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Uses

Pain

Symptomatic relief of mild to moderate pain.

Self-medication in children for the temporary relief of minor aches and pains and headache.

Self-medication in adolescents and adults for the temporary relief of minor aches and pains associated with headache, common cold, toothache, muscular aches, backache, arthritis, menstrual cramps, and sore throat.

Self-medication in fixed combination with acetaminophen and caffeine for the temporary relief of mild to moderate pain associated with migraine headache; also can be used for the treatment of severe migraine headache if previous attacks have responded to similar non-opiate analgesics or NSAIAs.

Fever

Self-medication for reduction of fever associated with colds, sore throats, and teething. (See Contraindications and see Pediatric Use under Cautions.)

Inflammatory Diseases

Symptomatic treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, osteoarthritis, spondyloarthropathies, and systemic lupus erythematosus (SLE).

Rheumatic Fever

Symptomatic treatment of rheumatic fever†. A drug of choice in patients with mild carditis (without cardiomegaly or CHF, with or without polyarthritis) or with polyarthritis only.

TIAs and Acute Ischemic Stroke

Reduction of the risk of recurrent TIAs and stroke or death in patients who have had single or multiple TIAs or ischemic stroke (secondary prevention).

Prevention of TIAs and stroke in patients undergoing carotid endarterectomy. In patients with asymptomatic or recurrent carotid stenosis who are not candidates for surgery, lifelong prophylaxis with aspirin is recommended by American College of Chest Physicians (ACCP).

Aspirin, dipyridamole and aspirin, or clopidogrel all considered acceptable options by ACCP, AHA and other clinicians for initial therapy in adults; in children, aspirin recommended following discontinuance of anticoagulation (e.g., unfractionated or LMW heparin, warfarin).

Also used in fixed combination with extended-release dipyridamole to reduce the risk of recurrent stroke, death from all vascular causes, or nonfatal MI in patients who have had TIAs or completed ischemic stroke caused by thrombosis.

Aspirin and dipyridamole combination or clopidogrel monotherapy may be preferable to aspirin monotherapy for secondary prevention based on somewhat greater absolute risk reduction for stroke; weigh benefit against additional costs of therapy.

Acute treatment of ischemic stroke† when thrombolytic therapy is contraindicated or not indicated. May be safely used with low-dose sub-Q heparin to prevent DVT in such patients.

Secondary Prevention of CAD and MI

Recommended by ACCP for reduction of the risk of vascular events in all patients with CAD regardless of the presence or absence of clinical manifestations.

Reduction of the risk of vascular mortality in patients with suspected acute ST-segment elevation MI (AMI).

Reduction of the risk of stroke and recurrent infarction in patients surviving an MI (secondary prevention).

Recommended by ACCP for use as monotherapy in low- to moderate-risk post-MI patients in most health-care settings.

Recommended by American Diabetes Association (ADA) for the prevention of cardiovascular events in diabetic patients who have evidence of large-vessel disease (e.g., history of MI, CABG, stroke or TIA, peripheral vascular disease, claudication, angina).

Recommended by ACCP for use in combination with short-term oral anticoagulation (e.g., warfarin therapy) in high-risk, post-MI patients (e.g., anterior MI or acute MI with severe left ventricular dysfunction, congestive heart failure, previous emboli, or echocardiographic evidence of mural thrombosis).

Recommend by ACC and AHA for short-term use in combination withwarfarin in patients with left ventricular thrombus and for long-term use in patients without an increased risk for bleeding.

Recommended by ACC and AHA for use in combination with long-term warfarin therapy in patients without coronary stents in whom other indications for anticoagulation exist (e.g., atrial fibrillation,cerebral emboli, extensive wall-motion abnormality).

Recommended by ACCP for use in combination with long-term oral anticoagulation (e.g., warfarin therapy) in post-MI patients where meticulous INR monitoring is standard and routinely accessible.

Has been used in combination with clopidogrel and other standard therapy (e.g., thrombolytic agents, heparin) during acute MI to reduce mortality, recurrent MI, recurrent ischemia, or stroke.

Primary Prevention of CAD and MI

May reduce the risk of a first MI† in certain patient populations (primary prevention). Balance of risks and benefits is most favorable in patients at moderate to high risk of CHD (based on age and 10-year risk of cardiac event >10%). Use of aspirin in such patients is suggested over either warfarin or no antithrombotic therapy.

