Proper Dosing of Anticoagulants in CAD/PAD - Episode 10
The Importance of CAD/PAD Education
Key opinion leaders discuss the need to educate patients and physicians and the potential consequences of managing CAD/PAD without proper data support or understanding.
Paul Dobesh, PharmD: I know you have insights on the potential consequences for people making assumptions where there’s no data.
James Groce III, PharmD: Well, again, permit me to use 1 of my other frequently used comments that I know you’ve heard me say before, Paul, and that is: If you want New England Journal of Medicine clinical trial results, you have to conduct yourself like a New England Journal of Medicine clinical trialist. I think you pointed out something that some of us may not have been aware of, and that is that, to date, again, just 1 of these drugs is approved by the Food and Drug Administration for this indication, with robust data that went over well in your earlier discussion. I think, again, that means making certain that whenever we transition patients from the acute care setting to the outpatient setting, using just every means possible to communicate, either entering it as a part of the written instructions or the sig, as we used to refer to that in pharmacy, in terms of what this drug is being used for, and even to the anecdote that you provided. If there’s a question or a concern by the pharmacist receiving the prescription in terms of, perhaps, that they’re not familiar with that dose or strength of rivaroxaban, rather than making it incumbent upon themselves for doing a substitution, it’s pretty simple; we do it daily: Pick up a phone and make an appropriate call to the provider for clarity of the situation—again, old-fashioned communication like we used to do, where we just simply spoke and talked with each other.
That again brings us to another point that I believe can be one of the things that we professionally, within our profession, do, and that is very much like what we’re doing here today, which is trying to educate our colleagues; educate ourselves about knowing the data, the outcomes of safety and efficacy. But basically, looking at it in terms of whether it’s within the building, within the community, within our state society organizations, and certainly at a national level, whether it’s APhA [American Pharmacists Association] or ASHP [American Society of Health-System Pharmacists] or any of the organizations that so many of us belong to. We need to have this discussion at those meetings and venues, as well, to make certain that everyone is aware of what for some might be a new strength of the drug and a new dosing interval in a new patient population. But indeed, the patient population…Going back to those demographic numbers and the statistics of the prevalence of this disease, these have impacts on so many patients that we see within our clinical practice. So I think all of these things that we’ve discussed this morning are important.
Paul Dobesh, PharmD: That’s great information, Jay, and I completely agree. As we wrap up here, I think about the importance of just continuing to educate ourselves, no matter where we’re at in our career, no matter where our work setting is. I think that’s where sessions like this one that we’re able to do here today become very helpful, because we’ve covered a lot of material here today. What is coronary artery disease and peripheral artery disease—we’ve looked at how prevalent this is, what we try to do today for primary prevention and secondary prevention, and clearly there are gaps. We try as much as we can to very eloquently point out the things that we try to do in our institutions to identify these patients and provide them optimal care, and now we see that with the results of the COMPASS trial, there’s really a new opportunity to provide a new optimal care. Like you said, in the COMPASS trial, there are always more adverse outcomes with aspirin than there were with adding low-dose rivaroxaban to that aspirin. Then we take this information and we try to use it in our institutions to the best of our abilities, making people aware of it, giving patients the option of “You know what, we can do better,” and just making sure then that as a profession of health care professionals and as a professional pharmacist, we’re doing it safely, making sure we’re using the right dose in the right patient.