Aspirin and Antiplatelet Medications (cont.)

Who should not be taking aspirin?

Patients who should not be taking aspirin include:

  • Patients with an allergy to aspirin or other NSAIDs;

  • Patients with active ulcers, especially those with bleeding ulcers, because of the side effects of ulcers and bleeding with aspirin. Among patients who must take aspirin but have had intestinal ulcers, the lowest does of aspirin should be used only after the ulcers heal. It should also be taken together with a proton pump inhibitor such as pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), or lansoprazole (Prevacid, Prevacid SoluTab) to decrease the risk of recurrent ulcers;

  • Pregnant women and nursing mothers (since aspirin is excreted into breast milk);

  • Teenagers and children with the flu or chickenpox because of the associated risk of Reye's syndrome, a serious disease of the liver and nervous system that can lead to coma and death;

  • Patients with advanced kidney or liver diseases since aspirin may cause toxicity to the kidney and liver;

  • Patients at risk for developing intracranial hemorrhage;

  • Some patients undergoing elective surgery or procedures (Patients taking aspirin should discuss with their doctors whether to stop aspirin for several days to up to two weeks before surgery and procedures to avoid excess bleeding.)

What are the side effects of aspirin?

Serious side effects of aspirin and other NSAIDs occur infrequently. However, they may occur and generally tend to be more frequent with higher doses. Therefore, it is advisable to use the lowest effective dose to minimize side effects.

The most common side effects of aspirin involve the gastrointestinal system.

Aspirin can cause:

  • ulcers of the stomach and duodenum (first part of the small intestine),

  • abdominal pain,

  • nausea,

  • gastritis (inflammation of the stomach), and

  • even serious gastrointestinal bleeding from ulcers.

Occasionally, aspirin may be toxic to the liver.

Sometimes, ulcers of the stomach and bleeding occur without any abdominal pain, and the only signs of bleeding may be:

Another serious but rare side effect of aspirin is intracranial hemorrhage (bleeding into the tissues of the brain), similar to a hemorrhagic stroke.

Aspirin can impair function of the kidney and liver, especially in patients who already have liver and kidney disease. Other side effects of aspirin include easy bruising, vertigo, ringing in the ears (tinnitus), and lightheadedness.

Serious side effects of aspirin, such as bleeding ulcers or intracranial bleeding, are rare (less than 1% of patients) among patients taking moderate doses of aspirin (for example, 325 mg/d). Serious side effects of aspirin should be even lower with low doses such as 75-160 mg/d. However, the actual incidence of serious bleeding with long-term use of low dose aspirin has not been clearly determined.

What is aspirin allergy?



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