What is the recommended duration of aspirin (acetylsalicylic acid) therapy for a patient with pericarditis?

Aspirin Duration for Pericarditis

For acute pericarditis, aspirin should be administered at 750-1000 mg every 8 hours for 1-2 weeks, followed by gradual tapering by 250-500 mg every 1-2 weeks until discontinuation, with treatment duration guided by symptom resolution and CRP normalization. 1

Initial Treatment Phase

• Start aspirin at 750-1000 mg every 8 hours for 1-2 weeks as the initial treatment duration for acute pericarditis 1, 2
• Always provide gastroprotection with a proton pump inhibitor when using aspirin 3
• Add colchicine 0.5 mg once daily (<70 kg) or twice daily (≥70 kg) for 3 months as mandatory adjunctive therapy to improve response and prevent recurrences 1, 2

Tapering Protocol

• Begin tapering aspirin only after symptoms resolve AND CRP normalizes 1, 3
• Decrease aspirin doses by 250-500 mg every 1-2 weeks during the tapering phase 1
• The total treatment course typically extends to weeks to months depending on clinical response 1
• For recurrent pericarditis, longer tapering times may be necessary for more difficult, resistant cases 1

Monitoring and Duration Guidance

• Use CRP levels as the primary objective marker to guide treatment length and assess response 1, 2
• Continue treatment until complete symptom resolution occurs 1, 3
• Each tapering attempt should only be made when symptoms are absent and CRP is normal 1
• When tapering multiple medications, taper one drug class at a time before discontinuing colchicine 1

Critical Pitfalls to Avoid

• Never stop aspirin before CRP normalizes - premature discontinuation is a major cause of recurrence 3
• Never taper aspirin while symptoms persist - this increases recurrence risk significantly 1
• Inadequate treatment duration of the first episode is the most common cause of recurrent pericarditis 2
• Without colchicine, recurrence rates are 15-30% after the initial episode, increasing to 50% after the first recurrence 2

Special Considerations for Recurrent Pericarditis

• For recurrent cases, aspirin dosing increases to 500-1000 mg every 6-8 hours (range 1.5-4 g/day) 1
• Treatment duration extends to weeks to months with even more gradual tapering 1
• Colchicine duration extends to at least 6 months for recurrent pericarditis 1
• Very slow tapering decrements may be needed in resistant cases 1