Class: Salicylates
VA Class: CN103
CAS Number: 50-78-2
Brands: Aggrenox, Alka-Seltzer, Anacin, Ascriptin, Ascomp, Aspergum, Bayer, BC Powder, Bufferin, Cope, Damason-P, Darvon, Easprin, Ecotrin, Endodan, Equagesic, Fiorinal, Fortabs, Gelpirin, Genacote, Goody’s, Halfprin, Lanorinal, Micrainin, Norgesic, Percodan, Soma Compound, St. Joseph, Stanbeck Powder, Synalgos-DC, Vanquish, ZORprin
Introduction
NSAIA; salicylate ester of acetic acid.a
Uses for Aspirin
Pain
Symptomatic relief of mild to moderate pain.a
Self-medication in children for the temporary relief of minor aches and pains and headache.841
Self-medication in adolescents and adults for the temporary relief of minor aches and pains associated with headache, common cold, toothache, muscular aches, backache, arthritis, menstrual cramps,836 and sore throat.837 840
Self-medication in fixed combination with acetaminophen and caffeine for the temporary relief of mild to moderate pain associated with migraine headache;701 702 703 also can be used for the treatment of severe migraine headache if previous attacks have responded to similar non-opiate analgesics or NSAIAs.701 702 703 778
Fever
Self-medication for reduction of fever associated with colds, sore throats, and teething.837 841 (See Contraindications and see Pediatric Use under Cautions.)
Inflammatory Diseases
Symptomatic treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, osteoarthritis, spondyloarthropathies, and systemic lupus erythematosus (SLE).a c l m
Rheumatic Fever
Symptomatic treatment of rheumatic fever†.a A drug of choice in patients with mild carditis (without cardiomegaly or CHF, with or without polyarthritis) or with polyarthritis only.h
TIAs and Acute Ischemic Stroke
Reduction of the risk of recurrent TIAs and stroke or death in patients who have had single or multiple TIAs or ischemic stroke (secondary prevention).c 646 682 691 737 818 842 881 m
Prevention of TIAs and stroke in patients undergoing carotid endarterectomy.646 690 769 828 m In patients with asymptomatic or recurrent carotid stenosis who are not candidates for surgery, lifelong prophylaxis with aspirin is recommended by American College of Chest Physicians (ACCP).828
Aspirin, dipyridamole and aspirin, or clopidogrel all considered acceptable options by ACCP, AHA and other clinicians for initial therapy in adults;818 881 in children, aspirin recommended following discontinuance of anticoagulation (e.g., unfractionated or LMW heparin, warfarin).825
Also used in fixed combination with extended-release dipyridamole to reduce the risk of recurrent stroke, death from all vascular causes, or nonfatal MI in patients who have had TIAs or completed ischemic stroke caused by thrombosis.691 716 738 739 743 881 883
Aspirin and dipyridamole combination or clopidogrel monotherapy may be preferable to aspirin monotherapy for secondary prevention based on somewhat greater absolute risk reduction for stroke; weigh benefit against additional costs of therapy.818
Acute treatment of ischemic stroke† when thrombolytic therapy is contraindicated or not indicated.691 699 700 716 818 862 May be safely used with low-dose sub-Q heparin to prevent DVT in such patients.818
Secondary Prevention of CAD and MI
Recommended by ACCP for reduction of the risk of vascular events in all patients with CAD regardless of the presence or absence of clinical manifestations.820 823 828 867
Reduction of the risk of vascular mortality in patients with suspected acute ST-segment elevation MI (AMI).c 579 635 636 646 669 742 765 819 820 821 m
Reduction of the risk of stroke and recurrent infarction in patients surviving an MI (secondary prevention).c 579 635 646 669 742 765 820 821 842 m
Recommended by ACCP for use as monotherapy in low- to moderate-risk post-MI patients in most health-care settings.820
Recommended by American Diabetes Association (ADA) for the prevention of cardiovascular events in diabetic patients who have evidence of large-vessel disease (e.g., history of MI, CABG, stroke or TIA, peripheral vascular disease, claudication, angina). 830 901
Recommended by ACCP for use in combination with short-term oral anticoagulation (e.g., warfarin therapy) in high-risk, post-MI patients (e.g., anterior MI or acute MI with severe left ventricular dysfunction, congestive heart failure, previous emboli, or echocardiographic evidence of mural thrombosis).820
Recommend by ACC and AHA for short-term use in combination withwarfarin in patients with left ventricular thrombus and for long-term use in patients without an increased risk for bleeding.821
