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?
Allergy to aspirin is a rare condition in which a patient
can develop swelling of tissues, spasm of the airways (bronchospasm) that causes
difficulty breathing, and even anaphylaxis, a life-threatening
condition. Clearly, patients
with a history of allergy to aspirin should not take aspirin. Since aspirin is
related chemically to the other NSAIDs, patients who are allergic to the other
NSAIDs, such as ibuprofen (Motrin) and naproxen (Aleve), also should not take
aspirin.
What interactions might aspirin have with other medications?
Aspirin may interact with other medications and cause undesirable side
effects. For example:
Aspirin, when taken together with an anti-coagulant such as warfarin (Coumadin) or
enoxaparin (Lovenox), can greatly impair the body's ability to form blood clots, resulting in
excessive bleeding spontaneously, from ulcers, or related to a procedure.
Therefore, patients on such combinations must be closely monitored by a doctor.
Aspirin can raise levels of
uric acid in the blood
and may need to be avoided in patients with increased uric acid levels or
gout.
Aspirin can increase the effect of medications used for
lowering blood sugar levels in patients with diabetes, resulting in abnormally
low blood sugar levels (hypoglycemia). Blood sugar levels may need to be more closely monitored.
Certain NSAIDs, particularly ibuprofen (Motrin, Advil), if
taken just before aspirin or in multiples doses each day, can reduce the
anti-platelet effects of aspirin and theoretically render aspirin less effective
in preventing heart attacks and ischemic strokes. The ibuprofen molecule is believed to adhere
to the COX-1 enzyme, thus keeping aspirin from reaching the enzyme.
What can be done to reduce the risk of ulcers from long-term aspirin use?
Long-term low dose aspirin use is generally safe. An
estimated 10% of the patients taking long-term aspirin (75-325 mg/day) can
develop ulcers. Most of these ulcers were asymptomatic (no abdominal pain or
bleeding). Patients at a higher risk of developing ulcers with low dose aspirin
included elderly patients age 70 years and older, and patients with H. pylori
stomach infection (see below). The risk of significant ulcer bleeding from aspirin is low
(approximately 1%). One can reduce the risk of bleeding by adding a daily dose
of a proton pump inhibitor for example,
pantoprazole (Protonix),
esomeprazole (Nexium),
rabeprazole (Aciphex), or
lansoprazole (Prevacid,
Prevacid SoluTab), and omeprazole
(Prilosec, Zegerid).
Chronic H. Pylori infection of the stomach is found in up to 30% of adults in
the U.S. Patients with gastritis due to H. pylori will have a higher risk of
bleeding when given aspirin or NSAIDs long-term. Eradication of H. pylori from
the stomach with antibiotics can reduce the risk of bleeding from chronic
aspirin use.
Buffered and coated aspirin do not seem to have any beneficial effect in
preventing ulcers and ulcer bleeding.
What are the limitations of aspirin treatment?
Aspirin is not always effective in preventing strokes and heart attacks.
Examples of possible causes of aspirin failure include:
Poor patient compliance (not taking the medication regularly)
Inadequate dosing
Concurrent intake of other NSAIDs such as ibuprofen that interferes with
the anti-platelet action of aspirin
Activation of platelet aggregation via pathways not blocked by aspirin
Aspirin resistance
What is aspirin resistance?
Aspirin resistance can be defined as the lack of
antiplatelet effect despite therapeutic doses of aspirin (75mg-150mg/day for at least five days). This lack
of anti-platelet response to aspirin increases the risk of developing heart
attacks, strokes, and related deaths. Aspirin resistance is different from other
causes of aspirin failure (see above), such as patient non-compliance or drug
interference from concomitant use of ibuprofen.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is cause by an inherited abnormal hemoglobin. Symptoms may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury. Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Kawasaki disease is a rare children's disease characterized by a fever that lasts more than five days and at least four of the following five symptoms are present: rash, swollen neck lymph gland, red tongue, swelling or redness of the hands or feet, and conjunctivitis. High doses of aspirin are used to treat Kawasaki disease. Cortisone and antiinflammatory drugs may also be used during treatment.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Vascular disease includes any condition that affects your circulatory system. Vascular disease ranges from diseases of your arteries, veins and lymph vessels to blood disorders that affect circulation.
Heart disease, particularly coronary artery disease is the leading cause of heart attacks. Women are more likely to die from a heart attack than men. High cholesterol, high blood pressure, obesity, and high triglycerides are contributors to heart disease. Some of the common symptoms of a heart attack in women include chest pain, shortness of breath, nausea, feeling faint or woozy, and more. Heart disease can be prevented by lifestyle changes and controlling high blood pressure, cholesterol, weight, and diseases such as diabetes.
Reye's syndrome (RS, or Reye syndrome) is a sudden, sometimes fatal, disease of the brain with degeneration of the liver. Reye syndrome occurs in children and comes after the chickenpox or an influenza-type illness, is also associated with taking medications containing aspirin. Symptoms include vomiting, listlessness, irritability or combativeness, confusion, delirium, delusions, convulsions, and loss of consciousness. Treatment depends on early diagnosis and focuses on protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
Eosinophilic fasciitis is a skin disease that causes thickening and inflammation of the skin and fascia. Symptoms include redness, warmth, and hardening of the skin, as well as occasional tissue and joint pain. Treatment for eosinophilic fasciitis aims to eliminate inflammation through the use of aspirin, NSAIDs, and cortisone. Aggressive forms of eosinophilic fasciitis may require the use of immune suppression medications.
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay inlcudes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack.
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble seeing with one or both eyes, dizziness, loss of balance, and more. Stroke prevention and reatable risk factors for stroke include lowering high blood pressure, quit smoking, heart disease, diabetes control and prevention.
Guinea worm disease (GWD or dracunculiasis) is an infection caused by the parasite Dracunculus medinensis. After a person drinks water contaminated by water fleas that harbor Guinea worm larvae, the larvae grow into adult worms (2-3 feet) in the small intestine and then migrate and emerge from the skin. Symptoms and signs include fever, swelling, and pain near the blister on the skin where the worm will emerge. As there is no medication to treat GWD and no vaccine to prevent infection, treatment focuses on minimizing pain and swelling (with the use of ibuprofen or aspirin) as the worms are slowly pulled from the wound over the course of a few days to a few months.
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