Discontinuation of Statin Therapy and Clinical Outcome After Ischemic Stroke

Abstract

Background and Purpose-The majority of patients with previous ischemic stroke are expected to benefit significantly from long-term statin therapy. However, discontinuation of medication therapy frequently occurs in clinical practice. The aim of this study was to assess the impact of discontinued statin therapy on clinical outcome in patients discharged after an acute ischemic stroke. Methods-The study population included 631 consecutive stroke survivors (322 men and 309 women; meanϮSD age, 70.2Ϯ7.6 years) without clinical evidence of coronary heart disease. All patients were discharged on statin therapy and were followed up for 12 months after the acute ischemic stroke. Results-Within 12 months from discharge, 246 patients (38.9%) discontinued statin therapy; the mean time from discharge to statin discontinuation was 48.6Ϯ54.9 days (median time, 30 days; interquartile range, 18 to 55 days). During follow-up, 116 patients died (1-year probability of deathϭ0.18; 95% CI, 0.15 to 0.21). Multivariate analysis demonstrated that after adjustment for all confounders and interactions, statin therapy discontinuation (hazard ratioϭ2.78; 95% CI, 1.96 to 3.72; Pϭ0.003) was an independent predictor of all-cause 1-year mortality. Conclusions-A large number of patients discontinue their use of statins early after acute stroke. Moreover, patients discontinuing statins have a significantly increased mortality during the first year after the acute cerebrovascular event.These findings suggest that patient care should be improved during the transition from a hospital setting to outpatient primary care.

Utilization of Statins Beyond the Initial Period After Stroke and 1‐Year Risk of Recurrent Stroke

“…The current study found adverse effects in patients who did continue statins through the acute period but then were no longer on the therapy more than 3 months after onset. A single‐center study found increased mortality among patients stopping statins in the first year after stroke 6. Our study affirms the deleterious effect of stopping statins after the initial period following a stroke but does so in a population 30‐fold larger, demonstrates increased risk of recurrent stroke, and controls more rigorously for the healthy‐user effect.…”

Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

“…Exposure to statins in the acute phase of experimental stroke appears to promote angiogenesis and synaptogenesis,15 and additional pleiotropic statin effects such as vasodilatory and antithrombotic properties have been reported 16. These experimental observations are supported by clinical findings of improved outcomes with acute statin use in myocardial infarction,17, 18, 19 stroke,3, 4, 20, 21 and major vascular surgery 22, 23…”

Pharmacist-Coordinated Multidisciplinary Hospital Follow-up Visits Improve Patient Outcomes

“…These errors include discontinuation of prescribed medications; noncompliance, including failure to fill medications or failure to be adherent; and delays in filling medications. [5][6][7] In the geriatric population, the most frequently reported unwanted events after discharge were related to prescription medication regimens mainly due to patients getting incorrect drugs or dosages. 8 Literature to date shows that some pharmacist interventions before and after discharge decrease medication-related errors.…”