Question: I recently had a patient with ischemic like she's pain (no ECG changes). When going through questions to administer ASA, the patient stated she could not have ASA as per her physician because she was recently placed on Clopidogrel after a stroke about 3 weeks ago. I ask the patient if she meant she should not have daily aspirin, or if a one-time aspirin was okay. She could not answer the question, and stated she did not want to be treated with the aspirin. Is the patient correct, or should I have pushed harder to administer it?

 Great question. Many patients are told by their physician not to take ASA if they are on Clopidogrel or Warfarin for instance. Yet, we know that in the setting of myocardial infarction, ASA is beneficial.

Both of these medications from our medical directives are not contraindications yet patients may lack that understanding given their past instructions from their physicians.

Our advice would be to inform the patients just that: single dose of ASA does carry benefit if this chest pain turns out to be an acute MI, and that benefit will not be outweighed by a negative interaction with their medications such as Clopidogrel or Warfarin.

If the patient still declines the medication, this is obviously their prerogative and please ensure to document this accordingly on your ACR.

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