---
title: "Pharmacist-led SPOS reduces polypharmacy and drug costs in acute ischemic stroke without harming r"
id: "plos-one-5-impact-of-a-pharmacist-led-optimization-strategy-for-cerebrovascular"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-5-impact-of-a-pharmacist-led-optimization-strategy-for-cerebrovascular"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101"
published_at: "2026-08-27T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Pharmacist-led SPOS reduces polypharmacy and drug costs in acute ischemic stroke without harming r
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-5-impact-of-a-pharmacist-led-optimization-strategy-for-cerebrovascular
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101)
- **Published At:** 2026-08-27T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Study type: a single-center pre–post intervention study at a tertiary hospital evaluating a pharmacist-led Stroke Pharmacotherapy Optimization Strategy (SPOS) in acute ischemic stroke (AIS). - Study period: June 2024 to April 2025; control cohort June–October 2024, SPOS cohort December 2024–April 2025. - Intervention: **pharmacist-led** SPOS using a “3-2-1” principle to limit non-recanalization cerebrovascular drugs to ≤3 and cerebrovascular-related traditional Chinese medicines to ≤2, plus pharmacist medication monitoring, patient education, and individualized adjustments. - Sample size: 416 patients total (204 control, 212 SPOS). - Primary medication outcomes: SPOS group received significantly fewer non-recanalization cerebrovascular drugs (mean 3.03 ± 1.18 vs 4.62 ± 1.15; P < 0.001) and fewer cerebrovascular-related traditional Chinese medicines (mean 1.04 ± 0.90 vs 1.93 ± 1.02; P < 0.001). - Clinical recovery: No significant difference in change in NIHSS (ΔNIHSS) or overall short-term neurological recovery between groups. - Safety and adverse events: Incidence of in-hospital adverse events was lower in the SPOS group (P = 0.034); no safety signal identified related to medication simplification during hospitalization. - Resource use and cost: Length of stay was similar between groups, but total hospitalization costs, drug costs, and the proportion of drug-related expenditures were markedly reduced in the SPOS group (all P < 0.001). - Conclusion: Implementing a **pharmacist-led** optimization strategy simplified cerebrovascular pharmacotherapy, lowered medication exposure and drug-related costs, and was associated with fewer adverse events without compromising short-term neurological outcomes. - Data access and ethics: Individual-level data are not publicly available due to confidentiality; de-identified data may be requested from the hospital ethics committee per the article. - Funding and conflicts: Funded by multiple Chinese national and regional grants; authors declared no competing interests.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0357101) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). 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guopharm@126.com (CG); lujinsysu@hotmail.com (JL) Affiliations Neurology and Genetics Clinical Pharmacy Team, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Department of Neurology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Shanghai Neurological Rare Disease Biobank and Precision Diagnostic Technical Service Platform, Shanghai, China, Neurological Disorder Center, Haikou Orthopedic and Diabetes Hospital of Shanghai Sixth People’s Hospital, Haiko, Hainan, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-1742-9877 ](https://orcid.org/0000-0003-1742-9877 "ORCID Registry") ⨯ * Cheng Guo , Roles Conceptualization, Resources, Supervision, Validation, Writing – review & editing * E-mail: Caoli2000@yeah.net (LC); guopharm@126.com (CG); lujinsysu@hotmail.com (JL) Affiliations Department of Pharmacy, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Neurology and Genetics Clinical Pharmacy Team, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China ⨯ * Jin Lu Roles Conceptualization, Funding acquisition, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing * E-mail: Caoli2000@yeah.net (LC); guopharm@126.com (CG); lujinsysu@hotmail.com (JL) Affiliations Department of Pharmacy, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Neurology and Genetics Clinical Pharmacy Team, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, State Key Laboratory of Neurology and Oncology Drug Development, Nanjing, Jiangsu Province, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0009-9362-9273 ](https://orcid.org/0009-0009-9362-9273 "ORCID Registry") ⨯ # Impact of a pharmacist-led optimization strategy for cerebrovascular pharmacotherapy beyond recanalization in acute ischemic stroke: A pre- and post-intervention study * Zhongqiu Zhang, * Xincai Zhao, * Mengqi Jia, * Fei Zhao, * Miaomiao Zhou, * Yadi Liu, * Jiangshan Deng, * Xiaoran Cai, * Yao Fu, * Jianping Zhang ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 27, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0357101) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357101) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357101) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0357101) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#sec005) * [Materials and methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#sec015) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#sec021) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#sec022) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#sec023) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357101) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101) ## Abstract ### 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. ## Figures ![Table 5](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.t005) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.g001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.g002) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.t004) ![Table 