Aspirin

Oral
Rectal
Class
Nonsteroidal anti-inflammatory drugs
Subclass
Salicylates
Substance name
Aspirin, acetylsalicylic acid, ASA
Brand names
Bayer Aspirin®, Bufferin®, St. Joseph Aspirin®, Halfprin®, Easprin®, Ecotrin®
Common formulations
Enteric-coated tablet
Dosage and administration
Adults patients
Symptomatic relief
Fever
•
Maintenance: 325-650 mg PO q4-6h PRN
•
Maximum: 4,000 mg per day
Headache
•
Maintenance: 500-1,000 mg PO q4-6h PRN
•
Maximum: 4,000 mg per day
Pain
•
Maintenance: 325-650 mg PO q4-6h PRN
•
Maximum: 4,000 mg per day
Treatment
AIS
•
160-325 mg PO daily
Administered within 24-48 hours after onset.
Angina pectoris
•
Loading: 162-325 mg PO once
•
Maintenance: 81-325 mg PO daily
NSTEMI
•
Loading: 162-325 mg PO once
•
Maintenance: 81-325 mg PO daily
STEMI
•
Loading: 162-325 mg PO once
•
Maintenance: 81 mg PO daily
TIA
•
160-325 mg PO daily
Administered within 24-48 hours after onset.
Acute pericarditis • Off-label
•
750-1,000 mg PO TID for 1-2 weeks
Decreased dose by 250-500 mg every 1-2 weeks after initial treatment.
Giant cell arteritis • Off-label
•
75-300 mg PO daily
Migraine attacks • Off-label
•
1,000 mg PO once
Recurrent pericarditis • Off-label
•
500-1,000 mg PO q6-8h
Decreased dose by 250-500 mg every 1-2 weeks after initial treatment.
Prevention
Cardiovascular events in patients with coronary artery disease
•
75-100 mg PO daily
Cardiovascular events, after CABG surgery
•
75-100 mg PO daily
Cardiovascular events, during carotid endarterectomy
•
75-325 mg PO daily
Cardiovascular events in patients with PAD • Off-label
•
75-325 mg PO daily
Myocardial infarction in patients with carotid artery stenosis • Off-label
•
75-325 mg PO daily
Preeclampsia in pregnant females • Off-label
•
81 mg PO daily started at 12 weeks of gestation
Preeclampsia in pregnant females with diabetes mellitus • Off-label
•
100-150 mg PO daily started at 12-16 weeks of gestation
Prosthetic valve thrombosis • Bridging • Off-label
•
75-100 mg PO daily
Thrombosis in patients with antiphospholipid syndrome • Asymptomatic • Off-label
•
75-100 mg PO daily
Thrombosis in patients with FMD • Off-label
•
75-100 mg PO daily
Thrombosis in patients with polycythemia vera • Off-label
•
75-100 mg PO daily
Thrombosis in patients with renal artery aneurysm • Off-label
•
81 mg PO daily
Secondary prevention
AIS
•
75-100 mg PO daily
Cardiovascular events, after PCI
•
75-100 mg PO daily
Myocardial infarction
•
75-100 mg PO daily
TIA
•
75-100 mg PO daily
Other off-label uses
•
Treatment of chronic limb-threatening ischemia
•
Treatment of niacin-induced flushing
•
Treatment of primary angiitis of the CNS
•
Prevention of cancer-associated thrombosis in patients with multiple myeloma (receiving systemic therapy)
•
Prevention of thrombosis in patients with essential thrombocythemia
•
Prevention of thrombosis in patients with AL amyloidosis
•
Secondary prevention of cardiovascular events in patients with hypertension
Indications for use
Labeled indications
Adults
•
Symptomatic relief of fever
•
Symptomatic relief of headache
•
Symptomatic relief of pain
•
Treatment of STEMI
•
Treatment of AIS
•
Treatment of angina pectoris
•
Treatment of NSTEMI
•
Treatment of TIA
•
Prevention of cardiovascular events in patients with coronary artery disease
•
Prevention of cardiovascular events, after CABG surgery
•
Prevention of cardiovascular events, in patients undergoing carotid endarterectomy
•
Secondary prevention of AIS
•
Secondary prevention of cardiovascular events, after PCI
•
Secondary prevention of myocardial infarction
•
Secondary prevention of TIA
Off-label indications
Adults
•
Treatment of acute pericarditis
