Impact of a pharmacist-led optimization strategy for cerebrovascular pharmacotherapy beyond recanalization in acute ischemic stroke: A pre- and post-intervention study

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.