Pharmacists' Intervention in Inappropriate Aspirin Prescribing in a Geriatric Primary Care Clinic.

Background

In recent years, aspirin use has been controversial for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events. Numerous clinical trials have proven that aspirin does not improve outcomes and increases major bleeding rates. Despite clinical trial data and guideline recommendations, there remains a large number of older adults taking aspirin for primary prevention.

Objective

Describe the impact that pharmacists had on the discontinuation of inappropriately prescribed aspirin in a geriatric primary care clinic.

Methods

This is a retrospective review of patients taking aspirin. A report was generated for all patients with aspirin on their medication list. The pharmacist determined the indication for aspirin. If patients were taking aspirin for primary prevention, the pharmacist recommended aspirin be discontinued.

Results

A total of 528 patients were included in this study. There were 321 (61%) females and 207 (39%) males. After analyzing aspirin indication, 122 (48%) were taking aspirin for primary prevention, 273 (52%) were taking aspirin for secondary prevention, and 133 (52%) were taking aspirin for another indication. The recommendation to discontinue aspirin was accepted 91 times and declined 30 times, yielding a 75% acceptance rate.

Conclusion

Aspirin has several appropriate indications for use; however, previous studies have shown that risk outweighs benefit when used for primary prevention of ASCVD events in the geriatric population. When aspirin is on a patient's medication list, it should be assessed routinely for appropriateness. This retrospective review by pharmacists highlights the need for review and discontinuation of aspirin when appropriate.