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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To implement an implicit bias awareness and action seminar program for the University of Utah Health pharmacy residency program and measure knowledge, awareness, and comfort around race-related topics. Summary An implicit bias awareness training program was implemented with a pre- and post-training survey to measure knowledge, comfort, and confidence around understanding and addressing biases. Fifty-one residents and preceptors participated in the implicit bias training, and 47 (92.2%) consented to take the survey. Twenty pharmacy residents and 27 preceptors attended at least 1 of the 4 training modules and completed the pre- and/or post-training survey. Eighteen of 20 residents (90.0%) and 19 of 27 (70.4%) preceptors completed the pretraining survey (37 total), while 11 of 20 residents (55.0%) and 10 of 27 (37.0%) preceptors completed the post-training survey (21 total). On the post-training survey, more correct answers were obtained for knowledge-based questions and a higher number of responses of strongly agree or agree was observed when assessing participants’ comfort and confidence in addressing personal biases, bringing marginalized people into a conversation, addressing biased situations, and intervening when bias is observed. Conclusion After training, higher scores were attained on the survey for overall comfort and confidence in addressing personal biases and identifying and acting on witnessed biases.

Introduction: Oral anticoagulants (OAC) (e.g., warfarin, rivaroxaban, dabigatran) and salicylates (e.g., aspirin) can trigger the occurrence of bleeding events when used alone or in combination. Objective: The objective of this study was to conduct a systematic review and meta-analysis to examine the risk of bleeding in individuals exposed to a combination of OAC and aspirin, compared to those taking OAC monotherapy. Methods: PubMed, EMBASE, Scopus, and Web of Science were queried in January 2021. Studies that described combined exposure to OAC and salicylates, had a control arm of monotherapy of OAC and reported the number of bleeding events in each arm were included. After studies were identified for potential inclusion, first, the title and abstract were screened, followed by a review of the full text. The following information was extracted from the included studies: citation, drug and dose of medication, the average age of participants, number of patients and bleeding events in each group, and population of interest. Pooled odds ratios were calculated using a random-effects model. Heterogeneity was evaluated with Cochran’s Q and I2 statistics. Results: A total of 509 studies were identified, of which 35 met the inclusion criteria for the meta-analysis. Studies were further categorized into two groups based on the design of the study (randomized control trial or observational studies). Out of 35 studies, 16 randomized control trials compared combined OAC and salicylates vs warfarin monotherapy and combination therapy was associated with an increased odds [OR: 1.37, (95% CI 1.17 to 1.61)] of bleeding compared to warfarin monotherapy. The second group consisted of 19 observational studies comparing combined OAC and salicylates vs warfarin monotherapy. The results suggested that combination therapy was associated with an increased odds [OR: 1.42, (95% CI 1.09 to 1.87)] of bleeding compared to aspirin monotherapy. Conclusion: Risk of bleeding is significantly increased among patients taking salicylates and OAC together as compared with those taking warfarin alone.

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