Recommended by ACC and AHA for use in combination with long-term warfarin therapy in patients without coronary stents in whom other indications for anticoagulation exist (e.g., atrial fibrillation,cerebral emboli, extensive wall-motion abnormality).821
Recommended by ACCP for use in combination with long-term oral anticoagulation (e.g., warfarin therapy) in post-MI patients where meticulous INR monitoring is standard and routinely accessible.820
Has been used in combination with clopidogrel and other standard therapy (e.g., thrombolytic agents, heparin) during acute MI to reduce mortality, recurrent MI, recurrent ischemia, or stroke.852 853 854 855 856 862
Primary Prevention of CAD and MI
May reduce the risk of a first MI† in certain patient populations (primary prevention).573 574 575 576 658 659 660 661 666 667 668 669 670 671 783 785 786 820 848 851 Balance of risks and benefits is most favorable in patients at moderate to high risk of CHD783 820 (based on age and 10-year risk of cardiac event >10%).668 669 820 832 Use of aspirin in such patients is suggested over either warfarin or no antithrombotic therapy.820
Recommended by ADA for primary prevention in patients with type 1 or type 2 diabetes mellitus who are at high risk for cardiovascular events (i.e., familial history of CHD, smoking, hypertension, obesity, albuminuria, elevated blood cholesterol or triglyceride concentrations) and in whom aspirin is not contraindicated.760 830 901
Benefit appears to be minimal or lacking in women at low risk for CHD, except possibly those ≥65 years of age; further study needed.846 847 848 849 850 851
Not currently recommended for primary prevention in the general population without known risk factors.646 658 661 662 669 674 675 676 783 784 847
Unstable Angina or Non-ST-Segment Elevation MI
Reduction of the risk of death and/or nonfatal MI in patients with unstable angina or non-ST-segment elevation (NSTE) acute coronary syndromes (ACSs).c 581 613 614 615 616 617 618 619 620 621 669 682 684 728 736 740 765 775 820 m ACCP recommends use with low molecular weight heparins over unfractionated heparin for the acute treatment of patients with NSTE ACSs.820
In patients with unstable angina or NSTE ACS who are not at high risk for bleeding, ACC and AHA recommend adding clopidogrel to aspirin and heparin therapy for reduction of cardiovascular and cerebrovascular events.765 768 771 820 823 824 833 865 866 867 868 905
In patients with unstable angina and moderate to high-risk features, use in combination with other antiplatelet therapies (e.g., tirofiban, eptifibatide) and heparin recommended by ACC, AHA, and ACCP.820 833
Chronic Stable Angina
Reduction of the risk of MI and/or sudden death in patients with chronic stable angina.c 646 669 680 728 736 820 822 m
May administer with clopidogrel in selected high-risk patients with chronic stable angina.820
Percutaneous Coronary Intervention and Revascularization Procedures
Reduction of cardiovascular risks (e.g., early ischemic complications, graft closure) in patients undergoing percutaneous coronary intervention (PCI) including coronary angioplastyc 646 686 824 865 866 or stent implantation, 686 824 865 866 886 887 888 889 m or CABG.c 646 683 685 781 782 823 m
Pretreatment with aspirin prior to PCI recommended by ACC and AHA.865 867 Adjunctive therapy with a loading dose of a thienopyridine derivative is preferred by ACCP over systemic anticoagulant therapy prior to the procedure.771 824 865
For patients unable to tolerate aspirin, ACC and AHA suggest pretreatment with clopidogrel,865 866 while ACCP suggests pretreatment with clopidogrel or ticlopidine prior to planned PCI.771 824
Continue low-dose aspirin therapy indefinitely as secondary prevention against cardiovascular events following PCI.824 865 867 880 No evidence that such long-term therapy affects the rate of restenosis.686 771 824
Recommended by ACC and AHA in combination with clopidogrel as short-term prophylaxis (≥1 month), preferably long-term prophylaxis (≤1 year) after PCI in patients with bare-metal stents who are not at high risk for bleeding.821 865 867
Prolonged prophylaxis (≤12 months) in combination with a thienopyridine derivative strongly recommended after PCI in patients with drug-eluting stents (DES) who are not at high risk of bleeding.886 887 888 890 891 892 894 902 (See Thrombosis Associated with Drug-eluting Stents under Cautions.)
