Pharmacist-Led Intervention Could Help Lower Rates of Inappropriate Aspirin Use

An intervention led by pharmacists in an outpatient setting resulted in successful deprescribing of aspirin that may have potentially been inappropriate, according to research presented at the American Society of Health-System Pharmacists 2023 Midyear Clinical Meeting and Exhibition, held from December 3 to 7 in Anaheim, California.¹

The United States Preventive Services Task Force recently released guidance that advises against low-dose aspirin use as a primary prevention of atherosclerotic cardiovascular disease in certain populations who have bleeding risks. Adoption of these recommendations are key to ensure the safety of patients without a diagnosis of the condition.

Investigators from the Hunterdon Medical Center in New York conducted a prospective study to evaluate changes to aspirin use following deprescribing interventions provided by pharmacists based on the updated recommendations. Data for the study was gathered from 2 primary care sites from February through June 2023.

The study cohort included 22 patients ages 40 years and older whose aspirin use for the primary prevention of atherosclerotic cardiovascular disease was considered inappropriate. Participants were selected based on age, atherosclerotic cardiovascular disease risk score, family history of premature atherosclerotic cardiovascular disease, and risk factors for bleeding.

Interventions provided by the pharmacists included educational in-services and patient-specific recommendations for deprescribing. Patient charts were then monitored for a response to the given recommendations. The primary study outcome was the percentage of recommendations accepted by providers.

Investigators found that 7 of the recommendations to deprescribe aspirin were accepted and 4 were rejected. Two of the recommendations were “considered missed opportunities as aspirin was not addressed during the patient visits.” Reasons given for rejecting the recommendations included having a high risk score, having a sharp increase in risk score at the most recent follow-up, and additional use of aspirin for stroke prophylaxis in atrial fibrillation.

Additionally, 9 of the recommendations that were given to providers had no action taken due to a lack of follow-up with patients during the study period.

“Expansion of this intervention to additional practice sites may be beneficial to promote appropriate aspirin use in patients without established cardiovascular disease,” the authors concluded. “Discussing patient-specific rationale for deprescribing and addressing provider concerns in real-time may help further increase acceptance rates of future interventions.”

Reference

1. Ko S, Durrani S, Philips A, et al. Impact of Pharmacist-Led Interventions on Deprescribing of Low Dose Aspirin for Primary Prevention. Presented at: American Society of Health-System Pharmacists Midyear Clinical Meeting & Exhibition; December 3-7, 2023; Anaheim, CA. Poster 8-0005.