Aspirin
Aspirin
- Last updated November 23, 2025
✅ Objectives
By the end of these revision notes, you should be able to:
- Understand the mechanism of action of aspirin
- Understand the clinical uses of aspirin
- Apply dental guidelines appropriately to manage patients on aspirin
What is aspirin?
Aspirin, or acetylsalicylic acid, is an incredibly commonly used drug. It is a non-steroidal anti-inflammatory drug (NSAID) with analgesia, antipyretic, anti-inflammatory and antiplatelet properties.
Understanding aspirin is crucial in dentistry due to the antiplatelet properties in relation to bleeding risk during dental procedures.
Mechanism of Action
Aspirin irreversible inhibits the enzyme cyclo-oxygenase (COX-1 and COX-2).
COX-1 inhibition
This blocks the conversion of arachidonic acid to prostaglandin H2. This reduces:
- Prostaglandins (reduces inflammation and pain)
- Thromboxane A2 (reduces platelet aggregation and vasoconstriction)
COX-2 inhibition
This decreases synthesis of prostaglandins involved in inflammation and fever.
The action of aspirin lasts for the lifetime of the platelet (approx. 7-10 days) and it is not monitored like warfarin.
Clinical Uses
Aspirin is an analgesic, antipyretic, antiplatelet and anti-inflammatory.
Due to these properties, aspirin is used for the following indications:
- Cardiovascular – this includes following a stroke or myocardial infarction
- Analgesic/anti-inflammatory – may be used for mild to moderate pain
- To manage pyrexia
Adverse Effects
Key adverse effects include gastrointestinal (gastric ulceration, bleeding, dyspepsia), haematological (prolonged bleeding time) and allergic responses amongst others.
Aspirin should not be used in patients who have an active stomach ulcer, hypersensitivity to NSAIDs, children <16 years (due to risk of Reye’s syndrome) and those with severe hepatic and renal impairment.
Dental Management
Prior to considering treatment, it is important to check if the patient has a significant bleeding history and if they are on concurrent antiplatelets or anticoagulants – this would warrant referral and specialist input.
The key guidance in relation to warfarin is the SDCEP Anticoagulant and Antiplatelet Guidance.
For patient’s on aspirin:
- Do not discontinue low-dose aspirin prior to routine dental treatment
If treatment is going ahead, then further measures can be taken to minimise complications associated with warfarin:
- Treat the patient early in the week and day
- Limit initial treatment area and stage extensive treatment
- Minimise trauma during extraction
- Utilise local haemostatic measures including active use of a haemostatic agent (collagen sponge etc) and suturing the socket
Ensure that the patient is provided with thorough post-operative instructions, including avoidance of NSAIDs.
Summary
- Aspirin irreversibly inhibits platelet aggregation for the lifetime of the platelet.
- It is commonly used in patients following cardiac events or strokes.
- Routine dental procedures are usually safe for patients on aspirin and do not require discontinuing the antiplatelet.
- Local haemostatic measures should be taken following dental extractions.
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