![]() ![]() When the patient stops taking aspirin, there will still be irreversibly inhibited platelets in the body until they have all been replaced 7-10 days after discontinuation. 5 Aspirin reversal time is roughly 7 days due to average lifespan of platelets being between 7 and 10 days. It has been shown to decrease risk of non-fatal MI by 21%, but on the other hand, has shown to increase the risk of bleeding by 48% due to its potent anti-platelet activity. 4 Because of this phenomenon, aspirin is most commonly prescribed for vascular disease including coronary artery disease and cerebrovascular disease to prevent thrombosis. Since platelets cannot make new COX-1, the inhibition of TxA2 is permanent for the life of the platelet. 3 Low dose aspirin irreversibly acetylates and inhibits COX-1 and only weakly inhibits COX-2. When COX-1 is inhibited, so is the creation of thromboxane A2 and thus platelet aggregation. The COX-1 enzyme is found within platelets, it helps to produce prostaglandin H2 which is then converted into thromboxane A2, a necessary platelet adhesion factor. 2 The GI side effects are most apparent and well documented and can increase risk of bleeding.Īspirin, one of the most widely used NSAIDs, is commonly prescribed by physicians for its anti-platelet activity through irreversible inhibition of COX-1. Among those, 11-12% of admissions are from gastrointestinal, nervous system, renal, or allergic effects of non-aspirin NSAIDs. 1 It is estimated that between 5-7% of hospital admissions are related to medication side effects. ![]() COX-2 regulates prostaglandins geared more towards mediating the body’s inflammatory response to injury and protecting against vascular ischemia. COX-1 and COX-2 regulate production of certain prostaglandins, COX-1 regulates prostaglandins that protect the gastrointestinal lining and activate platelets. Most NSAIDs inhibit COX-1 and COX-2 activity, although some are selective for COX-2. They possess analgesic, antipyretic, and anti-inflammatory properties. NSAIDs are the most commonly used class of drugs in the world. ![]() You want to address his pain and consider non-steroidal anti-inflammatory drugs (NSAIDs) as an option. He also endorses a headache and a minor laceration to the left arm. Point-of-care ultrasound reveals an unremarkable E-FAST exam. The patient has no significant past medical history or allergies. The patient is tachycardic at 115, his other vital signs are stable. A 27-year-old male presents to the emergency department with abdominal pain and rib pain after colliding with a tree at the local ski resort. ![]()
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