Acetylsalicylic Acid (Aspirin)

General Information


Arthritis (see Arthritis)

Coronary Artery Disease (CAD) (see Coronary Artery Disease)

Dysmenorrhea (see Dysmenorrhea)

Fever (see Fever)

Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident)

Recommendations (American Heart Association/American Stroke Association Acute Ischemic Stroke Guidelines, 2013) [MEDLINE]


Decrease the Risk of Malignancy

Transient Ischemic Attack (TIA) (see Transient Ischemic Attack)



Aspirin is a COX-1/COX-2 inhibitor (see Salicylates and Nonsteroidal Anti-Inflammatory Drug)



Oral (PO)

Dose Adjustment

Use in Pregnancy (see Pregnancy)

Use During Breast Feeding

Recommendations for Periprocedural/Perioperative Management of Aspirin (American College of Chest Physicians Clinical Practice Guideline for the Perioperative Management of Antithrombotic Therapy) (Chest, 2022) [MEDLINE]

Minor Procedures (Dental, Dermatologic, Ophthalmologic)

Elective Non-Cardiac Surgery

Elective Surgery

Coronary Artery Bypass Graft (CABG) Surgery (see Coronary Artery Bypass Graft)

Reversal of Aspirin Antiplatelet Effect

Clinical Efficacy


Adverse Effects

Cardiovascular Adverse Effects

Pseudo-Sepsis Syndrome (see Hypotension)

  • Epidemiology
    • Associated with Chronic Salicylate Ingestion
  • Diagnosis
    • Elevated Salicylate Level
  • Clinical
  • Treatment
    • As for salicylate intoxication

Endocrinologic Adverse Effects

Drug-Induced Hyporeninemic Hypoaldosteronism (see Hypoaldosteronism)

  • Physiology
    • Class Effect, Common to All NSAID’s
    • Dose-Dependent COX-inhibition -> decreased renal prostaglandin synthesis -> results in drug-induced hyporeninemic hypoaldosteronism
  • Clinical

Gastrointestinal Adverse Effects

Peptic Ulcer Disease (PUD) (see Peptic Ulcer Disease)

  • Physiology
    • Class Effect, Common to All NSAID’s

Hematologic Adverse Effects

Increased Risk of Hemolysis in the Setting of Glucose-6 Phosphate Dehydrogenase Deficiency (see Glucose-6-Phosphate Dehydrogenase Deficiency and Hemolytic Anemia)

  • Epidemiology
    • Doubtful Risk
    • Possible Risk: at doses >3 g/day
    • Doubtful Risk: at doses <3 g/day

Pulmonary Adverse Effects

Aspirin-Exacerbated Respiratory Disease (AERD) (see Aspirin-Exacerbated Respiratory Disease)

  • Epidemiology
    • Class Effect, Common to All NSAID’s with COX-1 Inhibitory Properties
    • Up to 5% of asthmatics are sensitive to aspirin
  • Physiology: unknown -> may involve COX inhibition resulting in decreased production of bronchodilator PGE2 and increased production of leukotrienes
    • Not dose-related -> can occur with even small doses of aspirin
  • Clinical
    • Samter’s Syndrome: aspirin sensitivity + asthma + nasal polyps
    • Commonly associated are rash and GI side effects
    • Aspirin may cause fatal bronchospasm

Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia)

  • Associated Agents
    • Acetylsalicylic Acid (Aspirin) (see Acetylsalicylic Acid)
    • Diclofenac (Aclonac, Cataflam, Voltaren) (see Diclofenac)
    • Diflunisal (Dolobid) (see Diflunisal)
    • Fenbufen
    • Fenoprofen (see Fenoprofen): case reports
    • Ibuprofen (Advil, Brufen, Motrin, Nurofen) (see Ibuprofen): case reports
    • Indomethacin (Indocin) (see Indomethacin)
    • Loxoprofen
    • Meloxicam (Mobic) (see Meloxicam)
    • Naproxen (Naprosyn, Aleve) (see Naproxen): appears to be more frequent with naproxen than other NSAID’s
    • Nimesulide
    • Phenylbutazone (XXX) (see Phenylbutazone)
    • Piroxicam (Feldene) (see Piroxicam)
    • Pranoprofen
    • *Sulindac (Clinoril) (see Sulindac): case reports
    • Tenidap
    • Tiaprofenic Acid
    • Tolfenamic Acid
  • Diagnosis
    • Open Lung Biopsy (see Open Lung Biopsy): poorly defined granulomas with infiltrating eosinophils
  • Clinical

Renal Adverse Effects

Acute Interstitial Nephritis (see Acute Interstitial Nephritis)

  • Physiology
    • Class Effect, Common to All NSAID’s

Acute Kidney Injury (AKI) (see Acute Kidney Injury)

  • Epidemiology
    • XXXX

Hyperkalemia(see Hyperkalemia)

  • Mechanism
    • Due to Drug-Induced Hyporeninemic Hypoaldosteronism

Increased Renal Sodium Reabsorption with Peripheral Edema

  • Risk Factors
  • Physiology
    • Decreased PGE2, Resulting in Increased Renal Sodium Reabsorption
    • Class Effect, Common to All NSAID’s
    • Dose-Dependent Effect
  • Clinical

Type 4 Renal Tubular Acidosis (RTA) (see Type 4 Renal Tubular Acidosis)

Other Adverse Effects

  • xxxx

Salicylate Intoxication

Aspirin Desensitization Therapy




Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident)


Periprocedural/Perioperative Management of Aspirin

Adverse Effects