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JAMA Patient Page
April 17, 2013

Aspirin Therapy

JAMA. 2013;309(15):1645. doi:10.1001/jama.2013.3866

Aspirin, also known as acetylsalicylic acid, has been used for many years to relieve pain, reduce fevers, and improve inflammation. Aspirin is one of the nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, meloxicam, and ketorolac. Another important effect of aspirin is its ability to make the blood less likely to clot. Aspirin does this by acting on the blood's platelets and interrupting the way the platelets work in the body's clotting system.

ASPIRIN RISKS

  • Before you begin to take aspirin to treat or prevent cardiovascular disease or other chronic medical conditions, discuss the risks and benefits with your doctor.

  • Persons who have gastrointestinal bleeding or are taking other anticoagulant medications should not take aspirin unless instructed by their doctor because of the risks of bleeding associated with aspirin.

  • Children should not be given aspirin if they have a viral or flu-like illness because of the risk of developing Reye syndrome.

  • Women who are pregnant should not take aspirin unless specifically instructed by their doctor.

  • Some over-the-counter vitamins, supplements, and herbal preparations can cause decreased blood-clotting ability. Always read labels and understand the ingredients, and use aspirin with caution if you take these supplements.

  • Certain other NSAIDs such as naproxen can interfere with the blood-thinning activities of aspirin. If you take other NSAIDs along with aspirin, discuss with your doctor whether your other NSAID may interfere with the benefits of your aspirin treatment.

ASPIRIN AND HEART DISEASE

  • Aspirin is part of emergency cardiac care and treatment protocols for suspected myocardial infarction (MI, or heart attack).

  • If you have already had an MI, you may be advised to take aspirin to reduce your chances of having another MI.

  • Some individuals at high risk of having a first MI may be prescribed aspirin as part of their MI prevention plan.

  • Persons who have had cardiac stents placed are often prescribed aspirin along with other anticoagulant medications. It is crucial to understand your doctor's instructions about taking these medications.

  • Do not begin taking aspirin on your own. Aspirin has risks that must be considered on an individual basis and discussed with your doctor.

  • Call 911 in the United States and Canada to activate the emergency response system if you think you are having a heart attack. Do not take aspirin unless instructed to do so by the emergency care personnel or the 911 operator.

ASPIRIN AND STROKE

  • Aspirin may be used to treat cerebrovascular (blood vessels in the brain) disease and to prevent stroke.

  • Individuals who have had a stroke may take aspirin to prevent having another stroke.

  • Activate the emergency response system if you think you are having a stroke. Do not take aspirin if you think you are having a stroke. About 15% of strokes are caused by bleeding in the brain and can be made worse by taking aspirin.

ASPIRIN AND PERIPHERAL ARTERIAL DISEASE

Aspirin may be prescribed to persons who have peripheral arterial disease (PAD). Keeping the blood less “sticky” helps prevent clots from forming in small arteries. Since people with PAD have an increased risk of heart attack and stroke, aspirin therapy can help prevent cardiovascular events in patients with PAD, although medications other than aspirin that interrupt platelet function are more effective.

Sources: American Heart Association; National Heart, Lung, and Blood Institute; Mayo Clinic; American Academy of Pediatrics; American Society of Regional Anesthesia

ASPIRIN AND SURGERY

  • Make sure you tell your surgeon and your anesthesiologist if you are taking aspirin.

  • For many elective procedures, you may be asked to stop taking aspirin for a week before and after the operation.

  • Spinal, epidural, and other regional anesthetic techniques may be safely performed if you are taking aspirin. However, other anticoagulant medications have different, longer-lasting effects than aspirin and may influence surgical procedures and the anesthetics used.

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page index on JAMA 's website at www.jama.com. Many are available in English and Spanish. A Patient Page on aspirin sensitivity was published in the December 22, 2004, issue and one on peripheral artery disease was published in the January 7, 2009, issue.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Topic: MEDICINES

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