IM Steroid Injection While Taking Aspirin
Yes, you can safely receive an intramuscular (IM) steroid injection while taking aspirin. The evidence demonstrates that aspirin use does not significantly increase the risk of bleeding complications with steroid injections, and IM injections carry substantially lower bleeding risk than neuraxial (epidural/spinal) procedures.
Key Safety Evidence
IM injections are fundamentally safer than neuraxial procedures regarding bleeding risk. A large prospective study of 1,214 epidural steroid injections—which carry higher bleeding risk than IM injections due to proximity to the spinal cord—found zero spinal hematomas (major hemorrhagic complications) in patients taking NSAIDs including aspirin 1. Minor bleeding (blood noted during needle placement) occurred in only 5.2% of cases and was not increased by NSAID use 1.
Aspirin does not need to be discontinued for IM steroid injections. The research confirms that epidural steroid injection is safe in patients receiving aspirin-like antiplatelet medications, and IM injections pose even less risk than epidural procedures 1.
Clinical Context and Risk Stratification
The bleeding risk hierarchy matters: IM injections are considered low-risk procedures compared to neuraxial injections 2. While rare epidural hematomas have been reported following epidural injections in elderly patients on aspirin 2, these cases involved:
- Advanced age (79 years old)
- Neuraxial (epidural) approach—not IM
- Secondary prevention dosing after myocardial infarction 2
For standard IM steroid injections, aspirin continuation is appropriate because:
- IM injections do not approach the spinal canal
- Bleeding complications are easily compressible and visible
- The risk-benefit strongly favors continuing aspirin, especially for cardiovascular protection 3, 4
Important Caveats
Monitor for these specific risk factors that could modify your approach:
- Age ≥60 years increases bleeding risk 5
- History of stomach ulcers or bleeding problems 5
- Taking blood thinners (anticoagulants) in addition to aspirin 5
- Taking multiple NSAIDs simultaneously 1
- Three or more alcoholic drinks daily 5
Aspirin dosing considerations: Most patients take 75-325 mg daily for cardiovascular protection 3, 4. The study demonstrating safety included 104 patients on ≤325 mg aspirin daily with no major complications 1.
Post-Injection Monitoring
Expect these normal findings:
- Corticosteroid injections are safe and effective for musculoskeletal conditions 6, 7
- Post-injection flare, facial flushing, and local tissue reactions are the most common side effects—not bleeding 7
- Patients with diabetes should monitor blood glucose closely for two weeks following injection 6
- Systemic complications from injectable corticosteroids are rare 7
Do not confuse minor neurologic symptoms with bleeding: After any steroid injection, 3-4% of patients may experience temporary worsening of symptoms (median duration 3 days), which is unrelated to bleeding and resolves spontaneously 1.
Contraindications to Consider
Absolute contraindications to the injection itself (unrelated to aspirin):
- Active infection at injection site 6
- Known allergy to corticosteroids 6
- Severe bleeding disorders beyond aspirin use 5
The combination of aspirin with corticosteroids does increase GI bleeding risk when both are taken systemically long-term 3, but this does not apply to a single IM steroid injection where systemic absorption is minimal and temporary.