*5.2.2 Reye syndrome*

Reye condition, named after the Australian pathologist, Dr. R.D. Reye was first portrayed in 1963. It is an uncommon yet deadly condition with an expected death pace of somewhere in the range of 30% and 45%. It is a type of encephalopathy auxiliary to fatty changes in an otherwise healthy liver. The clinical vignette of Reye disorder comprises a viral infection of upper respiratory tract disease in kids and corresponding ingestion of aspirin for the treatment of fever. It is imagined that mitochondrial injury is optional to the previous viral disease which is the main hit to both the liver and the cerebrum. Aspirin or similar medicine gives the subsequent hit finishing the disorder. The occurrence has significantly diminished because of better mindfulness and utilization of acetaminophen for the treatment of fever in kids rather than aspirin. Despite the fact that the relationship between aspirin and Reye condition exists, a few authors contend that during diagnosis, salicylate levels were not routinely checked, biopsies were not acquired, and hereditary/intrinsic blunders of metabolism were not precluded [44, 45].

#### *5.2.3 Intracerebral hemorrhage*

Aspirin increases the risk of intracranial bleeding versus placebo [46].

### *5.2.4 Nephrotoxicity*

Previous studies have shown conflicting results about the use of aspirin and the risk of chronic kidney diseases. Some earlier studies have shown that the use of aspirin is associated with chronic kidney disease [47].

#### *5.2.5 Bleeding*

Aspirin makes 2 3-crease increment in the danger of dose related peptic ulcer bleeding, a hazard that does not appear to be diminished by the utilization of enteric-covered aspirin. Sung et al. demonstrated that among people who had peptic ulcer blood loss, constant low-dose aspirin utilize expanded the danger of repetitive bleeding yet brought about lower overall cardiovascular and cerebrovascular mortality rates [48].

#### **5.3 Contraindication**

Aspirin is contraindicated in patients who salicylate sensitive, hemophilic, in peptic/bleeding ulcers, in children suffering from chicken pox or influenza. Cautious use is desirable in patients with anemia, impaired hepatic or renal functions, and asthma and in pregnant or nursing mothers. It should be avoided

**31**

*Risk-Benefit Events Associated with the Use of Aspirin for Primary Prevention…*

in diabetics with low cardiac reserve or frank CHF and in juvenile rheumatoid

Aspirin displaces warfarin, naproxen, sulfonylurea, phenytoin and methotrexate from binding sites. It antagonizes uricosuric action of probenacid. It blunts diuretic action of furosemide and thiazides and reduces the action of spironolactone. Aspirin reduces protein bound iodine levels by displacement of thyroxine; but

Efforts were being done for decades to prevent and treat cardiovascular disease (CVD). By the twentieth century, CVD had become a major cause of mortality and morbidity, and many efforts were being made to prevent it worldwide [51–53]. Given the prevalence of CVD, several strategies are being considered for its prevention, including lifestyle changes as well as strict management of cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia, and metabolic syndrome. In addition to traditional methods, other alternative methods have also been studied for its prevention. Along with this, some exploiters have used aspirin for the prevention of CVD, and with some controversy, it is believed that aspirin is

Today aspirin is widely used for the primary prevention of CVD. In the United States alone, 40% of adults over the age of 50 are using aspirin for the prevention of CVD [56]. Aspirin is an irreversible and nonselective cyclo-oxygenase (COX) inhibitor class of drug, whose work is to reduce thromboxane A2 production and inhibit platelet aggregation and vasoconstriction. The ability to prevent platelet aggregation provides the potential to reduce arterial thrombosis, and when used at low doses, it is beneficial in preventing myocardial infarction (MI) and stroke. On the other hand, aspirin also inhibits the production of prostaglandin as well as reducing the side effects of GI bleeding by inhibiting COX 1 and protecting the gastrointestinal (GI) mucosa [57]. It has been assessed through successive clinical trials that aspirin is effective in the prevention of CVD. A number of tests have been performed to demonstrate its efficacy and it has been found that it is beneficial in secondary prevention of CVD even in patients with previous MI or ischemic stroke

Recently, the publication of a number of studies has raised doubts about the benefits of using aspirin as a primary prevention for patients with moderate cardiovascular risk. Three of the trials were published in 2018, A Study of Cardiovascular Events in Diabetes (ASCEND), Aspirin in Reducing Events in the

