Key result
Pharmacist-led strategy linked to ~34% fewer non-recanalization stroke drugs without worsening neurological recovery.
Why the study?
Polypharmacy involving cerebrovascular agents is common in acute ischemic stroke, but its clinical and economic value remains unclear.
Does a pharmacist-led Stroke Pharmacotherapy Optimization Strategy (SPOS) reduce polypharmacy and drug-related costs without compromising neurological recovery in patients with acute ischemic stroke?
Observational (n=416)
No
Does a pharmacist-led Stroke Pharmacotherapy Optimization Strategy (SPOS) reduce polypharmacy and drug-related costs without compromising neurological recovery in patients with acute ischemic stroke?
Absolute Event Rate: 3.03% vs 4.62%
p-value: p=<0.001
A pharmacist-led medication optimization strategy in acute ischemic stroke safely reduced polypharmacy and hospitalization costs without compromising short-term neurological recovery.
May support pharmacist-led deprescribing to lower stroke drug costs and polypharmacy without harming short-term recovery; hypothesis-generating pending randomized confirmation.
Objective Polypharmacy involving cerebrovascular agents is common in acute ischemic stroke, but its clinical and economic value remains unclear. This study evaluated the impact of a pharmacist-led Stroke Pharmacotherapy Optimization Strategy (SPOS) in reducing polypharmacy, drug-related costs, and adverse events while preserving neurological recovery. Methods A pre-post study was conducted at a tertiary hospital from June 2024 to April 2025. The control cohort included patients admitted from June to October 2024, and the SPOS cohort included patients admitted from December 2024 to April 2025. SPOS followed the “3-2-1” principle (≤3 non-recanalization cerebrovascular drugs, [NR-CVDs]; ≤ 2 cerebrovascular-related traditional Chinese medicines, [CR-TCMs]) to simplify pharmacotherapy and integrated pharmacist-led medication monitoring, patient education, and individualized adjustments. Results A total of 416 patients were included (204 control, 212 SPOS). The SPOS group received significantly fewer NR-CVDs (SPOS group: 3.03 ± 1.18 vs control group: 4.62 ± 1.15; P < 0.001) and CR-TCMs (SPOS group: 1.04 ± 0.90 vs control group: 1.93 ± 1.02; P < 0.001), without difference in ΔNIHSS or overall neurological recovery. Although the length of hospital stay was similar between groups, total hospitalization costs, drug costs, and the proportion of drug-related expenditures were markedly reduced in the SPOS group (all P < 0.001), and the incidence of adverse events was lower in the SPOS group (P = 0.034), with no evident safety signal associated with medication simplification during hospitalization. Conclusions Pharmacist-led SPOS in acute ischemic stroke reduced unnecessary cerebrovascular medications and drug costs and was associated with a lower incidence of in-hospital adverse events, without compromising short-term neurological recovery.
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Zhang et al. (2026) conducted an observational in Acute ischemic stroke (n=416). Pharmacist-led Stroke Pharmacotherapy Optimization Strategy (SPOS) vs. Standard medical management (usual care) was evaluated on Number of non-recanalization cerebrovascular drugs (NR-CVDs) (p=<0.001). The pharmacist-led Stroke Pharmacotherapy Optimization Strategy significantly reduced the number of non-recanalization cerebrovascular drugs (3.03 vs 4.62) and drug costs compared to usual care, without compromising short-term neurological recovery.
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