Aspirin for CV prevention - For which patients?
University of Rhode Island College of Pharmacy, Kingston, RI 02881, USA.The Journal of family practice (Impact Factor: 0.89). 09/2011; 60(9):518-23.
Put your patient on aspirin? Take him off? Here's what you need to know to get it right.
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ABSTRACT: Objective(s): The aim of this paper is to describe the utility of electronic personal health records (ePHRs) to identify patients with potential risk factors for aspirin-induced upper gastrointestinal bleeding (UGIB).Setting: ER-Card, LLC. a for-profit ePHR company located in Rhode Island from October 2008 to May 2010.Practice description: Clinical pharmacists reviewed the records of 615 patients enrolled in an ePHR service. Records included patient self-report of all known medical conditions, current prescription medications, and self-care therapies utilized.Practice innovation: Pharmacists reviewed ePHR profiles for actual or potential medication-related problems. Patients taking low-dose aspirin (81 mg-325 mg daily) were screened for known additional risk factors for aspirin-induced UGIB. Patients identified were notified to contact their provider for information and/or providers were contacted directly by pharmacists with therapy recommendations.Main outcome measure(s): Number of patients at increased risk for aspirin-induced UGIB as a result of concomitant medications.Results: Ninety-seven patients (16% of total records screened) with an average age of 72.1 years had risk factors for aspirininduced UGIB. In addition to daily aspirin therapy patients reported regular use of nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors (38%), other antiplatelet agents (22%), anticoagulants (24%), corticosteroids (4%), or a combination of these medications (12%). None of the patients included in this analysis reported use of prescribed or overthe-counter gastroprotective therapy (such as proton-pump inhibitors or histamine-2 receptor antagonists).Conclusion: Pharmacist screening of patient self-reported health information as part of an ePHR service can result in the detection of a significant number of patients at increased risk for aspirin-induced UGIB.
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