Development and Implementation of a Pharmacist-Led Aspirin Deprescribing Algorithm in Older Adults

Area of Science:

• Geriatric Medicine
• Cardiology
• Pharmacology

Background:

• Low-dose aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older adults is linked to increased bleeding without proven benefit.
• This study addresses inappropriate aspirin use in patients over 70.

Purpose of the Study:

• To evaluate the effectiveness of an aspirin deprescribing algorithm in reducing inappropriate aspirin use in patients aged 70 and older.
• To assess the safety of aspirin deprescribing, including bleeding events and cardiovascular outcomes.

Main Methods:

• A pre- and post-interventional study involving patients over 70 on low-dose aspirin.
• Development and implementation of an interdisciplinary aspirin deprescribing algorithm.
• Monitoring inappropriate aspirin use, bleeding events, major cardiovascular events, and hospitalizations over a 5-month follow-up period.

Main Results:

• Inappropriate aspirin use decreased from 24.9% in the pre-implementation phase to 20.3% in the post-implementation phase (p < 0.01).
• 118 patients were eligible for deprescribing, and 22 had aspirin deprescribed.
• No significant differences were observed in major/minor bleeds, major cardiovascular events, or cardiovascular hospitalizations between groups.

Conclusions:

• An aspirin deprescribing algorithm effectively reduces inappropriate aspirin use in older adults for primary ASCVD prevention.
• Algorithm-guided deprescribing can mitigate bleeding risks and polypharmacy in the elderly population.