Editorials

Aspirin, like all other drugs, is a poison

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7270.1170 (Published 11 November 2000) Cite this as: BMJ 2000;321:1170

We do not know who should be given what dose and for how long

  1. Martin R Tramèr, staff anaesthetist (martin.tramer@hcuge.ch)
  1. Division of Anaesthesiology, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland

    Papers p 1183

    Aspirin is an old drug. Some 2000 years ago the Greeks used the bark and leaves of the willow tree (which contains salicylic acid) to relieve pain and fever. At the end of the 19th century acetyl salicylic acid started being produced on an industrial scale and aspirin soon became a widely used painkiller. In the late 1960s it was found that a single dose of aspirin irreversibly inhibits the normal aggregation of platelets by suppressing the cycloxygenase mediated synthesis of thromboxane A2. The effect of aspirin persists until newly formed platelets have been released; their biological lifespan is about nine days.

    Sometimes, adverse drug reactions can be turned to advantage, and the antithrombotic effects of aspirin have been widely exploited. Aspirin has been given successfully both to healthy people and to patients with coronary artery disease to prevent myocardial infarction, to patients with acute myocardial infarction to reduce vascular mortality, to patients with atrial fibrillation to prevent stroke and systemic embolism, and to patients with a history of stroke or transient ischaemic attack to prevent further ischaemic events.1-5

    It has been suggested that aspirin should be …

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