Acetylsalicylic Acid (Aspirin)

General Information


Arthritis (see Arthritis)

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

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Dysmenorrhea (see Dysmenorrhea)

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Fever (see Fever)

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

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

  • Oral Aspirin (Initial Dose: 325 mg) is Recommended within 24-48 hrs After Stroke Onset (Class I, Level of Evidence A)
    • Administration of Aspirin (or Other Antiplatelet Agents) as an Adjunctive Therapy within 24 hrs of Intravenous rtPA is Not Recommended (Class III, Level of Evidence C)
    • Aspirin is Not Recommended as a Substitute for Other Acute Interventions in Stroke, Including Intravenous rtPA (Class III, Level of Evidence B)


  • Post-Operative Pain
  • Soft Tissue/Musculoskeletal Injury

Decrease the Risk of Malignancy

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

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

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  • Hepatic: predominantly


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
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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

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Salicylate Intoxication

Aspirin Desensitization Therapy




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


Periprocedural/Perioperative Management of Aspirin

Adverse Effects