Pharmacist intervention and anti‐platelet medication monitoring in patients following stroke and transient ischemic attack. Issue 3 (16th December 2020) - Greger, Jessica
Abstract: Introduction: Aspirin and clopidogrel are mainstays in secondary stroke prevention; however, some patients do not demonstrate optimal antiplatelet effects from these therapies. Objectives: The primary objective of this study was to determine if pharmacist medication intervention paired with anti‐platelet medication monitoring with whole blood aggregometry improved responsiveness to antiplatelet treatment when compared with standard‐of‐care, alone in patients at risk of recurrent stroke or transient ischemic attack (TIA). Methods: This retrospective chart review at an outpatient neurology practice examined patients treated post‐stroke or post‐TIA between 2005 and 2017. Patients were categorized as either having undergone platelet function testing (PFT) with pharmacist intervention and standard‐of‐care or standard‐of‐care alone. Patient populations for each group were matched based on age, sex, and ABCD 2 risk scores. Pharmacotherapeutic management and interventions were assessed in each group. Results: A total of 342 patients were included as two matched groups (n = 171 for each group) with parallel baseline characteristics. Drug‐drug interactions were identified ( P < .0001), and counseling on adherence ( P = .0008) occurred statistically significantly more often with a pharmacist involved in patient care. After pharmacist intervention and PFT, 83% of patients were considered responsive to their antiplatelet therapy compared with 27% at baseline in the pharmacist intervention group ( P < .0001). Conclusion: Pharmacist interventions optimized secondary stroke/TIA prophylaxis therapy, decreased drug‐drug interactions, and increased adherence counseling. Patients who underwent PFT and pharmacist intervention transitioned from nonresponsive to responsive to their antiplatelet therapy regimen.