What are the contraindications for Acetylsalicylic acid (Aspirin)?

From the Guidelines

Aspirin is contraindicated in patients with a history of hypersensitivity to aspirin or other NSAIDs, active peptic ulcer disease, bleeding disorders, severe liver disease, or children under 21 years with viral infections due to the risk of Reye's syndrome, as stated in the guidelines 1. The contraindications for aspirin use are due to its mechanism of action, which irreversibly inhibits platelet aggregation and prostaglandin synthesis, leading to an increased risk of bleeding and other adverse effects. Some key points to consider when evaluating contraindications for aspirin use include:

• A history of hypersensitivity to aspirin or other NSAIDs, which can increase the risk of allergic reactions and anaphylaxis 1
• Active peptic ulcer disease, which can increase the risk of gastrointestinal bleeding and perforation 1
• Bleeding disorders, such as hemophilia or thrombocytopenia, which can increase the risk of bleeding and hemorrhage 1
• Severe liver disease, which can affect the metabolism and clearance of aspirin and increase the risk of adverse effects 1
• Children under 21 years with viral infections, due to the risk of Reye's syndrome, a rare but potentially life-threatening condition 1 For patients with these contraindications, alternative analgesics or antiplatelet agents should be considered based on the specific clinical situation, such as clopidogrel or other P2Y12 inhibitors 1.

From the FDA Drug Label

Warnings Reye's syndrome: Children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use this product, Allergy alert: Aspirin may cause a severe allergic reaction which may include: hives, facial swelling, asthma(wheezing), shock Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding

The contraindications for aspirin include:

• Children and teenagers who have or are recovering from chicken pox or flu-like symptoms due to the risk of Reye's syndrome
• Patients with a history of severe allergic reaction to aspirin, which may include hives, facial swelling, asthma (wheezing), or shock Aspirin should be used with caution in patients with a history of stomach ulcers or bleeding problems 2

From the Research

Contraindications for Aspirin

The following are contraindications for aspirin use:

• A history of peptic ulcer disease or gastrointestinal bleeding 3
• Older age 3
• Concomitant use of NSAIDs, including coxibs 3
• Concomitant use of anticoagulants or other platelet aggregation inhibitors 3
• The presence of severe co-morbidities 3
• High aspirin dose 3
• Hyper-response to aspirin, which may be a risk factor for bleeding 4
• Use of proton pump inhibitors, which may increase the risk of lower gastrointestinal bleeding in low-dose aspirin users 5
• Use of warfarin, which may increase the risk of lower gastrointestinal bleeding in low-dose aspirin users 5
• Use of steroids, SSRIs, and NSAIDs, which may increase the risk of lower gastrointestinal bleeding in low-dose aspirin users 6

Risk Factors for Gastrointestinal Bleeding

The following are risk factors for gastrointestinal bleeding associated with aspirin use:

• A history of peptic ulcer disease or gastrointestinal bleeding 3, 6
• Older age 3
• Concomitant use of NSAIDs, including coxibs 3, 6
• Concomitant use of anticoagulants or other platelet aggregation inhibitors 3, 5
• The presence of severe co-morbidities 3
• High aspirin dose 3, 7
• Long-term use of aspirin 7
• Use of proton pump inhibitors, which may increase the risk of lower gastrointestinal bleeding in low-dose aspirin users 5
• Use of warfarin, which may increase the risk of lower gastrointestinal bleeding in low-dose aspirin users 5
• Use of steroids, SSRIs, and NSAIDs, which may increase the risk of lower gastrointestinal bleeding in low-dose aspirin users 6