Stroke imposes a substantial clinical and economic burden worldwide, and ischemic stroke comprises the majority of incident cases in many settings. Polypharmacy and drug-related problems are common among hospitalized ischemic stroke patients and are associated with increased potential drug–drug interactions, adverse events, and higher drug-related costs. In this context, pharmacists are increasingly engaged in efforts to promote rational medication use and value-based care.
The study evaluated whether a structured, pharmacist-led optimization strategy could reduce unnecessary cerebrovascular medication exposure and associated costs after recanalization in acute ischemic stroke (AIS), while preserving short-term neurological recovery.
This was a pre–post intervention study carried out at a tertiary hospital from June 2024 to April 2025. The control cohort comprised patients admitted between June and October 2024; the SPOS cohort comprised patients admitted between December 2024 and April 2025. The analysis included a total of 416 patients: 204 in the control period and 212 in the SPOS period.
The intervention, termed the Stroke Pharmacotherapy Optimization Strategy (SPOS), implemented a simple medication-simplification rule summarized as the "3-2-1" principle: limit non-recanalization cerebrovascular drugs (NR-CVDs) to ≤3 and cerebrovascular-related traditional Chinese medicines (CR-TCMs) to ≤2. SPOS was delivered by pharmacists and combined the medication-simplification rule with pharmacist-led medication monitoring, patient education, and individualized adjustment of regimens during hospitalization.
All included patients were hospitalized with acute ischemic stroke during the specified control and intervention periods. The study compared medication exposure, clinical outcomes, adverse events, length of stay, and cost measures between the control and SPOS cohorts. Exact inclusion and exclusion criteria were described in the original article; details beyond cohort timing and sample sizes were not reported in the abstract and available text provided here.
Implementation of SPOS was associated with a significant reduction in the number of cerebrovascular agents prescribed beyond recanalization. Specifically, the mean number of NR-CVDs per patient fell from 4.62 ± 1.15 in the control group to 3.03 ± 1.18 in the SPOS group (P < 0.001). Use of CR-TCMs also decreased from a mean of 1.93 ± 1.02 in control patients to 1.04 ± 0.90 with SPOS (P < 0.001). These reductions reflect adherence to the practical limits set by the "3-2-1" principle and active pharmacist involvement in regimen consolidation.
Short-term neurological recovery, measured by change in NIH Stroke Scale (ΔNIHSS) and overall recovery during hospitalization, did not differ between the control and SPOS cohorts, indicating that medication simplification did not compromise early neurological outcomes.
Regarding safety, the incidence of in-hospital adverse events was lower in the SPOS group compared with control (P = 0.034). The authors reported no evident safety signal attributable to medication simplification during hospitalization.
Although the length of hospital stay was similar across cohorts, SPOS was associated with significant reductions in cost measures. Total hospitalization costs, direct drug costs, and the proportion of hospital expenditures attributable to drugs were all markedly decreased in the SPOS group (all P < 0.001). These findings suggest that targeted pharmacist-led medication optimization can contribute to reduced drug-related spending in the acute stroke setting.
The study demonstrates that a structured, pharmacist-led medication strategy using a clear simplification rule can meaningfully reduce exposure to multiple cerebrovascular agents and lower drug costs without worsening short-term neurological outcomes. The reduction in adverse events observed in the SPOS cohort further supports a potential safety benefit from decreasing polypharmacy and intensifying pharmacist oversight.
These results align with broader efforts to improve medication value and safety through pharmacist integration into multidisciplinary acute care teams. The SPOS model—combining explicit prescribing limits with monitoring and education—offers a practical approach for hospitals seeking to optimize cerebrovascular pharmacotherapy after recanalization.
This was a single-center pre–post study; causality may be influenced by temporal or unmeasured confounders. Detailed patient selection criteria, baseline characteristics beyond those summarized here, and granular adverse event types were not fully reproduced in the summary text provided. The authors note that individual-level data cannot be publicly shared because of confidentiality constraints; de-identified data may be available on reasonable request to the hospital ethics committee.
In this pre–post intervention study of patients hospitalized with acute ischemic stroke, implementation of a pharmacist-led Stroke Pharmacotherapy Optimization Strategy reduced the number of non-recanalization cerebrovascular drugs and cerebrovascular-related traditional Chinese medicines, decreased drug-related costs, and was associated with fewer in-hospital adverse events, all without compromising short-term neurological recovery measured by ΔNIHSS. These findings support the role of pharmacists in simplifying cerebrovascular pharmacotherapy to enhance safety and reduce costs in acute stroke care.