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ASA administration with an allergy or sensitivity

Question# 786

Can you please define the contraindication for cardiac ischemia medical directive, of allergy or sensitivity to NSAIDs for ASA administration.

I recently came across a patient with allergies to ibuprofen and ketorolac however is prescribed low dose (non coated)aspirin for CAD which is taken daily.

Is it reasonable to administer ASA to this patient experiencing ischemic chest pain?

Answer:

Firstly, we appreciate your desire to provide mortality benefit for this patient with ischemic chest pain. In terms of your question, administering medications like ASA relies on a risk/benefit analysis. As long as the patient is advised of the potential risks and is accepting of those risks, then therapy/medication can be provided. “Allergic reactions to ASA form a clinical spectrum, and not all patients with a reported ASA allergy have ASA-induced anaphylactoid reaction” (Ramanuja, Breall, & Kalaria, 2004). This is where a thorough history taking, and event analysis is important. Also, it is very important to have thorough documentation surrounding the reasoning of providing ASA to these patients. Patching to the BHP for consultation is always welcomed and encouraged in the event you are unsure or have questions.

More specifically to the medical directive, some patients may be actually only allergic to specific NSAIDs, again referring to the spectrum of reactions that are possible. The patient you described, allergic to Ibuprofen and Ketorolac, simply may not be allergic to ASA and/or their physician has determined the benefits outweigh the risks for them to take it daily. It is also important to note that ASA has been shown to positively affect morbidity and mortality. Based on the patient having ASA as part of their regular medication regimen and has taken it before without complications, it would be reasonable to administer ASA to this patient if within your clinical judgement it would benefit them. And as with all medications we provide, further documentation of the effects, positive or negative, is best practice.

References

Ramanuja, S., Breall, J. A., & Kalaria, V. G. (2004). Approach to “Aspirin Allergy” in Cardiovascular Patients. Circulation.

Published

26 March 2024

ALSPCS Version

5.3

Views

92

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.