Impact of a pharmacist-led optimization strategy for cerebrovascular pharmacotherapy beyond recanalization in acute ischemic stroke: A pre- and post-intervention study.
Pharmacist-led Stroke Pharmacotherapy Optimization Strategy (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.
Key Findings
Results
The SPOS group received significantly fewer non-recanalization cerebrovascular drugs (NR-CVDs) compared to the control group.
SPOS group received 3.03 ± 1.18 NR-CVDs vs control group 4.62 ± 1.15 NR-CVDs (P < 0.001)
The SPOS followed a '3-2-1' principle targeting ≤3 NR-CVDs and ≤2 cerebrovascular-related traditional Chinese medicines (CR-TCMs)
Total of 416 patients included: 204 in control cohort and 212 in SPOS cohort
Study conducted at a tertiary hospital from June 2024 to April 2025
Results
The SPOS group received significantly fewer cerebrovascular-related traditional Chinese medicines (CR-TCMs) than the control group.
SPOS group: 1.04 ± 0.90 CR-TCMs vs control group: 1.93 ± 1.02 CR-TCMs (P < 0.001)
The reduction in CR-TCMs was part of the '3-2-1' principle guiding the SPOS intervention
The SPOS intervention integrated pharmacist-led medication monitoring, patient education, and individualized adjustments
Results
Neurological recovery was not compromised by medication simplification in the SPOS group.
No statistically significant difference in ΔNIHSS (change in NIH Stroke Scale score) between SPOS and control groups
Overall neurological recovery was similar between groups despite reduced medication use
No evident safety signal was associated with medication simplification during hospitalization
Results
Total hospitalization costs, drug costs, and proportion of drug-related expenditures were markedly reduced in the SPOS group.
All three cost measures (total hospitalization costs, drug costs, and proportion of drug-related expenditures) showed statistically significant reductions (all P < 0.001)
Length of hospital stay was similar between the SPOS and control groups
Cost reductions occurred despite comparable lengths of stay, suggesting medication simplification drove the savings
Results
The incidence of in-hospital adverse events was lower in the SPOS group compared to the control group.
The difference in adverse event incidence between groups was statistically significant (P = 0.034)
No evident safety signal was associated with medication simplification during hospitalization
Reduced polypharmacy in the SPOS group was associated with fewer adverse events
Background
Polypharmacy involving cerebrovascular agents is common in acute ischemic stroke, but its clinical and economic value remains unclear prior to this study.
The study was motivated by the unclear value of polypharmacy with cerebrovascular agents in acute ischemic stroke
The SPOS was designed to reduce polypharmacy, drug-related costs, and adverse events while preserving neurological recovery
A pre-post study design was used, with the control cohort admitted June–October 2024 and the SPOS cohort admitted December 2024–April 2025
What This Means
This research suggests that having a pharmacist lead a structured medication optimization program for acute ischemic stroke patients can safely reduce the number of drugs patients receive beyond clot-dissolving treatments. The program, called SPOS, followed a '3-2-1' principle that aimed to limit patients to no more than three non-clot-dissolving brain medications and no more than two traditional Chinese medicines. Compared to a control group of 204 patients, the 212 patients in the SPOS group received about 1.6 fewer brain-targeted drugs and nearly one fewer traditional Chinese medicine on average, while experiencing no difference in neurological recovery scores during their hospital stay.
This research also suggests that reducing unnecessary medications was associated with meaningful cost savings. Total hospitalization costs, drug costs, and the share of the hospital bill spent on drugs were all significantly lower in the SPOS group. Importantly, patients in the SPOS group also experienced fewer adverse events during their hospital stay, suggesting that simplifying medications did not just save money but may have also improved safety. The length of hospital stay was similar between both groups.
The practical implication of this research is that pharmacist involvement in stroke care — through structured medication review, patient education, and individualized drug adjustments — may help reduce unnecessary prescribing without harming patient recovery. This is particularly relevant in settings where polypharmacy (the use of many medications simultaneously) is common, as it points to an opportunity to streamline care, reduce costs, and potentially lower the risk of drug-related complications in stroke patients.
Zhang Z, Zhao X, Jia M, Zhao F, Zhou M, Liu Y, et al.. (2026). Impact of a pharmacist-led optimization strategy for cerebrovascular pharmacotherapy beyond recanalization in acute ischemic stroke: A pre- and post-intervention study.. PloS one. https://doi.org/10.1371/journal.pone.0357101