Recommended by ADA for primary prevention in patients with type 1 or type 2 diabetes mellitus who are at high risk for cardiovascular events (i.e., familial history of CHD, smoking, hypertension, obesity, albuminuria, elevated blood cholesterol or triglyceride concentrations) and in whom aspirin is not contraindicated.

Benefit appears to be minimal or lacking in women at low risk for CHD, except possibly those ≥65 years of age; further study needed.

Not currently recommended for primary prevention in the general population without known risk factors.

Unstable Angina or Non-ST-Segment Elevation MI

Reduction of the risk of death and/or nonfatal MI in patients with unstable angina or non-ST-segment elevation (NSTE) acute coronary syndromes (ACSs). ACCP recommends use with low molecular weight heparins over unfractionated heparin for the acute treatment of patients with NSTE ACSs.

In patients with unstable angina or NSTE ACS who are not at high risk for bleeding, ACC and AHA recommend adding clopidogrel to aspirin and heparin therapy for reduction of cardiovascular and cerebrovascular events.

In patients with unstable angina and moderate to high-risk features, use in combination with other antiplatelet therapies (e.g., tirofiban, eptifibatide) and heparin recommended by ACC, AHA, and ACCP.

Chronic Stable Angina

Reduction of the risk of MI and/or sudden death in patients with chronic stable angina.

May administer with clopidogrel in selected high-risk patients with chronic stable angina.

Percutaneous Coronary Intervention and Revascularization Procedures

Reduction of cardiovascular risks (e.g., early ischemic complications, graft closure) in patients undergoing percutaneous coronary intervention (PCI) including coronary angioplasty or stent implantation, or CABG.

Pretreatment with aspirin prior to PCI recommended by ACC and AHA. Adjunctive therapy with a loading dose of a thienopyridine derivative is preferred by ACCP over systemic anticoagulant therapy prior to the procedure.

For patients unable to tolerate aspirin, ACC and AHA suggest pretreatment with clopidogrel, while ACCP suggests pretreatment with clopidogrel or ticlopidine prior to planned PCI.

Continue low-dose aspirin therapy indefinitely as secondary prevention against cardiovascular events following PCI. No evidence that such long-term therapy affects the rate of restenosis.

Recommended by ACC and AHA in combination with clopidogrel as short-term prophylaxis (≥1 month), preferably long-term prophylaxis (≤1 year) after PCI in patients with bare-metal stents who are not at high risk for bleeding.

Prolonged prophylaxis (≤12 months) in combination with a thienopyridine derivative strongly recommended after PCI in patients with drug-eluting stents (DES) who are not at high risk of bleeding. (See Thrombosis Associated with Drug-eluting Stents under Cautions.)

Use in combination with clopidogrel suggested by ACC and AHA in patients undergoing brachytherapy for restenosis following PCI and stent implantation†.

Recommended by ACCP for use in all patients undergoing saphenous vein or internal mammary artery bypass grafting (regardless of effect on graft patency) based on indication in all patients with CAD. ACC and AHA recommend use after saphenous vein CABG to reduce risk of graft closure.

May be used in combination with oral anticoagulants in patients with saphenous vein bypass grafts who have underlying conditions necessitating use of oral anticoagulants (e.g., prosthetic heart valves).

Embolism Associated with Atrial Fibrillation/Flutter

An alternative or adjunct to oral anticoagulation for reduction of the incidence of thromboembolic episodes in selected patients with chronic atrial fibrillation† or atrial flutter†.

Use of either aspirin or warfarin is suggested by ACC, AHA, and other clinicians in patients with nonvalvular atrial fibrillation with intermediate risk of stroke.

Recommended for use in patients with atrial fibrillation at low risk for stroke or who are poor candidates for oral anticoagulation.

Recommended for use in patients with “lone” atrial fibrillation (e.g., those younger than 75 years of age without prior stroke or TIA) over warfarin because relatively low risk of stroke in these patients does not warrant risks of oral anticoagulation.

Embolism Associated with Valvular Heart Disease

Used as an alternative or adjunct to oral anticoagulation for reduction of the incidence of thromboembolic episodes in selected patients with valvular heart disease†.

Recommend by ACCP for use in patients with mitral valve prolapse and unexplained symptomatic TIAs.

