title: The High Frequency of Guideline-Approved and Guideline-Disapproved Medication Use in Stroke and Transient Ischemic Attack.
abstract: OBJECTIVE
  Administration of evidence-based pharmacotherapy improves stroke outcome while the use of non-evidence-based medications may not be of benefit and leads to unnecessary patient care costs. The aim of our study was to determine the frequency of guideline-approved and guideline-disapproved pharmacotherapy use in acute stroke management in the Czech Republic (CR).
  
  
  METHODS
  Using the ICD-10 codes, 500 stroke and transient ischemic attack (TIA) patients were randomly selected (random selection of 10 hospitals and then 50 patients from each hospital) from the National Registry of Hospitalized Patients for strokes occurring in 2011. Discharge summaries were reviewed for medications prescribed during hospitalization and at discharge.
  
  
  RESULTS
  Of the 500 requested discharge summaries, 484 were available for review (response rate 97%). Up to 479 (96%) summaries were sufficient for evaluation and of these, 393 were confirmed to have a stroke or TIA diagnosis. Brain imaging (computed tomography or magnetic resonance imaging) was performed in 97% of the 393 cases. Intravenous thrombolysis was administered to 7% of patients with ischemic stroke (rate was 0%-25% in different hospitals). Up to 97% of patients with ischemic events (TIA or ischemic stroke) were treated with antiplatelets or anticoagulants. At least 1 non-evidence-based medication was administered to 28% of the 393 patients (rate was 5%-89% in different hospitals).
  
  
  CONCLUSIONS
  Guideline-disapproved pharmacotherapy is common in stroke and TIA patients in the CR and processes should be put into place to lessen the frequency of their use. The use of guideline-approved medications is also high and should be further promoted.
authors.affiliation: International Clinical Research Centre, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Jackova
authors.affiliation: International Clinical Research Centre, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St Anne's University Hospital, Brno, Czech Republic; Department of Internal Medicine, Haematology and Oncology, University Hospital Brno, Brno, Czech Republic; Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Petra
authors.initials: P
authors.lastname: Sedova
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.affiliation: International Clinical Research Centre, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Bryndziar
authors.affiliation: Institute for Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Zvolsky
authors.affiliation: Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, University Hospital Brno, Brno, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Bednarik
authors.affiliation: International Clinical Research Centre, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St Anne's University Hospital, Brno, Czech Republic. Electronic address: mikulik@hotmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018153:Czech Republic; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use; D063886:Patient Discharge Summaries; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: Czech Republic; Stroke; cost-effectiveness; evidence-based; guidelines; pharmacotherapy