Pharmacist-Led Deprescribing Efforts Can Reduce Inappropriate Aspirin Use in Older Adults

Older adults who take aspirin for primary prevention of cardiovascular disease are at an increased risk of bleeding. According to 1 published study, the risk may be as high as 5% in patients older than 80 years.¹ Pharmacists participating in deprescribing efforts may effectively reduce the risk by stopping aspirin.

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Deprescribing is the process of discontinuing medications that are deemed harmful or no longer beneficial. Pharmacists may become active in deprescribing in several ways. They may complete medication reviews, educate patients, and collaborate with other health care providers.²

A team of investigators from Colorado documented a successful effort to deprescribe aspirin in the June 2024 issue of The Senior Care Pharmacist. The study highlighted the potential benefit of clinical pharmacists' active approach in an outpatient setting.³

The investigators studied deprescribing efforts at an urban safety-net institution in Denver. The study group consisted of 131 patients older than 70 years without atherosclerotic cardiovascular disease. Each had aspirin listed as an active medication. In its 2019 guideline update, the American College of Cardiology and American Heart Association recommended against using aspirin in this group due to increased bleeding risk.⁴

Clinical pharmacists spoke to patients to advise them to discontinue aspirin. When patients were unavailable for consultation, the pharmacist sent a recommendation to the primary care provider (PCP) to stop aspirin therapy.³

According to the study findings, 60% of patients discontinued aspirin after speaking with a pharmacist. Eight patients discontinued after a clinical pharmacist recommendation to the patient’s primary care provider. Of the 6 patients who declined to discontinue, 5 preferred to discuss the issue with their PCP, and an outside provider told 1 to take aspirin. The median length of time clinical pharmacists spent on consulting was 8 minutes.³

The investigators deemed the clinical pharmacist-led intervention as successful. They indicated that the study findings suggest an active deprescribing approach is likely more effective than written prescriber recommendations. The authors concluded that pharmacists played a vital role in the multidisciplinary team for effective deprescribing.³

References

1. Mahady SE, Margolis KL, Chan A, et al. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut. 2021 Apr;70(4):717-724. doi:10.1136/gutjnl-2020-321585

2. Ashkanani FZ, Rathbone AP, Lindsey L. The role of pharmacists in deprescribing benzodiazepines: A scoping review. Explor Res Clin Soc Pharm. 2023 Sep 2;12:100328. doi:10.1016/j.rcsop.2023.100328

3. Ramos VH, Hayes L, Simmons K, Trudeau B, Boka A. Pharmacist-Led Deprescribing of Aspirin in Older People in an Outpatient Setting. Sr Care Pharm. 2024 Jun 1;39(6):212-217. doi:10.4140/TCP.n.2024.212

4. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646. doi:10.1161/CIR.0000000000000678