University of Wisconsin–Madison Medical College of Wisconsin

Interdisciplinary Deprescribing of Aspirin Through Prescriber Education and Provision of Patient-Specific Recommendations

Cameron Draeger, PharmD; Fahad Lodhi, MD; Nicole Geissinger, MD; Tonja Larson, PharmD, BCPS, BCACP, BCGP; Sara Griesbach, PharmD, BCPS, BCACP

WMJ. 2022;121(3):220-225

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Background: Inappropriate aspirin use can lead to increased frequency of bleeding events and poor patient outcomes.

Objectives: Compare current aspirin prescribing to guideline recommendations and analyze the impact of pharmacist education for clinicians with provision of patient-specific recommendations.

Methods: Internal medicine residents received 1 educational session on appropriate aspirin use. Over a 5-month period post-education, 100 patients on aspirin with a clinic appointment were screened and their charts reviewed. Aspirin use was classified based on guideline recommendations as follows: (1) recommended, (2) weigh the risk and benefits, (3) not recommended, (4) dose change recommended, or (5) outside of guideline recommendation. A recommendation for aspirin deprescribing was then communicated to the clinician prior to the patient’s appointment. Prescriber practice following the appointment was collected and analyzed.

Results: Inappropriate aspirin use occurred in 29% (n = 29) of patients prior to their appointment. Of these, aspirin was not recommended in 65.5% (n = 19), and a dose reduction from 325 mg to 81 mg was recommended in 34.5% (n = 10). Of the 81 patients who kept their appointment, pharmacist recommendations to deprescribe aspirin were communicated to the clincian for 20 patients (24.7%) and resulted in a 55% aspirin deprescription.

Conclusions: The majority of patients identified as using aspirin inappropriately fell into 3 groups: (1) patients taking 325 mg aspirin, (2) patients taking aspirin for primary prevention, and (3) patients taking aspirin concomitantly with an anticoagulant. Strategies that may lead to optimization of aspirin use include lectures and patient-specific chart reviews with pharmacist recommendation.

Author Affiliations: Department of Clinical Pharmacy, Marshfield Clinic Health System, Marshfield, Wisconsin (Larson, Griesbach); Department of Internal Medicine, Marshfield Health Clinic System, Marshfield, Wisconsin (Lodhi, Geissinger); Pharmacy Residency, Marshfield Medical Medical Center, Marshfield, Wisconsin (Draeger).
Corresponding Author: Sara Griesbach, PharmD, BCPS, BCACP, Marshfield Clinic Health System, Marshfield Center, 1000 N Oak Ave, 4P5 East Wing, Marshfield, WI 54449; phone 715.221.9820; email
Acknowledgements: The authors acknowledge Emily Andreae, PhD, and Marie Fleisner from the Marshfield Clinic Research Institute for assistance with manuscript editing and submission.
Funding/Support: None declared.
Financial Disclosures: None declared.
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