5](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.t005) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.g001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.g002) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357101.t001) **Citation:** 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 21(8): e0357101. https://doi.org/10.1371/journal.pone.0357101 **Editor:** Wen-Jun Tu, Chinese Academy of Medical Sciences and Peking Union Medical College, CHINA **Received:** May 27, 2026; **Accepted:** August 12, 2026; **Published:** August 27, 2026 **Copyright:** © 2026 Zhang et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** The data underlying this study cannot be made publicly available because they contain potentially identifiable patient information and are subject to ethical and institutional restrictions. According to the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, public sharing of individual-level data without appropriate approval would compromise participant confidentiality. De-identified individual-level data may be made available upon reasonable request to the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Email: liuyuanec@163.com), for researchers who meet the criteria for access to confidential data and whose proposed use has been approved by the Ethics Committee. **Funding:** This work was supported by a Grant from the National Natural Science Foundation of China (82104142 to JL, 82371255 to LC); Shanghai Neurological Rare Disease Biobank and Precision Diagnostic Technical Service Platform, Shanghai Science and Technology Innovation Action Plan (23DZ2291500 to LC); 2025 Shanghai Youth Innovation Project in Pharmaceutical Services (Category A) (SPAYXFW2025A12 to JL); Talent Project established by the Chinese Pharmaceutical Association Hospital Pharmacy Department (No. CPA-Z05-ZC-2025-003 to JL); Ministry of Science and Technology of China, National Key Laboratory of Neuro-Oncology Drug Development, Youth Program (2025) (SKLSIM-20250349 to JL); and Shanghai Magnolia Talent Program (Pujiang Project), 2025 (No. 25PJD096 to JL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Healthcare systems worldwide are facing the growing challenge of rising medical expenditures and the need to ensure the sustainability of health insurance funds [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref001)]. Many countries have implemented reforms emphasizing rational medicine use, value-based healthcare, and standardized evidence-based medication management. Within this evolving healthcare landscape, pharmacists play an increasingly vital role in promoting rational pharmacotherapy [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref002)], improving therapeutic outcomes [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref003),[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref004)], and enhancing the overall value of healthcare delivery [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref005),[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref006)]. Globally, stroke is a leading cause of death and disability, and its burden continues to rise. In China, stroke has become the leading cause of mortality and long-term disability. Among Chinese adults aged 40 years and older in 2020, an estimated 17.8 million individuals were living with stroke (prevalence 2.6%), with 3.4 million incident cases (incidence 505.2 per 100,000 person-years) and 2.3 million stroke-related deaths (mortality 343.4 per 100,000 person-years); ischemic stroke accounted for 86.8% of all incident cases [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref007)]. These figures underscore the substantial clinical and economic imperative to optimize acute stroke care, including its pharmacotherapy. Polypharmacy is highly prevalent in clinical practice and is particularly prominent among stroke patients. Previous studies have shown that approximately 67.7% of hospitalized ischemic stroke patients experienced drug‑related problems (DRPs) [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref008)]. Another investigation reported that over 91% of stroke patients had at least one potential drug‑drug interaction (pDDI), with polypharmacy (use of more than 10 medications) identified as a significant predictor of high‑severity pDDIs [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref009)]. These findings highlight that polypharmacy is both common and closely associated with impaired medication safety and increased drug‑related cost [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref010)]. In acute ischemic stroke (AIS), the therapeutic benefits of vascular recanalization are limited by narrow time windows, contraindications and reperfusion injury [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref011)–[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref013)]. Even after successful recanalization, infarct expansion may continue, adversely impacting neurological recovery [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref014),[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref015)]. Consequently, multiple neuroprotective and cerebrovascular agents such as edaravone dexborneol [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref016),[17](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref017)], butylphthalide [[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref018)], urinary kallidinogenase [[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref019)], as well as traditional medicines such as ginkgo biloba extract [[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref020)], Qingkailing [[21](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref021)], and Qishiwei Zhenzhu Pill [[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref022),[23](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357101#pone.0357101.ref023)], have been frequently prescribed. However, the concurrent use of multiple cerebrovascul
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