Aspirin before 911

[LVN2006]

I hear on the news and for many years to give aspirin if somebody is experiencing chest pains or heart attack. my teacher says wont work?

[anticoagulationurse]

ASA is specifically contraindicated with a patient taking COUMADIN. The two meds interact and PRN use of NSAIDS is generally not advised. (Although some docs recommend low doses of ASA - 81mg - routinely with Coumadin since they work differently). The difference is, the interaction of routine low dose ASA with Coumadin is predictable. The large doses typically recommended for possible MI would definitely interact with the Coumadin quickly causing an elevated INR which would then place the patient at increase risk for hemmorage, especially if invasive procedures are involved during intervention of the MI. I would ask the doc for an order specifically for the situation or at least have some protocols in place to protect the patient.

[emtb2rn, BSN, RN, EMT-B]

Per my ACLS training, ASA is only contraindicated in pts w/known ASA hypersensitivity. No mention of coumadin or any other drug contra. ASA apparently works by blocking platelet aggregation and artery constriction.

[jmgrn65, RN]

ASA is specifically contraindicated with a patient taking COUMADIN. The two meds interact and PRN use of NSAIDS is generally not advised. (Although some docs recommend low doses of ASA - 81mg - routinely with Coumadin since they work differently). The difference is, the interaction of routine low dose ASA with Coumadin is predictable. The large doses typically recommended for possible MI would definitely interact with the Coumadin quickly causing an elevated INR which would then place the patient at increase risk for hemmorage, especially if invasive procedures are involved during intervention of the MI. I would ask the doc for an order specifically for the situation or at least have some protocols in place to protect the patient.

IN the event of an MI, the patient should still take an asa even if on coumadin. Most of our patients are on both.

[anticoagulationurse]

I totally agree that ASA and Coumadin work differently and beneficially to decrease platelet aggregation and lots of patients take both. However, I've seen dangerously elevated INRs in patients who have taken 325mg-500mg of ASA (just one dose) as quickly as the following day. The effect can last for days in some cases require Vit K reversal. This can further jeopardize the patient by then causing a subtherapeutic INR, increasing the risk for clots which is problmatic in an MI. I would still request an order. And for curiosity, check up on the resulting INR the next day or two.