Aspirin at Christmas
11 December 2001
Christmas can lead to stress from pressure to complete office work on time for the big break, or even from too many late night parties. It could produce a serious strain on the heart, even a heart attack. Many people are unsure what to do when a family member or work colleague collapses with severe chest pains. Here are some useful tips.
‘Early’ and ‘immediate’
aspirin
Despite solid proof that swallowing a single aspirin tablet within a few hours
of the start of chest pain can save thousands of lives a year, most heart attack
victims are not given it – and some die as a result.
Most members of the public will not be aware that immediate administration of
half (150mg) an aspirin tablet (if the patient is fully conscious) could save a
life or reduce the severity of a heart attack even before the paramedics arrive.
Limiting the time between onset of pain and treatment of heart attacks is vital
to survival.
A dose of between 75mg and 150mg a day of aspirin is enough to prevent clots or
platelet aggregation. This is of crucial benefit to people with narrowed
coronary arteries or who are in the throes of myocardial infarction.
The ISIS-2 trial, co-ordinated in Oxford, reported on randomized aspirin and
thrombolytic treatment after infarction in over 17,000 patients and the CAST
trial involving 21,000 stroke patients gave evidence of a reduction in mortality
when aspirin was given early after the onset of symptoms. The ISIS-2 trial
showed that aspirin given within 0-4 hours of a heart attack reduced risk by 25%
and if given within 5-24 hours after symptoms, reduced risk by 21%.
A report by the British Heart Foundation now recommends early therapeutic
intervention with aspirin and rapid transferal of patients to hospital for
intravenous thrombolysis with what is often described as a ‘clot buster’
drug.
Members of a family or work colleagues are thus ideally placed to begin early
treatment with aspirin in patients with suspected acute MI, since aspirin can
easily be given straight away. The recommended dose of aspirin given at this
stage is 150mg (half a standard aspirin tablet) and the patient should be
advised to chew the tablet to aid absorption. You must confirm that the patient
is conscious and able to swallow before recommending the early or immediate
administration of aspirin. Unconscious patients or those unable to swallow
should not be given any medication by mouth but referred to emergency
professional treatment immediately.
The advantage of this therapeutic strategy is that if the pain turns out to be
simply muscular, aspirin will not have been inappropriate, whereas if the pain
does arise from an infarct, ‘immediate’ or ‘early’ aspirin intervention
may well save a life or prevent disability.
So for a heart attack – know the warning signs
· Deep chest pain
· Pain spreading to back, jaw or left arm
· Weakness
· Nausea and vomiting
· Anxiety – a feeling of ‘doom’
· Restlessness
· Sweaty. Skin cold to touch
What to do
· Call your local emergency service
· Call a doctor
· Check patient is fully conscious
· Check if conscious patient can swallow (try a teaspoon of water first)
· Ask if allergic to aspirin
· Get patient to chew half a regular aspirin (not more)
· If patient is unconscious wait until ambulance arrives
Although MIs can occur at any time of the day, they are most common in the early
morning, within a few hours of waking up. This is often when the patient is
still at home and the first person to be able to help will be the husband, wife
or teenage child.