Aspirin is a nonsteroidal anti-inflammatory drug that has a variety of uses in pediatrics. It is used in conditions such as Kawasaki disease, polyarthritis of rheumatic fever, rheumatic heart disease, and systemic rheumatoid arthritis. Although aspirin is an effective antipyretic agent, because of its association with Reye syndrome in children and adolescents, it is not recommended for the treatment of fever.

Several complications are associated with aspirin use. In a patient who is receiving long- term aspirin therapy, the most likely complication is a gastric ulcer. Aspirin is believed to cause gastric ulcers by inhibiting prostaglandin synthesis, thus altering the normal mucosal protective mechanisms. Of those patients taking non-steroidal anti-inflammatory drugs chronically, approximately 25% experience gastric ulcers, and many more experience erosions.

Aspirin can cause reactions that appear to be allergic, such as urticaria, angioedema, or asthma. However, such reactions to aspirin probably are not immunoglobulin E-mediated; rather, they are related to inhibition of prostaglandin synthesis because structurally unrelated nonsteroidal anti-inflammatory drugs can produce similar reactions. Anaphylaxis usually is not seen with aspirin use.

The prevalence of Reye syndrome (acute encephalopathy and fatty degeneration of the liver) has decreased markedly since the relationship between the syndrome and aspirin use in patients who had varicella or influenza was recognized in the 1970s.

Aspirin and other non-steroidal anti-inflammatory drugs can cause tinnitus and, rarely, hearing loss that is reversible with discontinuation of the drug. Although some hematologic problems are associated with aspirin use, including anemia, thrombocytopenia, reduced platelet function, prolonged prothrombin times, coagulopathy, and disseminated intravascular coagulation, generalized bone marrow suppression is not a common complication.  

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