•
Treatment of chronic limb-threatening ischemia
•
Treatment of giant cell arteritis
•
Treatment of migraine attacks
•
Treatment of niacin-induced flushing
•
Treatment of primary angiitis of the CNS
•
Treatment of recurrent pericarditis
•
Prevention of cancer-associated thrombosis in patients with multiple myeloma (receiving systemic therapy)
•
Prevention of cardiovascular events in patients with PAD
•
Prevention of CRC (in patients 50-69 years)
•
Prevention of myocardial infarction in patients with carotid artery stenosis
•
Prevention of preeclampsia in pregnant females
•
Prevention of preeclampsia in pregnant females with diabetes mellitus
•
Prevention of prosthetic valve thrombosis (bridging)
•
Prevention of thrombosis in patients with antiphospholipid syndrome (asymptomatic)
•
Prevention of thrombosis in patients with essential thrombocythemia
•
Prevention of thrombosis in patients with FMD
•
Prevention of thrombosis in patients with AL amyloidosis
•
Prevention of thrombosis in patients with polycythemia vera
•
Prevention of thrombosis in patients with renal artery aneurysm
•
Secondary prevention of cardiovascular events in patients with hypertension
Safety risks
Contraindications
Hypersensitivity to aspirin or its components or other salicylates or NSAIDs
Active peptic ulcer disease
Asthma, rhinitis, or nasal polyps
Post-tonsillectomy
•
Do not use aspirin for at least 7 days after tonsillectomy or oral surgery.
Viral infections in children and adolescents
•
Do not use aspirin for viral infections in pediatric and adolescent patients.
Warnings and precautions
Bleeding
•
Use caution in patients taking other NSAIDs, antiplatelets, or anticoagulants.
•
Use caution in patients with excessive alcohol use (≥ 3 drinks per day).
•
Use caution in patients with inherited or acquired bleeding disorders.
•
Use caution in patients taking other NSAIDs, antiplatelets, or anticoagulants.
•
Use caution in patients with excessive alcohol use (≥ 3 drinks per day).
•
Use caution in patients with inherited or acquired bleeding disorders.
Specific populations
Renal impairment
GFR ≥ 10 mL/min
•
Use acceptable. No dose adjustment required.
GFR < 10 mL/min
•
Avoid use.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
No dose adjustment required. Administer the dose after dialysis session.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use acceptable. No dose adjustment required.
Child-Pugh C (severe)
•
Avoid use.
Pregnancy and breastfeeding
Pregnancy
< 12 weeks of gestation • Australia Category: C
•
Avoid use.
≥ 12 weeks of gestation • Australia Category: C
•
Use only if clearly needed.
Breastfeeding
Do not use during breastfeeding.
•
Consider alternative agents that may be safer.
Unknown drug levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
Adverse reactions
Very common > 10%
•
Gastrointestinal bleeding, dyspepsia
Common 1-10%
•
Abdominal discomfort, nausea, vomiting
Uncommon < 1%
•
Angioedema, bronchospasm, peptic ulcer disease, hematemesis, melena, skin rash
Unknown frequency
•
Agitation, cerebral edema, coma, DRESS syndrome, ↓ blood glucose, ↓ serum potassium, dehydration, diaphoresis, gastritis, hepatitis, ICH, ↑ blood glucose, ↑ liver enzymes, ↑ serum sodium, ↑ serum uric acid, ↑ urine protein, interstitial nephritis, lethargy, medication overuse headache, metabolic acidosis, renal failure, renal papillary necrosis, abdominal pain, confusion, dizziness, headache, hearing loss, hyperventilation, loss of appetite, pruritus, seizure, tinnitus, respiratory alkalosis, Reye's syndrome
Interactions
Drug(s)
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