Upper gastrointestinal irritation is the most common side effect of aspirin therapy, while life-threatening gastrointestinal bleeding is uncommon. 41 As noted above, intracranial hemorrhage, the most feared complication of anticoagulation and antithrombotic therapy, appears to occur rarely with aspirin alone. 15 Some patients are markedly sensitive to aspirin such that even low doses lead to markedly prolonged bleeding times and risk of severe clinical hemorrhage, particularly related to surgery or trauma. Uremic patients are especially sensitive to bleeding induced by aspirin. The combination of alcohol and aspirin can also prolong a patient's bleeding time.

Unfortunately, the BT is a poor test to confirm bleeding complications of aspirin. If aspirin-associated bleeding is suspected [e.g., persistent oozing after tooth extraction despite normal platelet count (>100,000/pL) and coagulation studies], further workup should include obtaining a careful history for ingestion (significant unintentional ingestion may occur, since some 300 over-the-counter medications contain aspirin), and a salicylate level. Management of acute aspirin-induced hemorrhage involves the transfusion of enough normal platelets to increase the platelet count by 50,000/pL (e.g., 6 U). Because of the irreversible effect of aspirin on platelets, the hemostatic compromise might last for 4 to 5 days after aspirin has been discontinued, and platelet transfusions may have to be repeated daily.

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