Evaluation of Post-Stroke Medication Prescription Practices

Abstract

Background and Objectives: Toronto Western Hospital (TWH), an Ontario regional stroke centre, cares for approximately 900 stroke patients annually. The objective of this study was to determine if TWH met antithrombotic prescribing benchmarks set forth by Accreditation Canada for Distinction in Acute Stroke Services. The evaluation and treatment of modifiable risk factors, and potential practice differences between the Neurovascular Unit (NVU) and the Emergency Department (ED), were also assessed. Methods: A retrospective chart review was completed for all patients with an ischemic stroke or transient ischemic attack between July 1st and December 31st, 2016. Two hundred and sixty-three patients met inclusion criteria for analysis. Medications prescribed for secondary prevention were evaluated. The proportions of patients receiving guideline-based therapies on discharge from the NVU and ED were compared using Fisher’s exact test. Results: Antithrombotic therapy was prescribed on discharge to 88% of ED and 97% of NVU patients (p=0.003). Patients with atrial fibrillation were equally likely to receive anticoagulants on discharge (83% ED, 80% NVU; p=1.00). Antiplatelet therapy was received within 48 hours by 70% of eligible ED and 97% of eligible NVU patients (p<0.001). Antihypertensives were prescribed to 98% of ED and 85% of NVU patients diagnosed with hypertension (p=0.004). There were no significant differences in prescribing rates of statins, antihyperglycemics or smoking cessation interventions, though smoking cessation interventions were low in both groups (0% ED, 69% NVU; p=0.08). On admission, NVU patients were more frequently diagnosed with hypertension (76% vs. 54%, p<0.001) and dyslipidemia (92% vs 39%, p<0.001), and assessed for smoking status (71% vs 45%, p<0.001). Conclusions: TWH meets Accreditation Canada’s benchmark for antithrombotic prescribing. Outpatient referral for patients discharged directly from the ED may help complete the evaluation and treatment of modifiable risk factors. A future focus on assessment and prescribing of smoking cessation interventions is recommended.