Used as an adjunct to warfarin in patients with mitral valve disease associated with rheumatic fever and recurrent embolism despite warfarin therapy.

Thrombosis in Other Arteries and Arteriovenous Communications

Reduction of the risk of stroke and MI in patients undergoing peripheral percutaneous transluminal angioplasty (PTA) with or without stenting.

Reduction of the risk of long-term cardiovascular morbidity and mortality in patients with chronic limb ischemia (e.g., intermittent claudication) resulting from arteriosclerosis. Use of aspirin is suggested by ACCP over clopidogrel in these patients because of cost considerations.

Prolonging the patency of vascular grafts following peripheral bypass surgery (e.g., prosthetic infrainguinal femoropopliteal). Prophylaxis used in selected patients undergoing other bypass procedures and vascular reconstructions; consult specialized references for additional information.

Has been used following initial heparin therapy to reduce the risk of thrombotic occlusion in children with Blalock-Taussig shunts†.

Prosthetic Heart Valves

Has been used in conjunction with warfarin to reduce the risk of systemic thromboembolism and death in patients with mechanical prosthetic heart valves†.

In patients with a bioprosthetic valve in the aortic position, ACCP recommends aspirin or warfarin for the first 3 months following valve insertion.Follow-up long-term therapy recommended to protect against thromboembolism in patients with bioprosthetic heart valves† who are in sinus rhythm and without risk factors.

May be added to therapy with a low molecular weight heparin or unfractionated heparin in pregnant women with prosthetic heart valves† who are at high risk for thrombosis.

Thrombosis Associated with Fontan Procedure

Has been used for prevention of thromboembolic complications following Fontan procedure† (definitive palliative surgical treatment for most congenital univentricular heart lesions) in children. Antithrombotic therapy effective in <50% of patients and many prophylactic regimens in use; no consensus on optimal regimen.

Pericarditis

Drug of choice for the management of pain associated with acute pericarditis† following MI.

Kawasaki Disease

Treatment of Kawasaki disease; used in conjunction with immune globulin IV (IGIV).

Complications of Pregnancy

Has been used alone or in combination with other drugs (e.g., heparin, corticosteroids, immune globulin) for prevention of complications of pregnancy† (e.g., preeclampsia, pregnancy loss in women with a history of antiphospholipid syndrome and recurrent fetal loss).

Use in combination with subcutaneous low-dose unfractionated heparin or a low molecular weight heparin suggested by ACCP in women with a congenital thrombophilic deficit and recurrent spontaneous abortions, a second-trimester or later pregnancy loss, severe or recurrent preeclampsia, or abruption.

Combined prophylactic therapy with low dosages of aspirin and unfractionated heparin considered the regimen of choice in women with antiphospholipid syndrome and a history of multiple pregnancy losses, followed by postpartum oral anticoagulation therapy. Combination prophylactic therapy with aspirin and unfractionated or low molecular weight heparin followed by postpartum anticoagulation suggested in women with antiphospholipid syndrome and a history of multiple pregnancy losses,preeclampsia, intrauterine growth retardation, or abruption. In women with antiphospholipid syndrome and no prior venous thromboembolism or pregnancy loss, consider clinical surveillance alone or therapy with low-dose unfractionated heparin, once-daily low molecular weight heparin, and/or low dosages of aspirin.

Routine use of aspirin prophylaxis to reduce the incidence and severity of preeclampsia (even in patients at increased risk of preeclampsia) generally not recommended; can consider prophylaxis in women with prior severe or early-onset preeclampsia, chronic hypertension, severe diabetes, or moderate to severe renal disease. (See Pregnancy under Cautions.)

Prevention of Cancer

Limited data (observational studies) suggest that aspirin or other NSAIAs may reduce the risk of various cancers† (e.g., colorectal, breast, gastric cancer); such results generally not confirmed in randomized controlled trials.

Regular use (e.g., daily) associated with a reduction in the risk of recurrent colorectal adenomas and colorectal cancer† in some studies. Beneficial effects of NSAIAs in reducing colorectal cancer risk dissipate following discontinuance of such therapy. Preventive therapy with aspirin currently not recommended because aspirin does not completely eliminate adenomas; aspirin therapy should not be considered a replacement for colorectal cancer screening and surveillance.