CV Aspirin

Question 1

What is aspirin used for?(1)

Answer 1

For treatment of acute coronary syndrome and acute ischaemic stroke, where rapid inhibition of platelet aggregation can prevent or limit arterial thrombosis and reduce subsequent mortality.

Question 2

What is aspirin used for?(2)

Answer 2

For long-term secondary prevention of thrombotic arterial events in patients with cardiovascular, cerebrovascular and peripheral arterial disease

Question 3

What is aspirin used for?(3)

Answer 3

To reduce the risk of intracardiac thrombus and embolic stroke in atrial fibrillation where warfarin and novel oral anticoagulants are contraindicated.

Question 4

What is aspirin used for?(4)

Answer 4

To control mild-to-moderate pain and fever (see Non-steroidal anti-inflammatory drugs, although other drugs are usually preferred, particularly in patients with inflammatory conditions).

Question 5

Mechanism of Action

Answer 5

1. Inhibits cyclooxygenase (COX) to reduce thromboxane
2. Hence reducing platelet agg
3. Antiplatelet effects of aspirin occurs at low dose and lasts for life time of a platelet

Question 6

Adverse effects?

Answer 6

The most common adverse effect of aspirin is gastrointestinal irritation. More serious effects include gastrointestinal ulceration and haemorrhage and hypersensitivity reactions including bronchospasm. In regular high-dose therapy aspirin causes tinnitus. Aspirin is life-threatening in overdose. Features include hyperventilation, hearing changes, metabolic acidosis and confusion, followed by convulsions, cardiovascular collapse and respiratory arrest.

Question 7

Warnings?

Answer 7

1. Should not be given to children under 16
2. Or people with aspirin sensitivity
3. Or given in 3rd trimester
4. Or peptic ulcer or gout

Question 8

Important interactions?

Answer 8

Aspirin acts synergistically with other antiplatelet agents, which although therapeutically beneficial can lead to increased risk of bleeding. Thus, although it may be given with antiplatelet drugs (e.g. clopidogrel, dipyridamole) and anticoagulants (e.g. heparin, warfarin) in some situations (e.g. acute coronary syndrome), caution is required.

Question 9

Practical prescribing?

Answer 9

1. In ACS: Loading dose of 300mg the regular dose of 75mg

2. Omeprazole should be considered