Is aspirin (acetylsalicylic acid) indicated after a motor vehicle accident (MVA)?

Aspirin After Motor Vehicle Accident (MVA)

Aspirin is not routinely indicated following a motor vehicle accident unless there is suspicion of acute coronary syndrome (ACS). The decision to administer aspirin should be based on specific cardiac symptoms rather than the occurrence of trauma itself.

Assessment of Need for Aspirin After MVA

Cardiac Symptoms Requiring Aspirin

If a patient presents with chest pain or symptoms suggestive of ACS following an MVA:

• Administer nonenteric aspirin (160-325 mg) if there are signs of cardiac ischemia 1
• Have the patient chew the aspirin tablet to hasten absorption 1
• Only administer if there is no history of aspirin allergy or active/recent gastrointestinal bleeding 1

Trauma Considerations

• MVA alone is not an indication for aspirin therapy
• Aspirin may increase bleeding risk in trauma patients
• While one small study suggested preinjury aspirin use might reduce DVT risk in trauma patients 2, this is insufficient evidence to recommend routine aspirin administration after trauma

Aspirin Administration Protocol for Suspected ACS After MVA

If cardiac symptoms are present:

1. Immediate administration: Administer 160-325 mg nonenteric aspirin as soon as possible 1
2. Method: Have patient chew the tablet rather than swallow it whole for faster absorption 1
3. Contraindications: Withhold if patient has:
   • Known aspirin allergy
   • Active or recent gastrointestinal bleeding
   • Bleeding disorders
   • Currently taking anticoagulants 3

EMS Considerations

For emergency medical responders:

• EMS providers should administer nonenteric aspirin (160-325 mg) to patients with suspected ACS (Class I, LOE B) 1
• Emergency dispatchers may reasonably instruct patients with suspected ACS to chew an aspirin (160-325 mg) while awaiting EMS arrival, provided they have no history of aspirin allergy or signs of bleeding 1
• Early administration of aspirin (within first hours of symptom onset) shows benefit in reducing cardiovascular mortality compared to later administration 1

Common Pitfalls to Avoid

1. Administering aspirin for trauma without cardiac symptoms: Aspirin has no proven benefit for trauma management alone and may increase bleeding risk
2. Failing to recognize ACS symptoms after MVA: Stress and pain from trauma can mask or mimic cardiac symptoms
3. Delaying aspirin when ACS is suspected: Early administration is critical for reducing mortality 1
4. Using enteric-coated aspirin in acute settings: Slower absorption makes this formulation less effective for immediate treatment 1

Special Considerations

• Elderly patients: Carefully assess risk-benefit, as patients over 60 years may have higher bleeding risk 4
• Patients with trauma-related bleeding: Aspirin may worsen bleeding and should be avoided unless cardiac benefits clearly outweigh risks
• Patients already on daily aspirin: Document pre-injury aspirin use and consider this in treatment decisions

In summary, aspirin administration after an MVA should be guided by the presence of cardiac symptoms, not by the trauma event itself. When cardiac symptoms are present, early administration of nonenteric aspirin (160-325 mg) is recommended unless contraindicated.