asprin and diving

Asprin before a deep dive was quite the thing a few years ago. It doesnt thin the blood so much as make the platlets less sticky. Very good for deco aparently

Asperin has been found benificial in the treatment of patients suffering from DCI. Some are against it on the basis that it may cause internal bleeds in spinal tisue but most are against it on the basis they dont reely have any idea if its good or bad so best avoid it.

Like many i took aspering before every deep dive for about tow or three years. No problems to report but that dosent prove much I have done loads of deep dives without taking asperin and i havent got bent on those either.

ATB

Mark


Artical extract concernnig diving and Asprin:

The literature I have been able to review (cursory review due to the
limitations of my medical library) does not seem to indicate that aspirin
increases risk of pulmonary edema. The negative intrathoracic pressure
relative to the ambient water pressure definitely predisposes to pulmonary
edema (just read any account of deep breath-hold divers in their initial
stages -- most will describe multiple episodes of this negative pressure
pulmonary edema before their lungs adapt to such compression).

What I am not disputing is that aspirin may exacerbate hemoptysis (coughing
up blood) during an episode of pulmonary edema (Boussuges A. Pinet C. Thomas
P. Bergmann E. Sainty JM. Vervloet D. Haemoptysis after breath-hold diving.
European Respiratory Journal. 13(3):697-9, 1999 Mar. "Furthermore, these
divers had taken aspirin, which may have aggravated the bleeding."). That is
the therapeutic effect. If we don't want overly active clotting we have to
deal with a potential for more bleeding. It is not without risk which is why
each diver should make that decision in consultation with their physician,
and why the option is still left open for physicians to use or not based on
the risks and benefits. Pulmonary edema is from alveolar stresses, increased
left ventricular end diastolic pressure, decreased plasma oncotic pressure,
or a combination of factors. If the negative pressure causes edema, the
damage that resulted in edema can clearly also include capillary rupture and
therefore bleeding. After all, alveoli are nothing if not little collections
of capillaries. Bleeding will definitely be on a larger scale if
antiplatelets or anticoagulants are used. However, I have not seen 1 report
in the literature of massive hemoptysis from aspirin use in an injured diver
(medline search 1966 to April Wk 3, 2006 "Aspirin AND (Embolism, Air OR
Decompression Sickness OR Diving OR Barotrauma)"). 7-8 cases is something to
consider but by no means would it deter me from utilizing aspirin when
numerous studies with thousands of patients have proven the benefits in
morbidity and mortality for properly selected patients.

I would, however, caution anyone not to use aspirin as a pain reliever.
Aspirin has significant side effects, and has to be used in _very_ large
quantities relative to the 81-325 mg daily used for its effect on platelet
activity to have decent analgesic effects. However, it is over the counter,
and therefore you can make your own decisions as long as you feel you
understand the risks and benefits well enough to make an educated decision.
Personally, in my practice aspirin is only used as an antiplatelet agent.

>Similar cases were known with Isrealite combat swimmers at
similar occasions.<

The issue here is an issue of quantity. If we say that microscopic thrombi
really cause decompression sickness, and if we extrapolate data from
numerous studies on coronary artery thrombosis to the peripheral
vasculature, then aspirin may have significant benefit. However, no studies
I have been able to find have looked at, in a randomized controlled fashion
and significant numbers (i.e. sufficiently powered to change one's practice
by _proving_ superiority of one arm of treatment), divers using aspirin or
placebo pre- or post-diving accident. It is an option because there may be
some benefit, but there is also risk of harm (if you remember the old AHA
classifications they used to teach in ACLS this would be IIb, meaning
potential benefit but possible harm, versus class I, meaning proven benefit,
for hyperbaric oxygen therapy for DCI). The risk of exacerbating hemoptysis
in pulmonary edema needs to be considered but which is higher in frequency,
decompression illness or pulmonary edema from diving? You are talking about
risk, but I am asking you to weigh risk and benefit.

Divers all take risk upon themselves when deciding to enter the water. If I
buy a bad fill of gas, I may die (or get to use my DAN insurance). If I
ascent too rapidly, I may die (or, ditto...). If my equipment malfunctions,
I always carry that backup and a buddy! I do not mean to minimize the risks
of aspirin. I have seen life-threatening gastrointestinal bleeding
attributed to aspirin, and it does not make for a good shift in either the
ICU or the Emergency Department (particularly the smell, but that is a whole
different story). However, the risk of such a complication in someone
healthy enough to be actively pushing the limits of diving is low; not zero,
but low.

For those people on the list thinking about adding aspirin to their pre-dive
activities, please consider consultation with a diving medicine physician.
For someone already on aspirin for its cardio-protective effects, please
consider consultation with a diving medicine physician and your cardiologist
before continuing diving. Good divers, just as good pilots or good
physicians, assess and then manage risk within the best of their
capabilities.

If everyone on this list takes as good care of their health as they do with
their rigs then hopefully we will all dive happily for many years of our
long, healthy lives. Just remember, we don't know everything about medicine
in general.

Rudy Bescherer, Jr.