Use in combination with clopidogrel suggested by ACC and AHA in patients undergoing brachytherapy for restenosis following PCI and stent implantation†.865
Recommended by ACCP for use in all patients undergoing saphenous vein or internal mammary artery bypass grafting (regardless of effect on graft patency) based on indication in all patients with CAD.823 ACC and AHA recommend use after saphenous vein CABG to reduce risk of graft closure.867 885
May be used in combination with oral anticoagulants in patients with saphenous vein bypass grafts who have underlying conditions necessitating use of oral anticoagulants (e.g., prosthetic heart valves).768 823
Embolism Associated with Atrial Fibrillation/Flutter
An alternative or adjunct to oral anticoagulation for reduction of the incidence of thromboembolic episodes in selected patients with chronic atrial fibrillation† or atrial flutter†.744 747 749 773 774 776 826 880
Use of either aspirin or warfarin is suggested by ACC, AHA, and other clinicians in patients with nonvalvular atrial fibrillation with intermediate risk of stroke.826 k n o
Recommended for use in patients with atrial fibrillation at low risk for stroke or who are poor candidates for oral anticoagulation.744 747 748 749 767 773 774 776 826 880 881 k n o
Recommended for use in patients with “lone” atrial fibrillation (e.g., those younger than 75 years of age without prior stroke or TIA) over warfarin because relatively low risk of stroke in these patients does not warrant risks of oral anticoagulation.
Embolism Associated with Valvular Heart Disease
Used as an alternative or adjunct to oral anticoagulation for reduction of the incidence of thromboembolic episodes in selected patients with valvular heart disease†.746 764 827 881
Recommend by ACCP for use in patients with mitral valve prolapse and unexplained symptomatic TIAs.827
Used as an adjunct to warfarin in patients with mitral valve disease associated with rheumatic fever and recurrent embolism despite warfarin therapy.827 881
Thrombosis in Other Arteries and Arteriovenous Communications
Reduction of the risk of stroke and MI in patients undergoing peripheral percutaneous transluminal angioplasty (PTA) with or without stenting.690 828
Reduction of the risk of long-term cardiovascular morbidity and mortality in patients with chronic limb ischemia (e.g., intermittent claudication) resulting from arteriosclerosis.690 769 828 Use of aspirin is suggested by ACCP over clopidogrel in these patients because of cost considerations.828
Prolonging the patency of vascular grafts following peripheral bypass surgery (e.g., prosthetic infrainguinal femoropopliteal).690 769 828 Prophylaxis used in selected patients undergoing other bypass procedures and vascular reconstructions; consult specialized references for additional information.690 769 828
Has been used following initial heparin therapy to reduce the risk of thrombotic occlusion in children with Blalock-Taussig shunts†.662 718 825
Prosthetic Heart Valves
Has been used in conjunction with warfarin to reduce the risk of systemic thromboembolism and death in patients with mechanical prosthetic heart valves†.692 693 694 717 827
In patients with a bioprosthetic valve in the aortic position, ACCP recommends aspirin or warfarin for the first 3 months following valve insertion.827 Follow-up long-term therapy recommended to protect against thromboembolism in patients with bioprosthetic heart valves† who are in sinus rhythm and without risk factors.827
May be added to therapy with a low molecular weight heparin or unfractionated heparin in pregnant women with prosthetic heart valves† who are at high risk for thrombosis.845
Thrombosis Associated with Fontan Procedure
Has been used for prevention of thromboembolic complications following Fontan procedure† (definitive palliative surgical treatment for most congenital univentricular heart lesions) in children.662 825 Antithrombotic therapy effective in <50% of patients and many prophylactic regimens in use; no consensus on optimal regimen.662 825
Pericarditis
Drug of choice for the management of pain associated with acute pericarditis† following MI.635 821
Kawasaki Disease
Treatment of Kawasaki disease; used in conjunction with immune globulin IV (IGIV).636 637 638 662 825
Complications of Pregnancy
