Indikation:

Kontraindikation:

  • Läs alltid även på FASS.se
  • Blödningsanemi, magsår, tidigare GI-blödning
  • vissa operationer (ökad blödningsrisk)
  • ASA-allergi (läs dock sidan om ASA-allergi!)
  • Glukos-6-fosfatdehydrogenasbrist (G6PD) : ASA kan möjligen orsaka en hemolytisk kris hos patienter med G6PD (favism), en sjukdom som förekommer hos ca 1/350 nyfödda barn i Sverige. Det är dock omdebatterat om ASA är helt kontraindicerat hos G6PD-patienter som har en stark indikation för ASA, konsesus saknas. [1]Li J, Chen Y, Ou Z, Ouyang F, Liang J, Jiang Z, Chen C, Li P, Chen J, Wei J, Zeng J. Aspirin Therapy in Cardiovascular Disease with Glucose-6-Phosphate Dehydrogenase Deficiency, Safe or Not? Am J … Continue reading [2]Feghaly J, Al Hout AR, Mercieca Balbi M. Aspirin safety in glucose-6-phosphate dehydrogenase deficiency patients with acute coronary syndrome undergoing percutaneous coronary intervention. BMJ Case … Continue reading [3]Kafkas NV, Liakos CI, Mouzarou AG. Antiplatelet and invasive treatment in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency and acute coronary syndrome. The safety of aspirin. J Clin … Continue reading En RCT om ASA för strokeprevention hos G6PD-patienter pågår.

Dosering:

  • Laddningsdos 320 mg (upp till 500 mg) p.o. Laddningsdos kan även ges i.v. (250 mg – 500 mg).
  • Underhållsdos 75 mg 1×1 dagligen p.o.

Behandlingstid:

Vid AKS och stabil angina tills vidare (utsättning vid kontraindikation eller om patient utvecklar en OAK-indikation).

Kontroller:

Vid klinisk misstanke på anemi.

Kommentar:

I.v. laddning lämplig för patienter som inte kan svälja tabletter (chock, hjärtstop etc).

Länk till FASS.se här

ASA-historisk utveckling

(originalpublikationen- en disputation från 2019 – är på engelska):

The history of antiplatelet drugs began with Acetylsalicylic Acid (ASA). An essential step in platelet activation (initiated by platelet adhesion to collagen or von Willebrand factor) is platelets’ synthesis and release of the prostaglandin Thromboxane A2 and ADP.

ASA irreversibly blocks platelets’ cyclooxygenase by acetylation and thus reduces the production of the platelet-aggregation-stimulating Thromboxane A2 [4]Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF and Braunwald E. Braunwald’s heart disease : a textbook of cardiovascular medicine; 2019 [5]Opie LH and Gersh BJ. Drugs for the Heart : Expert Consult – Online and Print. Saint Louis: Elsevier Health Sciences; 2014 (Thromboxane was named after its platelet aggregation property at Karolinska Institute in the 1970s).[6]Hamberg M, Svensson J and Samuelsson B. Thromboxanes: a new group of biologically active compounds derived from prostaglandin endoperoxides. Proceedings of the National Academy of Sciences of … Continue reading [7]Fitzgerald DJ and Fitzgerald GA. Historical lessons in translational medicine: cyclooxygenase inhibition and P2Y12 antagonism.Circulation research. 2013;112:174-94 Bark and leaves from the willow tree, Salix, (see Linné) [8]Linné Cv and Salvius L. Caroli Linnaei … Species plantarum :exhibentes plantas rite cognitas, ad genera relatas, cum differentiis specificis, nominibus trivialibus, synonymis selectis, … Continue reading were used as anti-inflammatory and painkilling drugs for more than 3,000 years [9]Fuster V and Sweeny JM. Aspirin: a historical and contemporary therapeutic overview. Circulation. 2011;123:768-78 and recommended by Hippocrates 2,400 years ago [10]Mueller RL and Scheidt S. History of drugs for thrombotic disease. Discovery, development, and directions for the future. Circulation. 1994;89:432-49 for use as analgetics in childbirth, and analgesia and anti-inflammation were  even the indications for the drug Aspirin after the synthetic production of ASA (acetylated salicylate) in Germany at the turn of the 19th to the 20th century. [11]Mueller RL and Scheidt S. History of drugs for thrombotic disease. Discovery, development, and directions for the future. Circulation. 1994;89:432-49 The initially extracted salicylate, named after the tree Salix, had severe gastric side effects, illustrated by the fact that its current indication is usage as a keratolytic for warts. [12]Mueller RL and Scheidt S. History of drugs for thrombotic disease. Discovery, development, and directions for the future. Circulation. 1994;89:432-49 Before synthetic production, meadowsweet (spiraea ulmaria) was used for the production of ASA due to its higher concentration of salicylates, hence the name Aspirin was selected (acetyl spirsäure with the at-the-time popular suffix –in, as in Heroin by the same company Bayer or as in the U.S. Heparin).[13]Mueller RL and Scheidt S. History of drugs for thrombotic disease. Discovery, development, and directions for the future. Circulation. 1994;89:432-49

The effect of ASA on platelet aggregation first became known in the 1960s [14]Fitzgerald DJ and Fitzgerald GA. Historical lessons in translational medicine: cyclooxygenase inhibition and P2Y12 antagonism. Circulation research. 2013;112:174-94 [15]Fuster V and Sweeny JM. Aspirin: a historical and contemporary therapeutic overview. Circulation. 2011;123:768-78 [16]Mueller RL and Scheidt S. History of drugs for thrombotic disease. Discovery, development, and directions for the future. Circulation. 1994;89:432-49 and the first major study with clinical cardiovascular endpoints was conducted in the late 1970s to prove ASA was effective in the secondary prevention of stroke. [17]Group CCS. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. The New England journal of medicine. 1978;299:53-9 In 1983, a RCT showed a reduction of the rate of MI or death by 50% in patients with unstable angina treated with ASA, as compared to a placebo. [18]Lewis HD, Jr., Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE, 3rd, Schnaper HW, LeWinter MM, Linares E, Pouget JM, Sabharwal SC, Chesler E and DeMots H. Protective effects of aspirin … Continue reading In 1984, a RCT proved ASA was effective in preventing early and late saphenous vein graft occlusion after CABG, [19]Chesebro JH, Fuster V, Elveback LR, Clements IP, Smith HC, Holmes DR, Jr., Bardsley WT, Pluth JR, Wallace RB, Puga FJ and et al. Effect of dipyridamole and aspirin on late vein-graft patency after … Continue reading while in 1985, a Canadian multicenter RCT confirmed a 51% risk reduction (cardiac death or MI) in unstable angina [20]Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA, Jablonsky G, Kostuk WJ, Melendez LJ, Myers MG and et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian … Continue reading and three years later, the ISIS-2 trial showed a significant improved survival rate (25 prevented deaths for every 1,000 patients taking one month of ASA) and fewer re-infarctions and strokes in STEMI patients taking ASA alone or initially in combination with streptokinase. [21]Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct … Continue reading [22]Baigent C, Collins R, Appleby P, Parish S, Sleight P and Peto R. ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous … Continue reading

A medicine used for thousands of years could half the risk of death and MI. Based on this fantastic data, ASA has from the 1990s to today been a standard acute and secondary preventive treatmentfor all subtypes of acute coronary syndromes. 

Last Updated on June 26, 2021 by Christian Dworeck

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