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Stroke and transient ischaemic attack - Management
How should I manage the key drug interactions of low-dose aspirin?
- Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) with low-dose aspirin should be avoided where possible, because concomitant use increases the risk of gastrointestinal adverse effects and bleeding:
- Do not stop aspirin; cardiovascular protection should take precedence.
- Consider using paracetamol with or without codeine in place of an NSAID.
- If an NSAID is necessary, consider using gastroprotection with a proton pump inhibitor [MacDonald and Wei, 2003; NICE, 2005b].
- For further information on the management of people requiring low-dose aspirin and NSAIDs, see the CKS topic on NSAIDs - prescribing issues.
- Aspirin should be avoided in people taking methotrexate, if possible, as the excretion of methotrexate is reduced and risk of toxicity is increased.
- All antiplatelet drugs should be avoided in people taking anticoagulants, as the risk of bleeding and haemorrhage is increased.
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