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Additional info for Meyler's Side Effects of Drugs Aronson 15th Ed

Sample text

Withdrawal was followed by complete uneventful recovery. Pulmonary edema is a feature of salicylate intoxication, but this patient was taking a therapeutic dosage. Hematologic Thrombocytopenia, agranulocytosis, neutropenia, aplastic anemia, and even pancytopenia have been reported in association with aspirin. The prospect for recovery from the latter is poor, mortality approaching 50%. Hemolytic anemia can occur in patients with glucose-6phosphate dehydrogenase deficiency or erythrocyte glutathione peroxidase deficiency (SED-9, 128) (27–29).

Macrocytic anemia associated with folate deficiency has been described in patients with rheumatoid arthritis (30) and also in patients who abuse analgesic mixtures containing aspirin (30). Effects on coagulation Aspirin in high doses for several days can reduce prothrombin concentrations and prolong the prothrombin time. This will contribute to bleeding problems initiated by other factors, including aspirin’s local irritant effects on epithelial cells. It is therefore very risky to use aspirin in patients with bleeding disorders.

Patients with rheumatoid arthritis seem to be more sensitive, and the frequency of aspirin-induced dyspepsia in this group is 10–30% (SEDA-9, 129). However, these symptoms are generally poor predictors of the incidence of mucosal damage (SEDA-18, 90). The bleeding that occurs is usually triggered by erosions and aggravated by the antithrombotic action of aspirin. While it is reported to occur in up to 100% of regular aspirin takers, bleeding tends to be asymptomatic in young adults, unless it is associated with peptic ulceration, but it is readily detectable by endoscopy and the presence of occult blood in the feces.

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