Aspirin Administration in Dialysis Patients with Chest Pain

Rationale for Aspirin Use

The American Heart Association recommends that aspirin (162-325 mg) be administered promptly to patients with suspected acute coronary syndromes, regardless of dialysis status, as it significantly decreases mortality when administered early after symptom onset 3, 4
The 2015 AHA guidelines state that nonenteric aspirin should be given as soon as possible to all patients with suspected ACS, unless there is a known aspirin allergy or active gastrointestinal hemorrhage (Class I, LOE A) 2
Early administration of aspirin has been associated with higher survival compared to late administration 3

The recommended dose is 160-325 mg of non-enteric aspirin, chewed and swallowed, according to the American Heart Association guidelines 5, 6
EMS providers should administer nonenteric aspirin (160-325 mg) to patients with suspected ACS (Class I, LOE B to C), as recommended by the American Heart Association 2, 7
For patients unable to take aspirin due to hypersensitivity or major gastrointestinal intolerance, clopidogrel 300 mg can be administered as an alternative (Class IIa, LOE B), as suggested by the American College of Cardiology 1, 2

The American Heart Association recommends assessing for signs/symptoms suggestive of ACS and checking for absolute contraindications before administering aspirin 3
If no contraindications exist, 162-325 mg non-enteric aspirin should be administered to be chewed and swallowed, as recommended by the American Heart Association 5, 6
If aspirin is contraindicated, clopidogrel 300 mg can be considered as an alternative, according to the American College of Cardiology guidelines 1, 2