Major
Established
설명
Concurrent use significantly increases bleeding risk through dual anticoagulant/antiplatelet mechanisms. Even low-dose aspirin (81 mg) meaningfully raises the risk of major hemorrhage.
기전
Aspirin irreversibly inhibits COX-1-mediated thromboxane A2 synthesis, impairing platelet aggregation; additionally, aspirin may displace warfarin from plasma proteins and inhibit hepatic CYP2C9, increasing warfarin exposure.
임상적 중요성
Meta-analyses demonstrate a 2- to 3-fold increase in major bleeding events when aspirin is added to warfarin therapy.
관리 방법
Avoid combination unless clearly indicated (e.g., mechanical heart valves). If combined, use the lowest effective aspirin dose, tighten INR monitoring, and add gastroprotection (PPI).