Has been used alone or in combination with other drugs (e.g., heparin, corticosteroids, immune globulin) for prevention of complications of pregnancy† (e.g., preeclampsia, pregnancy loss in women with a history of antiphospholipid syndrome and recurrent fetal loss).594 595 596 597 599 600 601 605 626 627 628 647 648 650 651 652 653 654 705 706 707 708 709 710 711 712 713 714 715 726 817 845 857
Use in combination with subcutaneous low-dose unfractionated heparin or a low molecular weight heparin suggested by ACCP in women with a congenital thrombophilic deficit and recurrent spontaneous abortions, a second-trimester or later pregnancy loss, severe or recurrent preeclampsia, or abruption.845
Combined prophylactic therapy with low dosages of aspirin and unfractionated heparin considered the regimen of choice in women with antiphospholipid syndrome and a history of multiple pregnancy losses, followed by postpartum oral anticoagulation therapy.845 Combination prophylactic therapy with aspirin and unfractionated or low molecular weight heparin followed by postpartum anticoagulation suggested in women with antiphospholipid syndrome and a history of multiple pregnancy losses,preeclampsia, intrauterine growth retardation, or abruption.845 857 In women with antiphospholipid syndrome and no prior venous thromboembolism or pregnancy loss, consider clinical surveillance alone or therapy with low-dose unfractionated heparin, once-daily low molecular weight heparin, and/or low dosages of aspirin.647 652 845 857
Routine use of aspirin prophylaxis to reduce the incidence and severity of preeclampsia (even in patients at increased risk of preeclampsia) generally not recommended; 634 705 706 707 712 713 715 can consider prophylaxis in women with prior severe or early-onset preeclampsia, chronic hypertension, severe diabetes, or moderate to severe renal disease.815 816 817 (See Pregnancy under Cautions.)
Prevention of Cancer
Limited data (observational studies) suggest that aspirin or other NSAIAs may reduce the risk of various cancers† (e.g., colorectal, breast, gastric cancer);864 870 871 872 873 such results generally not confirmed in randomized controlled trials.864 874 875 876
Regular use (e.g., daily) associated with a reduction in the risk of recurrent colorectal adenomas and colorectal cancer† in some studies.789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 Beneficial effects of NSAIAs in reducing colorectal cancer risk dissipate following discontinuance of such therapy. Preventive therapy with aspirin currently not recommended because aspirin does not completely eliminate adenomas; aspirin therapy should not be considered a replacement for colorectal cancer screening and surveillance.790 793 794 795 796 814
Aspirin Dosage and Administration
Administration
Administer orally; may administer rectally as suppositories in patients who cannot tolerate oral therapy.a
Do not use aspirin preparation if strong vinegar-like odor is present.a
Oral Administration
Usually administer orally with food or a full glass of water (240 mL).a 836 m
Film-coated, extended-release, or enteric-coated may be associated with less GI irritation and/or symptomatic GI disturbances than uncoated tablets.a
Do not use delayed-release or extended-release tablets if rapid response is required.a
Swallow delayed-release and extended-release tablets whole; do not crush or chew.a
Prepare oral solution by dissolving 2 tablets for solution (Alka-Seltzer) in 120 mL of water; ingest the entire solution to ensure adequate dosing.838 843 844
Do not chew aspirin preparations for ≥7 days following tonsillectomy or oral surgery;841 837 do not place preparations directly on tooth or gum surface (possible tissue injury from prolonged contact).a
Rectal Administration
Do not administer aspirin tablets rectally.a
Dosage
When used for pain, fever, or inflammatory diseases, attempt to titrate to the lowest effective dosage.a
When used in anti-inflammatory dosages, development of tinnitus can be used as a sign of elevated plasma salicylate concentrations (except in patients with high-frequency hearing impairment).a
Pediatric Patients
Dosage in children should be guided by body weight or body surface area.a 841
Do not use in children and teenagers with varicella or influenza, unless directed by a clinician.841 (See Contraindications under Cautions.)
