Medication Profiles at Hospital Discharge Predict Poor Outcomes After Acute Ischemic Stroke.
Autor: | Barra ME; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA., Giulietti JM; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.; School of Pharmacy, Northeastern University, Boston, MA, USA., DiCarlo JA; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA., Erler KS; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA., Krenz J; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA., Roberts RJ; Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA., Lin DJ; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. |
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Jazyk: | angličtina |
Zdroj: | Journal of pharmacy practice [J Pharm Pract] 2024 Jun; Vol. 37 (3), pp. 600-606. Date of Electronic Publication: 2023 Jan 05. |
DOI: | 10.1177/08971900221150282 |
Abstrakt: | Objectives: To examine the relationship between medications prescribed during the first 6-months post-stroke and functional outcome. Materials and Methods: A retrospective analysis of ischemic stroke survivors enrolled in an observational stroke recovery study from June-2017 to July-2019 was performed. Survivors with favorable outcomes (modified rankin scale (mRS) score 0-2) were compared to those with unfavorable outcomes (mRS ≥3) 6-months after stroke on the following: discharge medication classes prescribed, achievement of recommended targets for blood pressure control, glycemic control, and LDL ≤70 mg/dL, medication changes, medication interactions, and medication list discrepancies. Results: Unfavorable 6-month outcomes occurred in 36/78 (46.2%) of survivors. Survivors with unfavorable outcomes were more likely to be prescribed a central nervous system-acting agent (97.2% vs 71.4%; P = .0022) and/or an anti-hyperglycemic agent (25.0% vs 9.5%; P = .009) at discharge. After adjustment of baseline covariates, total number of medications prescribed was associated with unfavorable 6-month outcomes (OR 1.13, 95% CI 1.0-1.28). Secondary stroke prevention measures were not achieved in a high proportion of survivors. Medication changes during 6-month follow up were common and survivors with unfavorable outcomes were more likely to have clinically significant drug-drug interactions. Discussion: At 6-months, survivors with unfavorable outcomes were found to be prescribed more medications, particularly central nervous system-acting and anti-hyperglycemic agents. There were also more drug-drug interactions in the medications prescribed compared to those with favorable outcomes. Together, these data suggest the need for enhanced screening of high-risk stroke survivors focused on close monitoring of polypharmacy, drug-drug interactions, and adverse events with pharmacotherapy. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
Databáze: | MEDLINE |
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