- Discussion:
- for mild pain, inflamation, RA, and prevention of
stroke and
DVT;
- dosage:
- adult: w/ pain and fever: 325-650mg q4hr PO, PR;
-
rhuematoid arthritis: 3-12gm/day;
- check serum levels, therapeutic = 20-30 mg/dl;
- at high levels small increase may produce substantial increase in drug levels;
- note early signs of toxicity include: N,V, diaphoresis, flushed appearance, thirst, cephalgia, vertigo, diarrhea, rapid HR;
-
risk reduction in DVT:
- references:
-
Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery.
-
Aspirin prophylaxis and surveillance of pulmonary embolism and deep vein thrombosis in total hip arthroplasty.
-
Prophylaxis of deep-vein thrombosis after total hip replacement. Dextran and external pneumatic compression compared with 1.2 or 0.3 gram of aspirin daily.
-
High and low-dose aspirin prophylaxis against venous thromboembolic disease in total hip replacement.
- Collaborative overview of randomized trials of antiplatlet therapy: reduction in DVT and PE by antiplatlet prophylaxis among surgical and medical patients.
Antiplatlet Trialists Collaboration. Br. Med J. Vol 308. 1994. p 235-245.
-
Aspirin prophylaxis for thromboembolic disease after total joint arthroplasty.
- Cautions:
- gastric irritation may be minimized by taking tablets after food or with antacids or by using enteric coated preparations;
- stroke risk &
MI: platlet inhibiting activity: 325mg PO qd to 650mg PO bid,
- caution w/ PUD,
asthma, bleeding tendencies,
hyperuricemia (note: low doses of ASA - 1-2.5 gm/day);
- cause urate retention; high dose - 3-5 gm/day - are uricouric;
- may inhibit the effect of probenecid and sulfinpyrazone;
- Peds:
- use linked to Reye's syndrome; avoid use with viral illness in children;
- antipyretics: 10-15 mg/kg/dose q4hr upto 80 mg/kg/24hr;
- RA: 60-100 mg/kg/24hr divided q4-6hr (monitor serum levels to maintain between15-30 mg/dl);
- Action:
- aspirin irreversibly inhibits cyclooxygenase by acetylation at its active site;
- cyclo-oxygenase is the enzyme that converts arachidonic acid to precursors of both
Prostacyclin &
throboxane;
- effect on platelets is due to recovery of cyclooxygenase production in endothelial cells and due to fact
that platelets encounter orally given aspirin in presystemic circulation before it is deacetylated in liver;
- platelets cannot produce cyclooxygenase, &
Thromboxane synthesis recovers only as new platelets enter circulation.
- life of a platelet is about 8 to 11 days.
- cyclooxygenase is continuously produced in endothelial cells, and they will recover their ability to synthesize
prostacyclin within a few hours;
- doses of 50 mg qd are sufficient to inhibit thromboxane A(sub 2) production;
Review Article: Medical Progress: The Clinical Importance Of Acquired Abnormalities Of Platelet Function.
Effect of aspirin on heterotopic ossification after total hip arthroplasty in men who have osteoarthrosis.
Current Concepts Review. Prophylaxis of Venous Thromboembolic Disease Following Hip and Knee Surgery.
The use of aspirin to prevent heterotopic ossification after total hip arthroplasty. A preliminary report.
Acute lower limb ischemia: failure of anticoagulant treatment to improve one-month results of arterial thromboembolectomy. A prospective randomized multi-center study.
Immediate postoperative aspirin improves vein graft patency early and late after coronary artery bypass graft surgery. A placebo-controlled, randomized study.
Prevention of one-year vein-graft occlusion after aortocoronary-bypass surgery: a comparison of low-dose aspirin, low-dose aspirin plus dipyridamole, and oral anticoagulants. The CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands.
