Pharmacist intervention and anti-platelet medication monitoring in patients following stroke and transient ischemic attack

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 ABCD² 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.