ASA Contraindications

[SWM_Medic]

Ok so this is a big one I tell all new paramedics. I got a call for a 37 y/o female with chest pain. she was in her third trimester with her 2nd child. The first one was a miscarriage. Now she had sub-sternal chest pain radiating left arm to her left jaw. 12-lead showed elevation in leads I, II, and depression in v4 and v5. With a history of cardiac problems to beat the band. So I did the standard treatment MONA. (Oxygen, Aspirin, Nitro, Morphine) When we got to the ER they wouldn't accept the pt Er dr said we had to go to L&D. When we got to L&D and gave report they wouldn't take the pt because of the Aspirin. I got yelled at by everyone who has any authority over me. From the ER doc to the my PMD to my Supervisor and ops manager down to the training officer. The PMD came in to work at 23:30 to yell at me. Apparently in the late trimesters you can't give Aspirin to a women because it will cause a disease that I can't remember the name of sorry. It basically causes the little heart valve that is supposed to shut during labor to remain open. If you ever wanna gives meds besides Albuterol, Dw50, mag sulfate and oxygen to a pregnant women. Call a Doc.

[ccmedoc]

Apparently in the late trimesters you can't give Aspirin to a women because it will cause a disease that I can't remember the name of sorry.

Could it be Patent ductus arteriosis. This has been connected to ASA administration in third trimester pregnancy. The closing of the ductus arteriosis within a few days of birth. With PDA, the connection does not close.

In utero, ASA has been associated with constriction of the Ductus Arteriosis, but only with high doses and late in pregnancy. Usually those doses taken for RA are quite high and ASA or other NSAIDs have been associated with the DA constriction, primary pulmonary hypertension in neonates, or oligohydramnios.

Low dose ASA , to my knowledge, has not been specifically shown damaging in late pregnancy but more research is necessary. Risk/benefit is important to analyze here.

This should be specifically discussed with med control and providers in the area as to what treatment would be acceptable. I don't think 324mg of ASA would be seen as high dose.

My opinion..

edit:..It was brought to me that one baby aspirin a day could be helpful in preventing pre-ecclampsia or HELLP syndrome..just another thought..

[JPINFV]

It basically causes the little heart valve that is supposed to shut during labor to remain open.

Foramen ovale

[Trauma612]

Please explain.

I cant due to the fact that I was just being foolish

[ERDoc]

I cant due to the fact that I was just being foolish

Gotcha. Sorry, you know how those things come across on the internet. However, if you feel the CVA is hemorhagic then ASA would be contraindicated. A pt with MI and a bleed is screwed however you want to look at it.

[DwayneEMTP]

Ok so this is a big one I tell all new paramedics. I got a call for a 37 y/o female with chest pain. she was in her third trimester with her 2nd child. The first one was a miscarriage. Now she had sub-sternal chest pain radiating left arm to her left jaw. 12-lead showed elevation in leads I, II, and depression in v4 and v5. With a history of cardiac problems to beat the band. So I did the standard treatment MONA. (Oxygen, Aspirin, Nitro, Morphine) When we got to the ER they wouldn't accept the pt Er dr said we had to go to L&D. When we got to L&D and gave report they wouldn't take the pt because of the Aspirin. I got yelled at by everyone who has any authority over me. From the ER doc to the my PMD to my Supervisor and ops manager down to the training officer. The PMD came in to work at 23:30 to yell at me. Apparently in the late trimesters you can't give Aspirin to a women because it will cause a disease that I can't remember the name of sorry. It basically causes the little heart valve that is supposed to shut during labor to remain open. If you ever wanna gives meds besides Albuterol, Dw50, mag sulfate and oxygen to a pregnant women. Call a Doc.

Hmmmm....what do the studies show concerning infant mortality with mothers that have died of MI I wonder?

I don't know what the incidence rate is secondary to asa for the above issues, but I've not seen that pregnancy is an absolute contraindication for asa...I'll have to look it up though.

We have many meds with precautions regarding pregnancy. Does the incidence of fetal morbidity truly outweigh the advantages of asa when applied to acute MI? Any of our smart people know the current thinking?

Dwayne

[ERDoc]

ASA is often used in women who are pregnant and have a history of miscarriages from a hypercoagulable state. It is given in a low dose. In late pregnancy high dose ASA, as well as NSAIDS, can cause premature closure of the ductus arteriosus (Google it to get the revelant info).

I think in this case it is a risk vs benefit issue. I would not fault you for giving one dose of ASA to someone who is actively infarcting, but it would seem that those where you took this pt disagree. Because this is such a rare event there is no good literature to support either side. Personally, I would rather save the mother and possibly lose the baby than lose both.

I also don't think going to L&D is the best idea either. The ER doc and the ER nurses are much better at dealing with MIs than an OB is. Keep them in the ER and call for stat cardiology and OB consults.

Any idea what the outcome of the case was?

[SWM_Medic]

The mom and baby came out okay. She wound having to get a stent and as far as I know the baby was delivered without incident. The risk benefit is defiantly something to consider here. I would like to point out that giving asa doesn't stop the clot from forming just assists it from getting any worse. So skipping the asa won't make a huge detriment with all the other factors considered. As far as where mom needs to go L&D vrs ER. I am not sure what the answer is. Since the hosp is a childrens hosp they do have excellent docs in L&D that can handle it. They never accept women over 24 wks in the ER. I am not sure if this is local policy or national. Still it's something I like to share.

[akroeze]

In my experience anything past 24 weeks around here that is from the knees up goes to L&D Triage, not ER triage with very few exceptions.

[snakemedic]

ASA is contraindicated in asthmatics unless they have taken ASA with 'no adverse reactions' (as per Medical Directives) As for the pregnancy and ASA, I think it was said eariler; risk vs benefit and if you are going to call the base hospital realize that it is a crap shoot and depending on the recent literature that the MD who picks up the patch line has been reading will determine weather or not you get your order....I have also been told "NO ASA and NO NITRO" but that being said you have to know the doc in question also...like I said, it's a crap shoot.

"keep yourself up to date and keep learning, it can only benefit the pt."