A 67-year-old male participant with hyperlipidemia, hypertension, diabetes mellitus type II, and peripheral neuropathy has a regimen of 22 medications, including aspirin 81mg QD and gabapentin 600 mg TID.
Upon review of his Electronic Medical Record (EMR), the CareKinesis pharmacist noticed the gabapentin was dosed at three times a day. This prompted the pharmacist to further evaluate the participant’s EMR and calculate his creatinine clearance by obtaining his serum creatinine, height, and weight. The pharmacist discovered that participant’s serum creatinine was 0.66 mg/dL, with a height of 6’1” and weight of 242 lbs. Creatinine clearance was 141 mL/min adjusted, indicating that gabapentin was dosed appropriately.
The CareKinesis pharmacist also noted that the patient was overweight and that his aspirin prescription, administered for primary prevention of cardiovascular disease, was dosed at 81 mg. A recent meta-analysis published in The Lancet evaluated various randomized control trials and showed that as body weight increases beyond 70 kg (154 lbs.), the effectiveness of aspirin in reducing cardiovascular events decreases. Alternatively, the findings indicate that increasing aspirin to doses of 325 mg or higher was better at reducing cardiovascular events in patients who weigh 70 kg or more. The major risk of bleeding is offset by increased body weight, as the study authors noticed less bleeding events in patients taking 81 mg aspirin.
Due to the patient’s weight, the CareKinesis pharmacist consulted with the PACE prescriber to increase the patient’s aspirin dosage to 325 mg to reduce potential cardiovascular events.