Purpose
To provide details about aspirin use at IHTC during hospital admission or as outpatient
Indication
For antiplatelet effects, pediatric studies have not been performed with doses derived from adult studies (e.g., arterial ischemic stroke prophylaxis)
USE
Dosage Forms
Aspirin is available in oral or rectal forms.
Initiating Therapy
| Administration: Take with water, food, or milk to decrease GI upset. Doses are typically rounded to a convenient amount (e.g., ¼ of 81 mg tablet). |
|
| Chewable (Immediate release) | Can cut, crush, chew. |
| Capsule (Immediate release) | Swallow whole; do NOT cut, crush, or chew. Take with full glass of water. |
| Enteric-coated (Immediate release) | Absorption can be delayed and/or decreased. Do NOT crush or chew enteric-coated tablets. Should be swallowed whole. |
| Rectal | Remove suppository from plastic packet and insert into rectum as far as possible. |
Oral Pharmacokinetics
| Half-life | ~2-4.5 h |
| Onset | ~within 10 min. |
| Duration | Platelet life-span (~5-7 days) |
| Excretion | Renal |
Rectal Phamracokinetics
| Half-life | ~4.5-9 h |
| Onset | ~4-5 h |
| Duration | Platelet life-span (~5-7 days) |
| Excretion | Renal |
Safety Precautions
Renal impairment: There are no recommendations in the manufacturer’s labeling, but consider the following:
- GFR >/= 10 mL/minute/1.73 m2: no dosage adjustment necessary
- GFR < 10 mL/minute/1.73 m2: avoid use
- Peritoneal dialysis: avoid use
- Intermittent hemodialysis: administer daily dose after dialysis session on dialysis days (50-100% dialyzable and concentration dependent with higher salicylate concentration being more readily dialyzable)
- CRRT: No dosage adjustment necessary, monitor serum concentrations
Hepatic impairment: Avoid use in severe liver disease
Drug-Drug interactions:
- Concurrent NSAID use may antagonize antiplatelet effects, especially if taken before aspirin.
- Concurrent antacid use leads to increased gastric pH which can decrease aspirin absorption.
- Check for drug-drug interactions.
Pediatric Dosing
Oral: 1-5 mg/kg/dose once daily (in general max 81 mg/dose)
Adult Dosing
Oral: 81-325 mg daily
Antiplatelet Monitoring Parameter and Reference Range
Routine antiplatelet testing is not required for monitoring of aspirin.
Perioperative Management
- Decision making regarding whether aspirin needs to be held depends on type of surgery, renal function, and balance of bleeding versus thrombosis risk. The duration for withholding is based upon the estimated platelet life span for high procedural bleeding risk. If it is indicated, aspirin should be discontinued at least 5-7 days prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding.
- Restart aspirin after the procedure as soon as adequate hemostasis has been established and once cleared by the surgeon or interventionalist.
Warnings
Children or teenagers recovering from chickenpox or flu-like symptoms should hold aspirin therapy in general until recovered. Changes in behavior (along with nausea or vomiting) may be an early sign of Reye syndrome.
Reversal Information
- For urgent needs without bleeding and/or reversal needed within hours, consider platelet transfusion.
- For urgent reversal with bleeding and/or needed immediately, consider platelet transfusion, DDAVP, antifibrinolytic therapy
Patient Education and Ongoing Management
Discharging IHTC physician/APP is responsible for ensuring adequate follow-up for antiplatelet management has been scheduled prior to patient leaving the hospital.
