Why is aspirin used in myocardial infarction?

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Discussion Overview

The discussion revolves around the effectiveness of aspirin in the context of myocardial infarction (MI) and its role in various cardiac disorders. Participants explore the timing of aspirin administration, its interaction with thrombus formation, and the distinction between acute and established coronary occlusions.

Discussion Character

  • Debate/contested
  • Technical explanation
  • Conceptual clarification

Main Points Raised

  • One participant questions the effectiveness of aspirin after primary hemostasis has occurred, suggesting that its role may be limited to prophylaxis or very early MI.
  • Another participant argues that aspirin has a synergistic effect with thrombolytic agents and can be beneficial even in acute situations, as thrombus formation may continue under certain conditions.
  • There is a distinction made between the use of antithrombotics/thrombolytics during an ongoing MI and in cases of established occlusion, where mechanical interventions may be necessary.
  • One participant emphasizes the importance of understanding the protocols for treating MI and the need for direct assessment of coronary occlusions, which may not be evident without catheterization.

Areas of Agreement / Disagreement

Participants express differing views on the timing and effectiveness of aspirin in relation to thrombus formation and the treatment of MI. There is no consensus on the optimal use of aspirin in these scenarios.

Contextual Notes

Participants highlight the complexity of hemostatic processes and the varying roles of different treatments depending on the stage of myocardial infarction and the condition of coronary arteries.

sameeralord
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Hello,

I'm simply confused how effective is giving aspirin in various cardiac disorder? Ok someone develops severe chest pain, presents to hospital within 3 hours due to MI?Is there any use in giving aspirin. I know aspirin disaggregates platelets, and this is primary haemostasis. Now within 3 hours I believe primary haemostasis is already done, so is their any point in giving aspirin. What I'm basically asking is how long does primary and secondary haemostasis take and also let's say a full thrombus was formed then is the only choice to lyse it with streptokinase, or does aspirin have an effect even after a full thrombus is formed.Then having said all that and if they are only true only use I can see of aspirin is prophylaxis in cardiac disorders or very early MI. Thanks :smile:
 
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sameeralord said:
Hello,

I'm simply confused how effective is giving aspirin in various cardiac disorder? Ok someone develops severe chest pain, presents to hospital within 3 hours due to MI?Is there any use in giving aspirin. I know aspirin disaggregates platelets, and this is primary haemostasis. Now within 3 hours I believe primary haemostasis is already done, so is their any point in giving aspirin. What I'm basically asking is how long does primary and secondary haemostasis take and also let's say a full thrombus was formed then is the only choice to lyse it with streptokinase, or does aspirin have an effect even after a full thrombus is formed.Then having said all that and if they are only true only use I can see of aspirin is prophylaxis in cardiac disorders or very early MI. Thanks :smile:

Aspirin (ASA) has been shown to have a synergistic effect with a number of thrombolytic agents and is often used in combination with them in the ER/ICU unless there are contraindications. While there is an ideal time period for using such agents, the idea of a "full thrombus" doesn't apply in the acute situation. A thrombus may continue to extend under the right conditions. The real end point is evidence for reperfusion.

http://www.rcpals.com/downloads/fibrinoforACS72006.pdf

http://www.ncbi.nlm.nih.gov/pubmed/2108852
 
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you need to look up the protocols to treating MI, it gives a nice algorithms of what to do. Also unless you have been to a catheter lab you don know how much the coronaries are occluded
 
mazinse said:
Also unless you have been to a catheter lab you don know how much the coronaries are occluded

You need to distinguish between the use of antithrombotics/thrombolytics in the acute situation (MI in progress) and established occluded coronary arteries. In the latter case, mechanical dilatation and the placement of stents or bypass surgery may be indicated, but not the thrombolytic therapy that the OP asked about.

http://emedicine.medscape.com/article/161446-overview

Opening coronary arteries with PCI (see link) may be an option in the acute situation as well, usually if drug treatment fails.
 
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