Drugs Associated With Ischemic Stroke

Abstract

Certain drugs may increase the risk of ischemic stroke (IS). Our goal was to review associations between frequently used drugs and IS. We created an initial list of frequently used drugs to search Pubmed/MEDLINE from 1966 to 2020 and reviewed phase III and IV data, case series, and drug authorities’ safety warnings to assess a potential association with IS. Drugs were grouped according to the World Health Organization Anatomical Therapeutic Chemical Classification System. Predefined criteria were applied to establish a level of evidence for an association, from A (high level of evidence of association) to E (high level of evidence of absence of association). In addition, we assessed relative risks and reviewed potential mechanisms of IS facilitation. We assessed 81 drugs or drug classes from 11 World Health Organization Anatomical Therapeutic Chemical Groups. We identified a high level of association for erythropoietin, combined contraceptives, oral estrogen replacement therapy, bevacizumab, tamoxifen, and antipsychotics and a moderate level for ponatinib, nilotinib, darunavir, and gonadotropin-releasing hormone agonists. Drug dose and treatment duration may modify the risk. For a substantial number of drugs, we found no association, and for others, there were insufficient data to categorize risk. We identified a high level of association of IS with a limited number of drugs, a potential association with some, and a lack of data for others. The summarized information may help clinicians to estimate the contribution of a drug to an IS, to better assess drug benefit-risk ratios, and to support decisions about using specific drugs.

Association between stroke and psychosis across four nationally representative psychiatric epidemiological studies

“…We also note that the majority of research in this area has focused on poststroke psychosis that likely contributes only a proportion of the co-prevalence of stroke and psychosis. As psychosis, and treatment for psychosis, is a risk factor for later stroke (Li et al, 2014; Marto et al, 2021), stroke in patients with a preceding history of psychosis is also likely to be an important contributory factor to co-prevalence. We also note here that initial studies report that patients with psychosis who later experience stroke have worse outcomes and are less likely to receive equitable care (Kisely et al, 2009; Willers et al, 2018) including timely invasive interventions (Nielsen et al, 2021).…”

“…Indeed, people with a diagnosis of schizophrenia have increased risk factors for stroke (Bresee et al, 2010), and are at higher risk of stroke (Li et al, 2014) and recurrent stroke (Fleetwood et al, 2021). The main treatment for psychosis, antipsychotic medication, raises the risk of stroke with strong evidence for the role of metabolic syndrome (Nielsen et al, 2021) and likely alternative mechanisms also including platelet aggregation, orthostatic hypotension and cardiac arrthymias (Marto et al, 2021). Studies on predictors of cardiovascular events more generally in patients with schizophrenia also highlight the role of shared risk factors that may raise the risk of both conditions independently (Osborn et al, 2015).…”

Ten things to know about ten cardiovascular disease risk factors – 2022

“…Risk factors for thrombosis include cigarette smoking, older age, atrial fibrillation, prosthetic heart valves, blood clotting disorders, trauma/fractures, physical inactivity (including prolonged bed rest / immobility), obesity, diabetes mellitus, HTN, dyslipidemia, certain drug treatments, [323] pregnancy, and cancer. Due to higher hormonal components, older oral contraceptives were associated with increased risk of thrombotic stroke.…”

A systematic review of the research progress of non-coding RNA in neuroinflammation and immune regulation in cerebral infarction/ischemia-reperfusion injury

“…The main treatment options for stroke in clude throm bolysis, anticoagulation , antihypertensive, plasmin reduction, and catheter intervention. Thrombolytic drugs and neuroprotective drugs are more commonly used (7)(8)(9). However, vascular recanalization after thrombolysis can lead to ischemia-reperfusion injury, and rt-PAs drugs have no effect on protecting or reversing neuronal ischemia-reperfusion injury (10,11).…”