Name: Malak Ahmed Rabea
ID: 200026759
Indications of Aspirin
INTRODUCTION
Aspirin (acetylsalicylic acid, ASA) is the first
discovered NSAID and remains a
cornerstone analgesic, antipyretic and anti-
inflammatory drug. It is a salicylate
derivative long used in conditions such as
headache, muscle/joint pain, arthritis, and
fever In addition, low-dose ASA is used to
reduce thrombotic cardiovascular risk (heart Figure: Pure acetylsalicylic acid (aspirin)
crystals (each ~5 mm).
attack and stroke) by inhibiting platelet
aggregation. Because many patients in rehabilitation take aspirin for pain or
heart disease, physical therapists must understand its pharmacology, uses,
and risks
Mechanism of Action
Aspirin irreversibly inactivates cyclooxygenase (COX) enzymes by
acetylating a serine residue in the active site This “suicide inhibition” blocks
the conversion of arachidonic acid to prostaglandin H₂ and downstream
prostaglandins (pain, fever, and inflammation mediators) as well as
thromboxane A₂ (a platelet activator). Unlike other NSAIDs (e.g. ibuprofen,
diclofenac) which reversibly inhibit COX, aspirin permanently disables COX-
1 (and partially COX-2) for the life of the enzyme. As a result, aspirin reduces
inflammatory prostaglandins (by COX-2 inhibition) and suppresses COX-1–
derived thromboxane A₂ in platelets. Even very low doses of aspirin (e.g. 30–
100 mg) markedly inhibit platelet COX-1, providing antithrombotic benefit.
In summary, aspirin’s analgesic and anti-inflammatory effects stem from
less prostaglandin synthesis, while its antiplatelet effect comes from
irreversibly blocking TXA₂ formation. (Figure: the COX pathway with aspirin
acetylation is detailed in pharmacology texts.)
Clinical Indications and Therapeutic Uses
1:- Pain and Inflammation: Aspirin is indicated for mild to moderate pain
and inflammatory conditions. It is effective for headaches, toothache,
menstrual cramps, muscle sprains/strains, and musculoskeletal pain from
arthritis. In rheumatic diseases (e.g. osteoarthritis, rheumatoid arthritis),
high doses of aspirin (3–4 g per day) can reduce joint inflammation and pain.
Aspirin also reduces fever (antipyresis) by resetting the hypothalamic
thermostat via prostaglandin inhibition. For acute pain (e.g. post-surgical or
injury), typical analgesic dosing is 300–1000 mg by mouth every 4–6 hours,
not exceeding ~3–4 g daily. Such dosing relieves pain and swelling from
common conditions (headache, cold/flu symptoms, and minor injuries).
Note that aspirin’s analgesic effect is primarily peripheral via PG
suppression, though central pathways may contribute.
2:- Cardiovascular Uses: Low-dose aspirin (typically 75–100 mg once daily)
is widely used in medical practice for its antiplatelet effect. In patients with
acute coronary syndromes or ischemic stroke, immediate aspirin
administration can prevent clot extension. Long-term, daily “baby aspirin”
reduces the risk of recurrent myocardial infarction, stroke, and other
atherothrombotic events. Current guidelines use aspirin carefully (often
favoring secondary prevention), but its role in reducing platelet aggregation
is well established.
3:-Prevention of deep vein thrombosis(DVT):aspirin may be used in patients
who are at risk but can’t tolerate anticoagulants
Also used post-surgery in orthopedic patients as a preventive measure
4:-Prevention of preeclampsia:low dose aspirin is recommended in pregnant
women with high risk of preeclampsia usually starting in second trimester
5:-Migraine treatment: sometimes combined with caffeine for acute relief of
attacks
6:-Minor Surgical or Dental Pain: Short-term use after tooth extraction or
minor outpatient procedures for pain control.
7:-Post-Myocardial Infarction Pericarditis :- Aspirin is preferred over NSAIDs
for treating inflammation of the pericardium following a heart
attack.
8:-Kawasaki Disease:
- Used in pediatric patients with this inflammatory syndrome to reduce fever
and prevent coronary
artery complications.8. Colorectal Cancer Prevention:
- Long-term use of low-dose aspirin may reduce the risk of colorectal cancer,
especially in patients with genetic predispositions like Lynch syndrome.
9:-Stroke Prevention in High-Risk Patients:
- Particularly in patients with hypertension, diabetes mellitus, dyslipidemia, or
history of transient ischemic attacks.
Other Uses: Aspirin is sometimes used in m dysmenorrhea (menstrual
cramp relief).
Dosage Forms and Administration
Aspirin is available in multiple formulations and routes:
• Oral tablets: Standard aspirin tablets (e.g. 81 mg, 325 mg, 500 mg) are
most common. These come in plain, buffered, or enteric-coated
forms. Enteric-coated or buffered tablets may reduce gastric irritation.