Pain
Oral
Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a
Dose may be given every 4 hours as necessary (up to 5 times in 24 hours).841
Age | Weight | Oral Dose |
|---|---|---|
<3 years of age | <14.5 kg | Consult clinician |
3–<4 years | 14.5–16 kg | 160 mg |
4–<6 years | 16–20.5 kg | 240 mg |
6–<9 years | 20.5–30 kg | 320 mg |
9–<11 years | 30–35 kg | 320–400 mg |
11 years | 35–38 kg | 320–480 mg |
For self-medication in children ≥12 years of age, 325–650 mg every 4 hours (maximum 4 g daily) or 1 g every 6 hours as necessary.836 e
For self-medication in children ≥12 years of age, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837
For self-medication in children ≥12 years of age, 650 mg (as highly buffered effervescent solution [Alka-Seltzer Original]) every 4 hours (maximum 2.6 g daily); alternatively, 1 g (Alka-Seltzer Extra Strength) every 6 hours (maximum 3.5 g daily).843 844
Rectal
Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a
Children ≥12 years of age: 325–650 mg every 4 hours as necessary (maximum 4 g daily).a
Fever
Oral
Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a
Dose may be given every 4 hours as necessary (up to 5 times in 24 hours).841
Age | Weight | Oral Dose |
|---|---|---|
<3 years of age | <14.5 kg | Consult physician |
3–<4 years | 14.5–16 kg | 160 mg |
4–<6 years | 16–20.5 kg | 240 mg |
6–<9 years | 20.5–30 kg | 320 mg |
9–<11 years | 30–35 kg | 320–400 mg |
11 years | 35–38 kg | 320–480 mg |
Children ≥12 years of age: 325–650 mg every 4 hours as necessary (maximum 4 g daily).a
For self-medication in children ≥12 years of age, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837
Rectal
Children 2–11 years of age: 1.5 g/m2 daily administered in 4–6 divided doses (maximum 2.5 g/m2 daily).a
Children ≥12 years of age: 325–650 mg every 4 hours as necessary (maximum 4 g daily).a
Inflammatory Diseases
Juvenile Rheumatoid Arthritis
Oral
Initially, 90–130 mg/kg daily in divided doses.c m Increase dosage as necessary for anti-inflammatory efficacy; target plasma salicylate concentration is 150–300 mcg/mL.c m Plasma concentrations >200 mcg/mL associated with an increased incidence of toxicity.c m
Rheumatic Fever†
Oral
Initially, 90–130 mg/kg daily given in divided doses every 4–6 hours for up to 1–2 weeks for maximal suppression of acute inflammation, followed by 60–70 mg/kg daily in divided doses for 1–6 weeks.a Adjust dosage based on response, tolerance, and plasma salicylate concentrations.a Gradually withdraw over 1–2 weeks.a
Various regimens suggested depending on severity of initial manifestations.a Consult published protocols for more information on specific dosages and schedules.a
Thrombosis
Acute Ischemic Stroke†
Oral
2–5 mg/kg daily suggested by ACCP following discontinuance of anticoagulant (e.g., unfractionated or LMW heparin, warfarin) therapy.825
Blalock-Taussig Shunt†
Oral
5 mg/kg daily has been suggested following intraoperative heparin.825
Fontan Procedure†
Oral
5 mg/kg daily has been suggested; optimal duration of therapy unknown.825
Mechanical Prosthetic Heart Valves†
Oral
6–20 mg/kg daily in combination with oral anticoagulation for patients with lack of response to oral anticoagulation or contraindication to full-dose oral anticoagulation suggested by ACCP.825
Bioprosthetic Heart Valves†
Oral
ACCP suggests same treatment as for adults825 (75–100 mg daily long term in those in sinus rhythm).827
Kawasaki Disease
Oral
Initially, 80–100 mg/kg daily given in 4 equally divided doses (in combination with IVIG); initiate within 10 days of onset of fever.636 637 638 639 640 662 825 May be necessary to monitor plasma salicylate concentrations.636 637 638 When fever subsides, decrease dosage to 3–5 mg/kg once daily.636 637 638 639 640 641
Continue indefinitely in those with coronary artery abnormalities;636 637 638 in the absence of such abnormalities, continue for 6–8 weeks after initial onset of illness or until platelet count and erythrocyte sedimentation rate return to normal.636 637 638 662 825
Adults
Pain
Oral
