Date of Award

Winter 1-4-2019

Document Type

Dissertation

Degree Name

MPharm Pharmacy Practice

Department

Department of Pharmacy Practice

First Advisor

Dr. Sanker Prasad Gorthi

Abstract

Background: Stroke is one of the leading causes of adult disability. Carotid artery stenosis (CAS) is a result of systemic atherosclerotic disease. Therefore, any risk factor predisposing a patient to progressive atherosclerosis can potentially manifest itself as stenosis of the carotid artery with resultant ischemic stroke and/or transient ischemic attack (TIA) like symptoms. An aggressive medical cardiovascular risk reduction approach, centered on the use of a statin when CAS is present, is the current standard of care. Therefore, the purpose of this study was to investigate the effect of statin use in ischemic stroke patients with and without CAS on neurological and clinical improvement. Methodology: A prospective observational study was carried out for 8 months (September 2018 to April 2019) in the Departments of Neurology, Kasturba Hospital, Manipal. A total of 200 ischemic stroke patients were included in our study. The patient demographics, clinical details such as age, sex, diagnostic methods, smoking history, familial history of stroke, past history of stroke or TIA, blood pressure, risk factors, drug detail were colleted. Drug prescription detais included were dosage and potency of statin. Relevant infomtion inluding clinical laboratory data were collected from medical records and using lab report viewer software of Kasturba hospital management system after taking informed consent from the patients. Degree of severity of stroke was determined based on NIHSS score and neurological improvement was calculated based on the relative decrease in NIHSS score at hospital discharge compared to hospital admission. Degree of disability of stroke was calculated at the time of discharge using mRS score. Statistical comparisons between different subgroups were performed using the chi-square test, independent t-test, Mann–Whitney U test, Kruskel-Wallis test where appropriate. We used the Kaplan–Meier product-limit method to estimate the survival time after the initial event. Result: The mean age of our study population was found to be 62.26±13.07. Male predominance (66.5%) for ischemic stroke were found in this study. We found a statistically significant association between stenosis and gender (p=0.003), hypertension (p= 0.034), smoking (p = 0.025) and statin potency (p= 0.037). Statin use after stroke in patients with and without CAS was associated with better neurological improvement during hospitalisation (p=0.048). Addtionally, statin use lowered the risk of recurrent stroke and mortality. High potency statin (Atorvastatin 40mg) is associated with better survival at 6 months (p=0.032). Conclusion: Statin treatment after stroke in patients with and without CAS appears to be associated with better early outcomes regarding neurological and clinical improvement; and reduced incidence of stroke recurrence.High potency statin have better survival at 6 months in ischemic stroke patients. In this hospital, we found DDD/100 bed days for Atorvastatin as 49.93 and for Rosuvastatin as 0.26.

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