When should I resume aspirin (acetylsalicylic acid) after a motor vehicle accident (MVA)?

Resuming Aspirin After a Motor Vehicle Accident

Aspirin should be resumed immediately after a motor vehicle accident (MVA) unless there is active bleeding or other contraindications to aspirin therapy. 1

Assessment After MVA

When deciding when to resume aspirin after an MVA, consider:

• Active bleeding: If there is active bleeding from injuries, aspirin should be withheld until bleeding is controlled
• Injury severity: For minor injuries without bleeding concerns, aspirin can be resumed immediately
• Surgical needs: If surgery is required, timing depends on surgical urgency and bleeding risk

Timing Guidelines for Resuming Aspirin

For patients without active bleeding or need for surgery:

• Resume aspirin immediately to maintain cardiovascular protection 2, 1
• Gaps in aspirin therapy >48 hours may lead to loss of cardioprotective effects 2

For patients requiring surgery after MVA:

• If surgery can be performed within a 48-hour window, aspirin can be safely restarted immediately after surgery at the previous treatment dose 2
• For non-urgent surgeries, consider reducing aspirin dose to 325 mg daily for 7 days prior to surgery, holding aspirin the day before and day of surgery, then restarting immediately postoperatively 2

For patients with stroke after MVA:

• For ischemic stroke without thrombolysis: Administer at least 160 mg aspirin immediately after brain imaging has excluded intracranial hemorrhage 2
• For ischemic stroke with thrombolysis: Delay aspirin until after the 24-hour post-thrombolysis scan has excluded intracranial hemorrhage 2

Important Considerations

• Platelet function recovery: After aspirin cessation, bleeding times normalize within 96 hours and platelet function tests within 144 hours 3
• Cardiovascular risk: Patients with established cardiovascular disease are at higher risk when aspirin is discontinued and should resume therapy as soon as safely possible 2
• Dosing: The optimal dose range for cardiovascular protection is 75-325 mg daily, with no significant difference in efficacy across this range 4

Special Situations

• Aspirin for cardiac symptoms after MVA: If experiencing chest pain or symptoms suggestive of acute coronary syndrome after an MVA, administer 160-325 mg of non-enteric coated aspirin immediately unless contraindicated 1
• Patients with atrial fibrillation on anticoagulants: These patients require special consideration regarding aspirin resumption and may need to prioritize anticoagulation therapy 2

Pitfalls to Avoid

• Prolonged discontinuation: Avoid unnecessarily prolonged discontinuation of aspirin therapy as this increases cardiovascular risk
• Failure to consider bleeding risk: Always assess for occult bleeding before resuming aspirin
• Ignoring surgical needs: If surgery is planned, coordinate aspirin management with the surgical team
• Using enteric-coated aspirin in acute settings: Non-enteric coated aspirin is preferred for immediate treatment when needed 1

Remember that the decision to resume aspirin after an MVA should balance the risk of thrombotic events against the risk of bleeding, with the primary goal of optimizing morbidity and mortality outcomes.