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ASA (acetyl-salicylic acid) known under the well known brand name "Aspirin"Just like Tylenol aspirin has been used for many decades and its risks are well known to the medical community and public. Aspirin is used nowadays not only for pain and inflammation but also for the prevention of recurrent strokes and heart attacks and during an acute heart attack. It works by binding to platelets which are the cells in your blood responsible for making blood clots. Correct clotting of blood is crucial as insufficient clotting like in hemophilia and other diseases will lead to patients bleeding out as their blood is incapable of making appropriate blood clots. On the other hand there are patients whose clotting system is overactive and they end up with blood clots in many parts of their body. Blood clots in the legs (DVT - deep venous thrombosis) can be very dangerous as those blood clots can dislodge and get into the lungs causing pulmonary emboli which can be fatal. Blood clots in the brain will lead to strokes and blood clots in the blood vessels nourishing the heart muscle will lead to heart attacks. In pain management aspirin is used as a pain reliever and for the treatment of inflammation in cases of arthritis. It is part of many combination preparations from darvon (propoxyphene + ASA) to percodan or tylox (oxycodone + ASA). ASA is considered a relatively weak pain medication comparable to Tylenol. Regular strength ASA is 325mg while extra strength (ES) ASA usually contains 500mg. Many over the counter (OTC) pain and headache medications contain ASA. The main concerns with ASA are as mentioned above impairment of blood clotting, gastritis/stomach ulcers and some kidney concerns. Some patients have true ASA allergy which can cause severe breathing problems. Usually ASA alone does not impair blood clotting to a dangerous level the way true blood thinners like coumadin (Warfarin) do. The concern is that a combination of ASA together with other over the counter herbs, supplements and vitamins can make the blood so thin as to cause severe hemorrhage (bleeding). It is known that high dose Vitamin E, garlic, ginseng and gingko biloba can work together to "thin" the blood to a potentially life-threatening level. It is very important to realize that just because something is sold over the counter it does not mean that it is completely safe, especially in combination with other prescribed or OTC medications and supplements. This is very important if you undergo any procedure around the spine (like epidural steroid injections) as excessive bleeding can lead to pressure on nerves and the spinal cord and lead to permanent nerve damage. Studies have shown that the use of ASA (in usual doses) and NSAIDS (ibuprofen, naprosyn and others) do not increase the risk of bleeding with pain procedures. The risk increases if the patient takes multiple medications and supplements that can impair blood clotting as mentioned above. The risk is very high in patients who take plavix (clopidrogrel) or coumadin (warfarin). In patient who take plavix or coumadin the recommendation is to stop the medication for 5-7 days to ensure that the blood clotting functions are back to normal. This has to be done in strict coordination with the prescribing physician (primary care physician, internal medicine specialist or heart specialist). As many people who take ASA have some stomach problems with them there are enteric-coated preparations available which may be better tolerated. The recommendation is to take ASA and so called NSAIDS (Non-steroidal anti inflammatory medications like ibuprofen and naprosyn) with some food to decrease the chance of stomach upset. There are also other strategies to decrease ASAs effect on the stomach by protecting it with medication like zantac, pepcid or prilosec (now all available OTC). The final concern is with the kidneys as some patient can develop high blood pressure and fluid retention (water in the feet and legs) with aspirin use. Let your physician know if you experience any of the aforementioned side effects. |
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