Residents and Fellows Research in Progress
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: Aspirin use for the primary prevention of ASCVD has historically been common practice. Current guidelines leave much of the decision-making to providers but provide a recommendation that aspirin use for primary prevention is inappropriate in patients at a high risk of bleeding. The Monroe Clinic Medical Group’s pharmacotherapy department is composed of clinical pharmacists (pharmacotherapists) who work under collaborative practice agreements to manage chronic diseases.
Research Question or Hypothesis: Ambulatory care pharmacists can assist in the deprescription of inappropriate medications, such as aspirin. The purpose of this project was to develop a process to identify patients who would benefit from the deprescription of aspirin for primary prevention.
Study Design: Single-center, retrospective chart review from August 2022 through March 2023.
Methods: A deprescription process was developed using primary literature. Inclusion criteria include adults >18 years taking daily aspirin with a concurrent NSAID, warfarin, DOAC, and/or enoxaparin. Exclusion criteria include a history of ASCVD, use of a P2Y12 inhibitor, or thrombocytosis. Pharmacotherapists performed chart reviews and contacted eligible patients. Data collection included the reason for deprescription and the acceptance rate of both providers and patients. Education was provided to all providers within the clinic about the importance of aspirin deprescription in appropriate patients.
Results: Two-hundred-eighty-five patients were reviewed to determine eligibility for aspirin deprescription. Of those patients, 158 (55%) were eligible. Seventy-one patients (45%) were eligible based on age >70, 36 patients (23%) for ASCVD risk < 7.5%, and 51 patients (32%) for increased risk of bleeding. Providers were messaged for 25 patients and 100% accepted the recommendation. Fifteen patients have been called to deprescribe aspirin with 80% accepting the intervention or no longer taking aspirin, and 20% declining.
Conclusion: Ambulatory Care pharmacists are well-positioned to deprescribe aspirin for primary prevention in appropriate patients.
Presenting Author
Stephanie Garvin PharmDSSM Health Monroe Clinic Medical Group
Authors
Julie Bartell PharmD
SSM-Monroe Clinic
Claudia Epland PharmD
University of Wisconsin Madison - School of Pharmacy