conditions such as deep vein thrombosis (DVT) or pulmonary embolism (PE). Warfarin (Coumadin) is taken by mouth, typically once daily. Your provider will adjust the dose based on your international normalized ratio (INR). Taking too much warfarin (Coumadin) can lead to side effects like bruising and serious bleeding. If needed, your provider can give you an antidote to reverse the effects of warfarin (Coumadin).

Indications for Warfarin

Prevention and treatment blood clots in the veins
Prevention and treatment blood clots linked to atrial fibrillation (AFib) or heart valve replacement
Prevention of more blood clots and to lower risk of death after a heart attack

Pros and Cons for Warfarin

Pros

Each strength of tablet is a unique color, making it easy to tell them apart
Only needs to be taken once a day
Has an antidote available in case of an emergency
Available as a lower-cost generic

Cons

Only prevents new blood clots from forming or getting bigger; it doesn't work on existing blood clots
Requires regular blood draws to check INR levels
Interacts with foods and many commonly-prescribed medications
Not safe to take during pregnancy