Life saving early and immediate aspirin: too little too late

23 Jan

There are a number of reasons why the earlier aspirin is given the greater the potential for saving life: Platelet emboli have been found within the coronary circulation in subjects whose death has been ‘‘sudden’’. If taken early enough, aspirin could cause disaggregation of the platelets in an embolus, could reduce the growth of any such emboli, and could prevent the development of a thrombus and its stabilisation by the incorporation of fibrin. Platelet aggregation and embolisation are highly active in unstable angina and aspirin is of greatly enhanced efficacy in this situation. Evidence suggests that the reduction in relative risk for subsequent non-fatal MI or death after aspirin administration is greater for unstable angina (51%) than it is for MI (25%). Antiplatelet agents also play an important role in the management of patients with non-ST segment elevation MI. There is a peak in the occurrence of MI in the early morning between about 04.00 and 10.00 h and this coincides with an increased sensitivity of platelets to aggregating agents. The readiness with which a patient is likely to call an ambulance or a doctor, and the availability of help during these hours, is probably less than later in the day. Furthermore, it is of relevance to ‘‘self help’’ in this situation that in the US Physicians trial it was found that the reduction in MI caused by aspirin treatment was significantly greater during the early morning (59%) than during the later part of the day (34%). Most patients with an ST segment elevation MI are likely to receive thrombolytic therapy. There is a pronounced heightening of platelet activity after thrombolysis, and prior treatment with aspirin abolishes the excess in re-infarction that otherwise follows fibrinolysis. It is essential therefore that aspirin is given before fibrinolytic therapy is commenced.
The earlier fibrinolysis is started the better, and the delegation of this to paramedics has been recommended.

The best way to ensure that aspirin has first been taken is for the patient to have taken it him/herself.

Postgrad Med J 2008
Life saving early and immediate aspirin: too little too late.
Malcolm Woollard, Peter C Elwood, Gareth Morgan.

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IMPORTANT NOTE: IF YOU NEED TO TAKE AN EMERGENCY DOSE OF ASPIRIN YOU MUST DIAL 999 FOR AN AMBULANCE FIRST – AND THEN IMMEDIATELY CHEW AND SWALLOW ONE 300mg SOLUBLE ASPIRIN.  If in doubt speak to your Doctor.

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