Aspirin bleeding risk

If history of aspirin-induced bleeding or bleeding risk factors present, use lower doses (i.e., 75-81 mg daily)... 

Doses and contraindications to glycoprotein Ilb/IIIa receptor blockers are described in Table 5-2. Major bleeding and rates of transfusion are increased with administration of a glycoprotein Ilb/IIIa receptor inhibitor in combination with aspirin and an anticoagulant,30 but there is no increased risk of intracranial hemorrhage in the absence of concomitant fibrinolytic treatment. The risk of thrombocytopenia with tirofiban and eptifibatide appears lower than that with abciximab. Bleeding risks appear similar between agents. 

Stroke Prevention All patients with paroxysmal, persistent, or permanent AF should receive therapy for stroke prevention, unless compelling contraindications exist. A decision strategy for stroke prevention in AF is presented in Fig. 6-9.27 In general, most patients require therapy with warfarin in some patients with no additional risk factors for stroke, aspirin may be acceptable. For some patients, serious consideration of the benefits of warfarin versus the risks of bleeding associated with warfarin therapy is warranted. The potential bleeding risks associated with warfarin may outweigh the benefits in... 

Randomized trials have been completed assessing the role of antiplatelet therapy with aspirin for primary stroke prevention. The use of aspirin in patients with no history of stroke or ischemic heart disease reduced the incidence of non-fatal myocardial infarction (MI) but not of stroke. A meta-analysis of eight trials found that the risk of stroke was slightly increased with aspirin use, especially hemorrhagic stroke. Major bleeding risk was also increased with aspirin use.4 Aspirin is beneficial in the primary prevention of MI, but not for primary stroke prevention. 

The AHA/ASA guidelines recommend that antiplatelet therapy as the cornerstone of antithrombotic therapy for the secondary prevention of ischemic stroke and should be used in noncardioembolic strokes. Aspirin, dopidogrel, and extended-release dipyridamole plus aspirin are all considered first-line antiplatelet agents (see Table 13-1). The combination of aspirin and clopido-grel can only be recommended in patients with ischemic stroke and a recent history of myocardial infarction or coronary stent placement and then only with ultra-low-dose aspirin to minimize bleeding risk. 

A clear increase in bleeding risk occurred as the dose of aspirin increased from < 100 mg to 100-300 mg to >300 mg in both placebo-treated (2,0%, 2,2%, 4,0% major bleeds, respectively) and clopidogrel-treated patients (2.5%, 3.5%, 4.9%). There was no clear evidence in CURE or in the antiplatelet triallist s collaboration of improved outcome with higher doses of aspirin. Thus it is recommended that clopidogrel be used in conjunction with maintenance doses of < 100 mg aspirin. 

VASODILATOR ANTIHYPERTENSIVES ASPIRIN t risk of bleeding when aspirin is co-administered with iloprost Uncertain at present Closely monitor the effects watch for signs of excess bleeding... 

SSRIs ANTIPLATELET AGENTS -ASPIRIN Possible risk of bleeding with SSRIs Uncertain. Possible additive effects including inhibition of serotonin release by platelets, SSRI-induced thrombocytopenia and l platelet aggregation Avoid co-administration with high-dose aspirin... 

THROMBOLYTICS ASPIRIN t risk of intracerebral bleeding when streptokinase is coadministered with higher-dose (300 mg) aspirin Additive effect Avoid co-ingestion when streptokinase is given for cerebral infarction use low-dose aspirin when co-admin-istered for myocardial infarction... 

NS AIDs ASPIRIN 1. Risk of gastrointestinal bleeding when aspirin, even low dose, is co-administered with NSAIDs 2. Ibuprofen 1 antiplatelet effect of aspirin 1. Additive effect 2. Ibuprofen competitively inhibits binding of aspirin to platelets 1. Avoid co-administration 2. Avoid co-administration... 

Yeil J et al 1995 Prophylactic aspirin and risk of peptic ulcer bleeding. British Medical Journal 310 827-830. 

Bleeding disorders—hemophilia Aspirin Increased risk of hemorrhage... 

Weil J, Colin-Jones D, LangmanM, Lawson D, Logan R, Murpl M, RawlinsM, Vessey M, Wainwright P. Prophylactic aspirin and risk of peptic ulcer bleeding. EMJ (199 310, 827-30. 

Wainwright P. Prc hylactic aspirin and risk ofpeptic ulcer bleeding. (199 310 827-... 

No haemostatic interaction was noted between danaparoid and aspirin in healthy volunteers. However, caution is recommended on combined use because of the possibility of increased bleeding risk. 

Low-dose aspirin did not alter the pharmacokinetics or pharmacodynamic effects of ai atroban. Neither abciximab nor eptifibatide appeared to alter ai atroban pharmacokinetics. There is no pharmacodynamic interaction between bivalirudin and aspirin, ticlopidine, ciopidogrei, abciximab, eptifibatide or tirofiban. Nevertheless, the manufacturers warn of the increased bleeding risks if argatroban, bivalirudin or lepirudin are used with antiplatelet drugs or thrombolytics. 

Most doctors recognize that the majority of their patients with coronary artery disease benefit from daily aspirin therapy. When such therapy is recommended, a low dose of 81 mg per day (one baby aspirin) is generally used. Because the longterm, regular use of aspirin poses risks of serious bleeding, the decision to begin such a program should be made only after consultation with a physician. 

Oxycodone compounds containing aspirin increase risks of gastric irritation and bleeding. 

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