Is it safe to take aspirin (acetylsalicylic acid) with a history of Immune Thrombocytopenic Purpura (ITP)?

From the Guidelines

No, it is not safe to take aspirin with a history of Immune Thrombocytopenic Purpura (ITP) due to the increased risk of bleeding complications 1.

Risks Associated with Aspirin and ITP

• Aspirin has antiplatelet effects, which can exacerbate thrombocytopenia and increase the risk of bleeding in individuals with ITP 1.
• The risk of GI bleeding is significantly increased when NSAIDs, such as aspirin, are used in persons with preexisting platelet defects or thrombocytopenia 1.
• The combination of aspirin and anticoagulants can increase the International Normalized Ratio (INR) by up to 15 percent, further increasing the risk of bleeding complications 1.

Precautions and Alternatives

• Aspirin should be avoided in persons with platelet defects or thrombocytopenia, including those with ITP 1.
• Alternative pain management options should be considered, such as acetaminophen, which does not have antiplatelet effects [not explicitly mentioned in the provided evidence, but a general medical knowledge].
• If aspirin is necessary, close monitoring of platelet count and bleeding risk is essential, and GI prophylaxis should be initiated to offset the increased risk of bleeding complications 1.

From the Research

Safety of Aspirin with Immune Thrombocytopenic Purpura (ITP)

• The safety of taking aspirin with a history of ITP is a complex issue, with some studies suggesting that it can be managed with caution 2.
• A case study published in the Journal of pharmacy practice found that a patient with ITP was safely discharged on aspirin monotherapy after treatment with pulse dexamethasone for four days, without any immediate complications 2.
• However, another study published in the International journal of clinical pharmacology and therapeutics reported a case of severe thrombocytopenia in a patient who developed thrombocytopenia in response to both aspirin and clopidogrel, suggesting that some patients may react similarly to other antiplatelet agents 3.
• A study published in The Journal of international medical research found that aspirin-induced platelet dysfunction can be aggravated by drinking alcohol, leading to prominent purpura 4.
• A review of patients with ITP and acute coronary syndrome (ACS) found that dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel can be used safely in patients with platelet counts between 50 G/L and 100 G/L and no bleeding symptoms, but individual evaluation is necessary 5.
• An experimental study published in Research and practice in thrombosis and haemostasis found that single antiplatelet therapy (APT) provides an appropriate balance of antithrombotic effect and limited bleeding in severe thrombocytopenia, with clopidogrel demonstrating a greater antithrombotic effect but slightly increased bleeding compared with aspirin 6.

Key Considerations

• Patients with ITP should be closely monitored when taking aspirin, as they may be at increased risk of bleeding complications 2, 3, 6.
• The use of aspirin in patients with ITP and ACS requires individual evaluation and careful consideration of the benefits and risks 5.
• Alcohol consumption may exacerbate aspirin-induced platelet dysfunction and increase the risk of bleeding complications 4.