Who does not get aspirin when it comes to chest pain?
Consider which of the following four patients should not be given aspirin:
1. Patient on Coumadin?
2. Patient with a history of GERD?
3. Patient with hemophilia?
4. Patient with Kuru?  (By the way, Kuru is an encephalitis that cannibals have by eating other people’s brains).
So which one of those patients doesn’t get aspirin?
I don’t like throwing a lot of statistics at people, but I need to share with you some numbers about this point. It’s important. We have to talk about the ISIS-2 study.
The ISIS-2 study showed that the use of aspirin alone significantly decreased the risk of vascular death by 21%. That means it’s not like they kind of did better, it’s not like the mortality was lower, it’s like you saved 21 lives out of 100. That is heroic!
Streptokinase, which is a clot buster, alone showed significant results versus placebo, 23 lives out of 100. So we have 21% and 23%, together they reduce deaths by 44%.
So what do these numbers mean to you? They mean streptokinase is as good as aspirin and aspirin is as good as streptokinase. Just so you know, clot busters are a medicine that costs thousands of dollars. The ISIS-2 study says that aspirin is as good as clot busters in saving lives.
Aspirin saves lives!
So back to the original question, who doesn’t get aspirin if they have chest pain? There is only one answer here…..
ALLERGY.
If they are allergic, they shouldn’t get aspirin. That’s it. If they’re allergic, you give them Plavix. That’s a class I recommendation, 300 mg of Plavix, but if they’re not allergic, they should get aspirin. How much aspirin?  It could be as much as a gram, 10 baby aspirins. It could be as little as licking an aspirin. We don’t know for sure. I like saying ‘chew two’ because it rhymes.
So remember, ASPIRIN SAVES LIVE!
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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.
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