Extended-release (sustained-release) tablets are also made for
arthritis dosing. Chewable aspirin (often 81–162 mg) is marketed for
those who have difficulty swallowing pills or for rapid action (e.g.
during chest pain). Dosage: For pain/inflammation, adults typically
take 325–650 mg every 4–6 hours (max ~3–4 g/day). For antiplatelet
effect, low-dose (75–100 mg daily) is used.
• Suppositories (rectal): Aspirin suppositories (e.g. 300–600 mg) are
used if oral intake is not feasible (vomiting, unconscious). Absorption
is slower and variable, so suppositories are generally reserved for fever
reduction or analgesia when needed. (One source notes ~20–60%
absorption if retained 2–4 h, improving with longer retention.) Tablets
should not be crushed and given rectally (would irritate the mucosa).
• Parenteral/IV: In some countries, a soluble form of aspirin (lysine-
acetylsalicylate) is available for intravenous infusion. This is mainly
used in hospitals for acute headache or stroke when rapid action is
desired. Such IV aspirin provides prompt antipyresis or analgesia.
Long-Term Benefits and Limitations
Benefits: In chronic use, aspirin provides sustained anti-inflammatory and
analgesic effects in conditions like arthritis. It is inexpensive and well-
studied, with over a century of use. Importantly, long-term low-dose aspirin
confers cardiovascular benefit in appropriate patients: it reduces secondary
MI or stroke risk by keeping platelets less sticky. For example, daily 75–100
mg aspirin has been shown to lower the incidence of recurrent clotting
events in heart disease patients. There is also evidence (from non-PT
studies) that aspirin might synergize with opioids to improve pain control.
Limitations: The major limitation to long-term aspirin therapy is toxicity.
Gastrointestinal toxicity is dose-dependent: chronic high doses can erode
gastric mucosa and cause ulcers, bleeding and gastritis. Indeed, aspirin
irreversibly inhibits COX-1, reducing protective prostaglandins in the
stomach lining, which leads to mucosal injury. Thus, long-term users often
develop gastritis or peptic ulcers. The risk of serious GI bleeding increases
with dose and duration. Other long-term risks include renal impairment
(analgesic nephropathy) and tinnitus (ringing in the ears) from salicylate
accumulaion. Aspirin can also induce acid–base disturbances (respiratory
alkalosis and metabolic acidosis) in overdose or chronic high-dose use (not
detailed here).
Furthermore, because aspirin permanently blocks platelets, chronic use
raises bleeding risk. Even low-dose aspirin increases the chance of
hemorrhagic stroke or gastrointestinal hemorrhage. For these reasons, in
long-term pain management, many clinicians prefer other NSAIDs (or
adjunctive therapies) if patients cannot tolerate aspirin’s GI effects. Finally,
aspirin is contraindicated in children with viral illness due to Reye’s
syndrome (see next section), so pediatric PT patients must avoid it.
Side Effects and Contraindications
Common side effects: The most frequent adverse effects are
gastrointestinal: stomach irritation, heartburn, nausea or indigestion.
Aspirin can cause mild gastritis and gastric discomfort, especially at higher
doses. Other common effects include ringing in the ears (tinnitus), dizziness
or headache at high doses. Aspirin also impairs platelet function, so
bruising or easy bleeding (e.g. nosebleeds, bleeding gums) can occur.
Serious adverse effects: Serious complications include GI bleeding and
ulcer perforation (potentially life-threatening). Prolonged use can also
trigger kidney injury (including acute renal failure) and liver toxicity. Aspirin
can worsen asthma in sensitive individuals; aspirin-intolerant asthma
(Aspirin-Exacerbated Respiratory Disease) causes bronchospasm,
wheezing or nasal polyps in a subset of asthmatics. A very rare but serious
side effect of daily aspirin is hemorrhagic (bleeding) stroke. High-dose
overdose leads to salicylate poisoning (tinnitus, hyperventilation, metabolic
acidosis, and neurological changes).
Contraindications: Aspirin must not be used in patients with known
hypersensitivity to salicylates or other NSAIDs (history of allergy, hives, or
asthma provoked by aspirin). It is contraindicated in active peptic ulcer
disease or any significant bleeding disorder, because it will worsen
bleeding. Patients with hemophilia or thrombocytopenia should avoid
aspirin. It should not be used concomitantly with other NSAIDs (to prevent
additive GI or renal toxicity). Aspirin is strictly contraindicated in children or
teenagers with viral infections (e.g. flu, chickenpox) due to the risk of Reye’s
syndrome, a rare but often fatal encephalopathy and liver failure. In
pregnancy, aspirin is generally avoided, especially in the third trimester (risk
of fetal blood vessel effects and bleeding), unless a low-dose regimen is
specifically prescribed (e.g. for preeclampsia prevention under physician
guidance). Aspirin should be used with caution in the elderly, in patients
with renal or hepatic impairment, and in those taking anticoagulants or
corticosteroids (because bleeding risk is higher).