Prescriptions Are the Remit of the Doctor
For responsible doctors and pharmacists, medication therapy safety has always had an important role in their patients’ and customers’ interests, which they understand well. Nowadays the subject has entered the political agenda—explicitly with patients’ entitlement to a medication plan if at least three medical drugs are prescribed.
In their article on the diagnosis and treatment of peripheral arterial vascular disease, the authors reference international guidelines for secondary prevention in symptomatic patients with peripheral arterial vascular disease and regard a platelet inhibitor as indicated (1). One might easily concede that 75–100 mg of aspirin a day is acceptable. However, a meta-analysis (2) showed that in patients with peripheral arterial vascular disease receiving placebo, cardiovascular events occurred in 9.6% of patients, and in those receiving aspirin such events affected 8.2% of patients. This corresponds to an absolute risk reduction of 1.4% and a number needed to treat (NNT) of 71. This means that 70 out of 71 patients do not benefit from aspirin prophylaxis, but have to expect bleeds. It gets even more serious when the authors demand that all patients with peripheral arterial vascular disease should be given a statin, independently of their LDL concentration, if no contraindication exists. To date, this problem has not been investigated in an intervention study.
The future medication plan for PAVD patients thus includes already two medical drugs with very marginal effects (aspirin) or without proof of efficacy (statin). I wonder how an interprofessional panel would reach an expert consensus in this setting (studies of evidence level C). Cooperation between doctors and pharmacists is all well and good, as well as desirable—but if politically prescribed, so to speak, it might deteriorate into a questionable and annoying routine. The consensus should be that drug prescribing is the responsibility of doctors—on the basis of “thorough training in clinical pharmacology and pharmacotherapy” (3).
Prof. Dr. med. Frank P. Meyer
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Lawall H, Huppert P, Espinola-Klein C, Rümenapf G: Clinical practice guideline: The diagnosis and treatment of peripheral arterial vascular disease. Dtsch Arztebl Int 2016; 113: 729–36 VOLLTEXT|
|2.||Berger JS, Krantz MJ, Kittelson JM, Hiatt WR: Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease: a meta-analysis of randomized trials. JAMA 2009; 301: 1909–19 CrossRef MEDLINE|
|3.||Thürmann PA: Medication safety—models of interprofessional collaboration. Dtsch Arztebl Int 2016; 113: 739–4 VOLLTEXT|