Evaluation of the Appropriateness of Aspirin Therapy in a Veteran Population.

Josmi Joseph, Shereen Salama, Aeman Choudhury
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Abstract

Background: Aspirin is commonly used for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) but may cause more harm than benefit. This study aimed to assess the percentage of patients who were inappropriately prescribed aspirin in the veteran patient population and to assess safety outcomes associated with inappropriate aspirin use.

Methods: Retrospective chart reviews were conducted on up to 200 patients with active prescriptions for 81-mg aspirin tablets filled between October 1, 2019, and September 30, 2021, at the Captain James A. Lovell Federal Health Care Center in Illinois. The primary endpoint was the percentage of patients inappropriately on aspirin therapy and whether these patients were being followed by a clinical pharmacy practitioner. Each patient record was reviewed to determine the appropriateness of aspirin therapy by assessing the indication for use. Safety data were collected for patients who were deemed to be using aspirin inappropriately, including documentation of any major or minor bleeding events.

Results: A total of 105 patients were included in this study. For the primary endpoint, 31 patients (30%) had a possible ASCVD risk and were taking aspirin for primary prevention, while 21 patients (20%) had no ASCVD and were taking aspirin for primary prevention. For the secondary endpoint, 25 patients were aged > 70 years, 15 patients were concurrently taking medications that might increase bleeding risk, and 11 patients had chronic kidney disease. Looking at the entire study patient population, for the safety endpoint, 6 patients (6%) experienced a major bleeding event while on aspirin, and 46 (44%) experienced a minor bleeding event while on aspirin.

Conclusions: Common factors seen in this study to warrant deprescribing aspirin for primary prevention included individuals aged > 70 years, concurrent use of medications that increase bleeding risk, and patients with chronic kidney disease. By assessing ASCVD and bleeding risks and having a risk/benefit discussion with patients and prescribers, aspirin used for primary prevention can be appropriately deprescribed when the risks of bleeding outweigh the benefits.

退伍军人阿司匹林治疗的适宜性评价。
背景:阿司匹林通常用于动脉粥样硬化性心血管疾病(ASCVD)的一级和二级预防,但可能弊大于利。本研究旨在评估退伍军人患者人群中不适当使用阿司匹林的患者百分比,并评估与不适当使用阿司匹林相关的安全性结果。方法:对伊利诺伊州詹姆斯·a·洛弗尔上尉联邦卫生保健中心2019年10月1日至2021年9月30日期间服用81毫克阿司匹林片剂的200多名患者进行回顾性图表回顾。主要终点是不适当服用阿司匹林的患者的百分比,以及这些患者是否由临床药学从业人员随访。每个病人的记录被审查,以确定适当的阿司匹林治疗的适应症评估使用。收集被认为不适当使用阿司匹林的患者的安全性数据,包括任何重大或轻微出血事件的记录。结果:本研究共纳入105例患者。对于主要终点,31名患者(30%)可能有ASCVD风险,正在服用阿司匹林进行一级预防,而21名患者(20%)没有ASCVD,正在服用阿司匹林进行一级预防。次要终点25例患者年龄> 70岁,15例患者同时服用可能增加出血风险的药物,11例患者患有慢性肾脏疾病。纵观整个研究患者群体,对于安全性终点,6名患者(6%)在服用阿司匹林时发生了大出血事件,46名患者(44%)在服用阿司匹林时发生了小出血事件。结论:在本研究中发现,在一级预防中需要减少阿司匹林处方的常见因素包括年龄> 70岁的个体、同时使用增加出血风险的药物和慢性肾脏疾病患者。通过评估ASCVD和出血风险,并与患者和开处方者进行风险/获益讨论,当出血风险大于获益时,可适当地开具用于一级预防的阿司匹林。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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