Dr. Pankaj Karan's Podcast

Aspirin (acetylsalicylic acid) is used in both low-dose (81 mg) and full-dose (325 mg) forms for different therapeutic purposes, primarily due to its antiplatelet, anti-inflammatory, and analgesic properties. Here's a breakdown of the key indications for each dose: Aspirin 81 mg (Low-Dose Aspirin) Mainly used for its antiplatelet (blood-thinning) effects to reduce the risk of cardiovascular events. ✅ Indications: Secondary prevention of: Myocardial infarction (MI) Ischemic stroke or TIA After coronary artery stent placement Post coronary artery bypass graft (CABG) Peripheral arterial disease (PAD) Primary prevention in select high-risk individuals (based on age, cardiovascular risk factors, and bleeding risk – per recent guidelines): Typically men and women aged 40–70 with increased cardiovascular risk and low bleeding risk Atrial fibrillation: In low-risk patients or those unable to take anticoagulants (less common now due to preference for DOACs) Aspirin 325 mg (Full-Dose Aspirin) Used for anti-inflammatory, analgesic, and antipyretic effects, as well as stronger antiplatelet activity when urgently needed. ✅ Indications: Acute coronary syndrome (ACS): Initial management of suspected MI: 325 mg chewed immediately STEMI/NSTEMI management Stroke prevention/treatment: Acute ischemic stroke: After ruling out hemorrhage (usually initial dose 160–325 mg) Post-vascular procedures or events: Higher-dose sometimes used short-term post-stenting or after carotid endarterectomy Pain, inflammation, and fever (historically): Arthritis, rheumatic diseases (now less common due to GI risk and availability of other NSAIDs) Kawasaki disease (pediatric use): Initial high dose for anti-inflammatory effects, followed by low-dose antiplatelet therapy Essential thrombocythemia or polycythemia vera: As an antiplatelet agent to prevent thrombotic complications ⚠️ Key Considerations: GI bleeding, peptic ulcers, bleeding disorders, or concurrent use of other anticoagulants are major contraindications. Enteric-coated formulations may reduce gastric irritation but do not significantly reduce bleeding risk.