What is the absolute contraindication to Acetylsalicylic acid (Aspirin)?

From the Guidelines

Aspirin is absolutely contraindicated in patients with known hypersensitivity or allergy to aspirin or other NSAIDs, active peptic ulcer disease, hemophilia or other bleeding disorders, and children with viral infections due to the risk of Reye's syndrome, as well as those with severe hepatic impairment, severe renal failure, or those in the third trimester of pregnancy, as stated in the most recent study 1. The contraindications exist because aspirin inhibits cyclooxygenase enzymes, reducing prostaglandin production, which can trigger severe reactions in sensitive individuals. Some key points to consider include:

• Aspirin's antiplatelet effects significantly increase bleeding risk in patients with bleeding disorders or active ulcers, as noted in 1 and 1.
• For children with viral illnesses, particularly influenza or chickenpox, aspirin use is associated with Reye's syndrome, a rare but potentially fatal condition causing brain and liver damage, as mentioned in 1.
• Alternative medications like acetaminophen should be considered in these situations, as suggested in the example answer.
• The most recent study 1 provides the most up-to-date information on the contraindications of aspirin, including the risk of GI bleeding and intracranial bleeding, and the importance of careful consideration of the risks and benefits of aspirin therapy in individual patients. It is essential to weigh the benefits of aspirin therapy against the potential risks and to consider alternative treatments when necessary, as discussed in 1, 1, and 1. Ultimately, the decision to use aspirin should be made on a case-by-case basis, taking into account the individual patient's medical history, current health status, and potential risks and benefits, as emphasized in 1 and 1.

From the FDA Drug Label

Do not Use if you are allergic to aspirin or any other pain reliever/fever reducerif you have ever had an allergic reaction to this product or any of its ingredients Allergy alert: Aspirin may cause a severe allergic reaction which may include: hives, facial swelling, asthma(wheezing), shock The absolute contraindication to aspirin is an allergy to aspirin or any of its ingredients, as it may cause a severe allergic reaction 2 2.

From the Research

Absolute Contraindication to Aspirin

The absolute contraindication to aspirin is not explicitly stated in the provided studies. However, the following conditions are considered as risk factors for gastrointestinal bleeding associated with aspirin use:

• A history of peptic ulcer disease or gastrointestinal bleeding 3
• Older age 3
• Concomitant use of NSAIDs, including coxibs 3
• Concomitant use of anticoagulants or other platelet aggregation inhibitors 3, 4
• The presence of severe co-morbidities 3
• High aspirin dose 3, 5

Risk Factors for Gastrointestinal Bleeding

The risk factors for gastrointestinal bleeding in aspirin users include:

• Low-dose aspirin use 6, 4
• Concomitant use of NSAIDs 6
• Concomitant use of anticoagulants 6, 4
• Concomitant use of steroids 6
• Concomitant use of selective serotonin reuptake inhibitors (SSRIs) 6
• Concomitant use of proton pump inhibitors (PPIs) 6
• Concomitant use of histamine-2 receptor antagonists (H2RAs) 6
• History of peptic ulcer disease or gastrointestinal bleeding 3, 5
• Older age 3
• Presence of severe co-morbidities 3

Management of Gastrointestinal Bleeding

There is a lack of clinical practice guidelines on how to manage gastrointestinal bleeding in patients taking anticoagulant or antiplatelet medications, including aspirin 7. However, the use of PPIs has been shown to reduce the risk of major gastrointestinal bleeding in patients taking low-dose aspirin 4.