Aspirin in the hospital

[chwcbesteph, RN]

Doing clinical prep on a pt with a hx of hypertension and hyperlipidemia, s/p right hip replacement. Pt is on Coumadin and also Aspirin. I am trying to figure out why a pt like this would be put on 81mg Aspirin in the hospital- a dose that is too low for pain relief or fever reduction. Wouldn't Coumadin be taking care of all blood thinning properties?

OR *a bell just rang*

Do Coumadin and Aspirin prevent clotting in different ways??

[BostonFNP, APRN]

Investigate aspirin in primary prevention.

And think about why the patient is on Coumadin so you know what to expect when you examine.

[chwcbesteph, RN]

Thank you :)

I've actually assessed this pt already- I'm just going over feedback of my paperwork. I noticed petechiae on scalp as well as bruising on both forearms (was unable to do a full assessment as pt was in the middle of physical therapy). I listed aspirin as an antiinflammatory and was told to think about it again.

But now I see that considering his cardiac status, he is likely on it to prevent MI.

[BostonFNP, APRN]

Why was he on Coumadin?

[chwcbesteph, RN]

He had had a stroke! Now I am remembering parts of his chart that weren't priorities. Sheesh.

[Aurora77]

From an ortho nurse perspective--total joint replacement patients are on anticoagulants postop. Depending on the surgeon, that may be Coumadin or Lovenox in hospital. A lot of the patients go home on aspirin for anticoagulation, though usually at the 325mg dose. This may not be entirely relevant to your specific patient, but it's possible.

[akulahawkRN, ADN, RN, EMT-P]

Thank you :)

I've actually assessed this pt already- I'm just going over feedback of my paperwork. I noticed petechiae on scalp as well as bruising on both forearms (was unable to do a full assessment as pt was in the middle of physical therapy). I listed aspirin as an antiinflammatory and was told to think about it again.

But now I see that considering his cardiac status, he is likely on it to prevent MI.

A little simplistic, but low dose aspirin works as an antiplatelet. It keeps them from sticking together. Why would someone need this type of therapy? That dose is probably a little too low for post-surgical anticoagulation, so... what else is in his history that would be a reason to not want his platelets to stick to each other?

[RN9742]

Probably related to his hypertension, and overall heart health. Many pts are put on 81mg of aspirin, he was likely on it at home so they just continued the regimen. As an anti platelet it would be more likely he was on 325mg.

[nurseprnRN, BSN, RN]

ASA is not given for hypertension. The standard dose of aspirin to slight decrease platelet activity for prophylaxis against platelet aggregation in plaque-y arteries, including coronary arteries (gold star, OP! :yelclap:) and cerebral arteries, to decrease chance of clot in those sensitive areas (MI, stroke) is 81mg/day, one baby aspirin. 325mg is too much.

Yes, aspirin works on platelets. Coumadin (warfarin) works on ....? And the heparins work on ... ? Good thinking, OP.

[chwcbesteph, RN]

I got it, now! Aspirin 81mg is being given to this pt as prophylaxis against platelet aggregation and Coumadin is being given because it works on the liver and Vitamin K synthesis to prevent blood clotting. Given for the same reasons, but different mechanisms.

Whew.