For self-medication, 325–650 mg every 4 hours (maximum 4 g daily) or 0.5–1 g every 6 hours as necessary.836 e
For self-medication, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837
Adults <60 years of age for self-medication: 650 mg (as a highly buffered effervescent solution [Alka-Seltzer Lemon-Lime or Original]) every 4 hours (maximum 2.6 g daily); alternatively, 1 g (Alka-Seltzer Extra Strength) every 6 hours (maximum 3.5 g daily).838 843 844
Adults ≥60 years of age for self-medication: 650 mg (as a highly buffered effervescent solution [Alka-Seltzer Lemon-Lime or Original]) every 4 hours (maximum 1.3 g daily); alternatively, 1 g (Alka-Seltzer Extra Strength) every 6 hours (maximum 1.5 g daily).838 843 844
Rectal
325–650 mg every 4 hours as necessary (maximum 4 g daily).a
Pain Associated with Migraine Headache
Oral
For self-medication, 500 mg (combined with acetaminophen 500 mg and caffeine 130 mg) as a single dose.701
Fever
Oral
325–650 mg every 4 hours as necessary (maximum 4 g daily).a
For self-medication, 454 mg (as chewing gum pieces) every 4 hours as necessary (maximum 3.632 g daily).837
Rectal
325–650 mg every 4 hours as necessary (maximum 4 g daily).a
Inflammatory Diseases
Rheumatoid Arthritis and Arthritis and Pleurisy of SLE
Oral
Initially, 3 g daily in divided doses.c l m Increase dosage as necessary for anti-inflammatory efficacy; target plasma salicylate concentration is 150–300 mcg/mL.c l m Plasma concentrations >200 mcg/mL associated with an increased incidence of toxicity.c l m
Osteoarthritis
Oral
Up to 3 g daily in divided doses.c m
Spondyloarthropathies
Oral
Up to 4 g daily in divided doses.c m
Rheumatic Fever†
Oral
Initially, 4.9–7.8 g daily in divided doses given for maximal suppression of acute inflammation.a Adjust dosage based on response, tolerance, and plasma salicylate concentrations.a
Various regimens suggested depending on severity of initial manifestations.a Consult published protocols for more information on specific dosages and schedules.a
TIAs and Acute Ischemic Stroke
Secondary Prevention
Oral
50–325 mg daily in patients who experienced a noncardioembolic stroke or TIA (i.e., atherothrombotic, lacunar, or cryptogenic stroke).a m 646 691 818
Alternatively, 25 mg (in combination with dipyridamole 200 mg) twice daily (morning and evening) or clopidogrel (75 mg daily).738 818
50–100 mg daily suggested by some clinicians for patients at moderate to high risk of bleeding complications.818
Continue secondary prevention indefinitely.646 691 818 m
Acute Treatment† of Ischemic Stroke
Oral
160–325 mg daily, initiated within 48 hours of stroke onset in patients who are not receiving thrombolytic therapy and continued for up to 2–4 weeks;691 699 700 818 then aspirin, dipyridamole and aspirin, or clopidogrel for secondary prevention.646 691 699 700 818
CAD and MI
Suspected AMI or ACS
Oral
160–325 mg as soon as AMI or ACS is suspected (no later than 24 hours after symptom onset), continued daily after MI.c m 579 635 646 669 765 819 820 821 862 (See CAD and MI: Secondary Prevention, under Dosage and Administration.)
Consider adjunctive therapy with clopidogrel (e.g., 300-mg loading dose, then 75 mg daily) for acute ST-segment elevation MI, unless contraindicated.852 853 854 855 856 862
75–325 mg daily initially for non-ST-segment elevation (NSTE) ACS also has been recommended.820
Rectal
300 mg daily may be considered for patients with severe nausea, vomiting, or upper GI tract disorders.821 862
Secondary Prevention
Oral
75–325 or 75–162 mg once daily, continued indefinitely, has been recommended;c 635 646 668 669 736 740 765 775 820 821 822 823 828 867 881 m current evidence suggests 75–81 mg daily sufficient for long-term cardiovascular disease prevention and associated with less GI bleeding risk.s
75–162 mg (possibly 75–81 mg)s daily in combination with long-term (up to 4 years), moderate-intensity (target INR: 2–3) oral anticoagulation recommended in post-MI patients where meticulous INR monitoring standard and routinely ac
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