From the Guidelines
Aspirin 100mg can be used with prophylactic Clexane (enoxaparin) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) as part of an anticoagulation and antiplatelet therapy regimen. This combination is recommended for all patients with NSTE-ACS, irrespective of the initial treatment strategy, as stated in the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1. The guideline suggests that anticoagulation, in addition to antiplatelet therapy, is recommended for all patients with NSTE-ACS.
The typical regimen for enoxaparin involves a dose of 1 mg/kg subcutaneous every 12 hours, which can be reduced to 1 mg/kg subcutaneous once daily in patients with creatinine clearance less than 30 mL/min, as indicated in the guideline 1. However, the recommended maintenance dose of aspirin to be used in this context is 81 mg daily, according to the same guideline 1.
It is essential to note that the combination of aspirin and enoxaparin increases the risk of bleeding, and patients should be monitored for signs of bruising and unusual bleeding. Healthcare providers should be informed about this regimen before any procedures, and dose adjustments may be necessary for patients with renal impairment, low body weight, or elderly patients. The duration of this combination therapy depends on the specific indication and should be determined by a healthcare provider.
Key points to consider when using aspirin with prophylactic Clexane include:
- Monitoring for bleeding risk
- Dose adjustments for patients with renal impairment or low body weight
- Informing healthcare providers about the regimen before procedures
- Determining the duration of therapy based on the specific indication.
From the Research
Indication for Aspirin and Clexane
The indication for aspirin (acetylsalicylic acid) 100mg with prophylactic Clexane (enoxaparin) can be understood by examining the use of antiplatelet and anticoagulant therapies in various clinical settings.
- Aspirin is commonly used for the primary prevention of cardiovascular events in patients at increased risk of developing symptomatic atherosclerotic vascular disease 2.
- The combination of aspirin and an anticoagulant, such as enoxaparin, is more effective than aspirin alone for the prevention of recurrent cardiovascular events in patients with acute coronary syndrome 3.
- In patients undergoing elective arthroplasty of the hip or knee, aspirin is perceived to be non-inferior to enoxaparin for the prevention of venous thromboembolism (VTE) 4.
- Dual pathway inhibition, which involves combining antiplatelet therapy with an anticoagulant, has been shown to be effective in reducing the risk of atherothrombotic events in patients with atherosclerotic disease 5.
Clinical Settings
The use of aspirin and enoxaparin can be considered in the following clinical settings:
- Primary prevention of cardiovascular events in patients at increased risk of developing symptomatic atherosclerotic vascular disease 2.
- Prevention of recurrent cardiovascular events in patients with acute coronary syndrome 3.
- Prevention of venous thromboembolism (VTE) in patients undergoing elective arthroplasty of the hip or knee 4.
- Reduction of the risk of atherothrombotic events in patients with atherosclerotic disease 5.
Dosage and Administration
The dosage and administration of aspirin and enoxaparin may vary depending on the clinical setting and patient population.
- Aspirin is typically administered at a dose of 100mg daily for the primary prevention of cardiovascular events 2.
- Enoxaparin is typically administered at a dose of 40mg daily for the prevention of VTE in patients undergoing elective arthroplasty of the hip or knee 4.
- The combination of aspirin and enoxaparin should be used with caution, as it may increase the risk of bleeding 3.