ASHP Midyear: Pharmacist Emphasizes Individualized Approach to Antiplatelet Therapy Management

Snehal Bhatt, PharmD, AACC, BCPS, FASHP, professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences, highlights the critical role of pharmacists as drug therapy experts in providing personalized patient care. He emphasizes the importance of pharmacists thoroughly assessing each patient's individual risks for thrombosis and bleeding before making informed decisions about antiplatelet therapy. While clinical guidelines and research studies provide a foundational knowledge base, the speakers stress that applying this information to real-world patients requires a deep dive into the patient's specific risk factors for future cardiovascular events, such as myocardial infarction and stroke, as well as their bleeding risk.

Pharmacy Times: How can pharmacists address patient concerns and manage potential adverse events?

Snehal Bhatt: That's a great question. That's really what we do as pharmacists because we're the drug therapy experts. I think the biggest thing is really trying to learn about who the patient is in front of you, learn about their individual thrombosis and bleeding risk because what we presented is clinical trials and guidelines, and that is helpful for foundation, as a starting point, as your foundational knowledge. But how do you then apply that to any individual patient? You really have to get into their specific risks for thrombosis and bleeding before you can really make informed, educated decision on whether or not to continue aspirin, switch aspirin to a different antiplatelet agent, or discontinue all those therapies altogether.

Pharmacy Times: Are there any factors that should be considered before a patient starts therapy with aspirin?

Bhatt: Like I said, I don't mean to repeat myself, but [we] definitely want to individualize therapy based on what is their risk for thrombosis, what's their risk for future cardiovascular events like subsequent myocardial infarction, what's the risk for a recurrent stroke? And the flip side to that is what's the risk of bleeding while trying to protect against those events, and so making patient-specific informed decisions, looking at well documents that are published risk scores, or looking at published data that helps to inform us on the types of thrombosis and bleeding risk will help pharmacists make informed, patient-specific decisions.

Pharmacy Times: Is there anything else you would like to add?

Bhatt: The biggest thing for us as pharmacists is that information and data continue to evolve, and so while it's challenging to me, I think it's exciting to see what's coming in the future, and there's going to be a lot more information that's going to help us be better patient care providers, by getting more information on the risks and benefits of aspirin versus other antiplatelet therapies to really help maximize cardiovascular protection, while also simultaneously reducing the risk of bleeding.