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Acetylsalicylic acid is a popular drug commonly used in colds and infections. However, not everyone knows that it is also used by patients who have neither an elevated temperature, nor even a runny nose and cough. Why?
Polopyrin or Aspirin are trade names of acetyl-salicylic acid. It was the first chemically synthesized drug in 1897 and ushered in the era of the pharmaceutical industry. So it would seem that such an old and well-known drug will not surprise us with anything. Meanwhile, in the second half of the twentieth century, it turned out that, in addition to its antipyretic, anti-inflammatory and analgesic properties, it has other features that can be successfully used by modern medicine.
To the rescue of the heart
Thanks to the advancement of molecular technology and the intensive development of biochemistry in the 60s, it turned out that acetylsalicylic acid also has the ability to inhibit platelet aggregation, i.e. platelet deposition on the walls of blood vessels. Once inhibited, the plaques remain inactive until they are lysed, i.e. dissolved, which takes place after approx. 7 days. Acetyl salicylic acid (called ASA) works by blocking the activity of biologically active substances called thromboxanes, which cause blood vessels to tighten and platelets to aggregate at the site where a clot forms. ASA also inhibits the precipitation of atherosclerotic plaques on the walls of blood vessels. Thus, acetylsalicylic acid has antithrombotic and anti-infarction properties. Hence the rationale for its use in cardiology, after 50 years of a career in the treatment of colds and fever.
Currently, acetylsalicylic acid used in low doses (30-300 mg / day) is still a recognized standard both in post-infarction therapies, strokes and in the early stages of coronary artery disease (the lowest prophylactic dose is 75 mg, and the most often recommended – 75-150 mg / day).
In addition, ASA is administered to prevent cerebral embolism in people with atrial fibrillation, in people with peripheral arterial occlusive disease, and after bypass implantation. It is also used in low doses to prevent venous thrombosis and pulmonary embolism, and for rheumatoid arthritis.
In 2007, a huge study (79 women) was completed, which showed that during 24 years of taking ASA, the mortality of women from cardiovascular causes decreased by as much as 38% after one year of taking the drug, and in the entire quarter of a century covered by the study, it was shown reduction in overall mortality by as much as 25%. Another clinical study found that there is no scientific evidence to support long-term use of ASA in doses greater than 75-81 mg.
There is no rose without thorns
The anti-aggregating properties of acetylsalicylic acid are beneficial for the heart, but at the same time carry a risk of haemorrhage due to the prolonged bleeding time. Therefore, there is a group of diseases and patients who suffer from them, who should not take it. First of all, due to the prolongation of bleeding time, acetylsalicylic acid cannot be used by people who have problems with blood clotting, i.e. those suffering from hemorrhagic diathesis, such as hemophilia or von Hillebrand’s disease. For the same reason, ASA should not be given to people undergoing dialysis – during dialysis, heparin is administered, which, in combination with ASA, dangerously prolongs bleeding time. Also, women during menstruation cannot take this substance even with a fever and a cold. A similar rule applies to people with nasal polyps and after surgery.
Acetylsalicylic acid also has a direct irritating effect on the gastric and duodenal mucosa, which may result in slight abdominal pain and nausea, but may also result in bleeding from gastric or duodenal ulcers. Therefore, active peptic ulcer disease is an absolute contraindication to the use of ASA preparations.
In the case of people allergic to salicylates and their derivatives, taking ASA may cause bronchial asthma in the so-called aspirin form. Therefore, if we suffer from asthma or allergies, it is better to take paracetamol.
Relatively recently, an association was found between the administration of ASA to children and the occurrence of Reye’s syndrome, which is burdened with high mortality. For this reason, its use was restricted to children after 12 years of age. Another study found an association between the use of ASA in pregnant women and the incidence of cleft palate, heart defects and lower birth weight in newborns. They are now also prohibited from taking ASA.
Seatbelts
In order not to expose yourself to the risk of side effects, even those as light as abdominal pain, acetylsalicylic acid should be taken with a meal and washed down with a glass of water. If, however, you develop black tarry stools or vomit that looks like coffee grounds, you should see your doctor. When we have a weak stomach or suffer from heartburn, it is better to choose ASA acid that dissolves only in the alkaline environment of the duodenum or small intestine, which will protect the stomach from side effects (Aspirin Protect, Enteric Polopyrine, Rhonal).
In addition, the composition of other antipyretic and anti-cold medications should be checked so that it does not turn out that we are taking ASA all the time, only under a different name (Acard, Aspirin, Upsarin, Alka-Seltzer). As a general rule, in order not to overburden the liver, ASA should not be used with other NSAIDs, e.g. ibuprofen or paracetamol.
Finally, it is important to know that the side effect is directly proportional to the dose. So if we care about the anti-aggregating effect of ASA, it is enough to take small doses below 300 mg a day, instead of large ones that have antipyretic properties.
If you are taking other drugs, especially those with anticoagulant activity (coumarin derivatives, e.g. Acenocumarol) or diuretics (Furosemide), you must discontinue ASA acid preparations, as they may either inhibit the diuretic effect of Furosemide or enhance the anticoagulant effect of Acenocumarol.
Tekst: mgr farm. Rafał Jabłoński
Source: Let’s live longer