My question is in regards to ASA being a contraindication for the administration of ibuprofen or ketorolac. I understand that ASA is classified as an NSAID, but in a previous ASKMAC, it was stated that ASA in low doses like baby aspirin is NOT a contraindication of the administration of ibuprofen or ketorolac. More specifically, i would like to know if the dose used by medics for cardiac ischemia (160-162mg ASA) should be considered a contraindication for the admin of ibuprofen or ketorolac. If a patient was initially c/o chest pain that resolved itself after ASA and nitro x1, is it acceptable to treat a 10/10 severe headache that the patient has been experiencing intermittently x2 days if there are no other contraindications? 

Thank you for your thoughtful question and review of our previous Ask MAC questions. SWORBHP Medical Council would support NSAID analgesia after low dose daily ASA of 81mg. Higher doses, including 160-162mg that could be administered by paramedics under the Suspected Cardiac Ischemia Medical Directive, would be a contraindication for NSAID analgesia.  In cases where ASA has been used by patients or administered by paramedics, acetaminophen can still be utilized as an analgesic agent to treat these other or secondary causes of pain.  The reason why NSAID use in contraindicated in potential cases of cardiac ischemia/acute coronary syndrome (unstable angina, NSTEMI, STEMI) is that they increase the risk of Major Adverse Cardiac Events (MACE) which refers to non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. 

Analgesia,Cardiac Ischemia,Cardiac/Circulation,Pain/Sedation/Nausea

160-162mg, 81mg, analgesia, ASA, Daily ASA, NSAID, Pain

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