The ASCEND study assessed the effectiveness and safety of aspirin use by arbitrarily assigning 14,480 diabetic patients into 100 mg aspirin or placebo teams and observing them for a median of 7.4 years. Internal hemorrhage has emerged as a haul within the safety assessment. All major bleeding during this study was 29% higher with the aspirin administration cluster and a high risk of bleeding was seen in patients with a high risk of vascular events. This study has concluded that aspirin

*DOI: http://dx.doi.org/10.5772/intechopen.93286*

hypothyroidism does not occur [50].

beneficial in the primary prevention of CVD [54, 55].

**6. Role of aspirin in CVD**

and at high risk [58].

Elderly (ASPREE), and ARRIVE.

**7. Risk factors**

arthritis [49].

**5.4 Drug interactions**

*Risk-Benefit Events Associated with the Use of Aspirin for Primary Prevention… DOI: http://dx.doi.org/10.5772/intechopen.93286*

in diabetics with low cardiac reserve or frank CHF and in juvenile rheumatoid arthritis [49].

### **5.4 Drug interactions**

*Drug Repurposing - Hypothesis, Molecular Aspects and Therapeutic Applications*

lower respiratory mucosal inflammation [43].

blunders of metabolism were not precluded [44, 45].

aspirin is associated with chronic kidney disease [47].

Aspirin increases the risk of intracranial bleeding versus placebo [46].

Previous studies have shown conflicting results about the use of aspirin and the risk of chronic kidney diseases. Some earlier studies have shown that the use of

Aspirin makes 2 3-crease increment in the danger of dose related peptic ulcer bleeding, a hazard that does not appear to be diminished by the utilization of enteric-covered aspirin. Sung et al. demonstrated that among people who had peptic ulcer blood loss, constant low-dose aspirin utilize expanded the danger of repetitive bleeding yet brought about lower overall cardiovascular and cerebrovas-

Aspirin is contraindicated in patients who salicylate sensitive, hemophilic, in peptic/bleeding ulcers, in children suffering from chicken pox or influenza. Cautious use is desirable in patients with anemia, impaired hepatic or renal functions, and asthma and in pregnant or nursing mothers. It should be avoided

*5.2.3 Intracerebral hemorrhage*

*5.2.4 Nephrotoxicity*

*5.2.5 Bleeding*

cular mortality rates [48].

**5.3 Contraindication**

Excessive sensitivity to NSAIDs is normal among everyone. The rate is about 1–2%. Unwanted effects could be as gentle as a simple rash to angioedema and hypersensitivity. In case of asthmatic or interminable rhino-sinusitis patients, the predominance of these allergic susceptible indications could be as high as 26%. In the event that this is joined by nasal polyps and inflammation of the respiratory tract with eosinophils, it is known as aspirin triad. NSAID-exacerbated respiratory malady (NERD) is new term related with this disorder because of upper just as

Reye condition, named after the Australian pathologist, Dr. R.D. Reye was first portrayed in 1963. It is an uncommon yet deadly condition with an expected death pace of somewhere in the range of 30% and 45%. It is a type of encephalopathy auxiliary to fatty changes in an otherwise healthy liver. The clinical vignette of Reye disorder comprises a viral infection of upper respiratory tract disease in kids and corresponding ingestion of aspirin for the treatment of fever. It is imagined that mitochondrial injury is optional to the previous viral disease which is the main hit to both the liver and the cerebrum. Aspirin or similar medicine gives the subsequent hit finishing the disorder. The occurrence has significantly diminished because of better mindfulness and utilization of acetaminophen for the treatment of fever in kids rather than aspirin. Despite the fact that the relationship between aspirin and Reye condition exists, a few authors contend that during diagnosis, salicylate levels were not routinely checked, biopsies were not acquired, and hereditary/intrinsic

*5.2.1 Hypersensitivity*

*5.2.2 Reye syndrome*

**30**

Aspirin displaces warfarin, naproxen, sulfonylurea, phenytoin and methotrexate from binding sites. It antagonizes uricosuric action of probenacid. It blunts diuretic action of furosemide and thiazides and reduces the action of spironolactone. Aspirin reduces protein bound iodine levels by displacement of thyroxine; but hypothyroidism does not occur [50].
