Although the daily use of aspirin reduces the risks of myocardial infarction, stroke and vascular death in patients at high risk of developing vascular disease, the use of preventative aspirin therapy in patients with no history of cardiovascular disease is controversial. For this reason, we studied the benefits and risks of aspirin therapy in the primary prevention of cardiovascular disease, in particular for aspirin at low doses. On performing a meta-analysis of 4 randomized trials with low-dose aspirin therapy for primary prevention, the low-dose aspirin was found to significantly reduce the risk of myocardial infarction (summary odds ratio (OR), 0.64 ; 95 % confidence interval (CI), 0.56 to 0.74). Though the all-cause mortality (summary OR, 0.94 ; 95 % CI, 0.84 to 1.04) was not significantly affected by aspirin therapy, it significantly increased the risk of gastrointestinal bleeding (summary OR , 2.03 ; 95 % CI, 1.55 to 2.65). These results suggest that low-dose aspirin therapy is beneficial in the primary prevention of myocardial infarction, but it increases the risk of gastrointestinal bleeding.

In this practical research, we assessed the effectiveness of Protocol-based Pharmacotherapy Management (PBPM) by community pharmacists and the Nagasaki University Hospital with the cooperation of the Nagasaki Pharmaceutical Association and Nagasaki City Pharmaceutical Association. This study was implemented from July 1 to December 15, 2018. We targeted outpatients prescribed anticancer drugs (the combination drug tegafur/gimeracil/oteracil (S-1) or capecitabine) from Nagasaki University Hospital. Community pharmacists con rmed the presence of adverse reactions in patients by follow-up phone calls throughout the medication period or drug withdrawal period, and reported patients situation to their attending doctors according to the protocol. Telephone support by community pharmacists was provided to 17 and seven patients for S-1 and capecitabine, respectively. The number of telephone support times was 45 (2.9 times per patient) and 20 (2.7 times per patient) for S-1 and capecitabine, respectively. There were several instances of adverse skin reaction and whole-body weariness, and hand-foot syndrome was con rmed with a particularly high frequency. Community pharmacists followed compliance with recommended methods of skin care and the usage of prescribed medications. The telephone support for patients included extension of the drug withdrawal period for S-1 and reduction of the dosage of capecitabine , which contributed to the safe discontinuation of drug treatment. This report is a valuable study that indicates PBPM between community pharmacists, hospital pharmacists and medical doctors through cooperation between key hospitals and regional pharmaceutical associations effectively achieved seamless medical cooperation.

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