Cerebrovascular accident (CVA), commonly called stroke, is a major cause of death, disability, and long-term dependence worldwide. It occurs when blood flow to a part of the brain is interrupted because of a blockage or rupture of a blood vessel. The main types are ischemic stroke, haemorrhagic stroke, and transient ischemic attack (TIA). Stroke management is often complicated because patients commonly have comorbidities such as hypertension, diabetes mellitus, cardiovascular disease, and renal impairment. They may require several medicines, including antiplatelets, statins, antihypertensives, anticoagulants, osmotic diuretics, antidiabetic drugs, antibiotics, and supportive medications. Although these treatments are necessary, the use of multiple drugs can increase the risk of polypharmacy, drug-drug interactions, adverse drug reactions, medication errors, and poor adherence.

Drug Utilization Evaluation (DUE), also called Drug Utilization Review or Medication Use Evaluation, is a structured method for assessing the prescribing, dispensing, administration, and monitoring of medicines. It helps determine whether medications are selected appropriately and used in the correct dose, frequency, and duration according to treatment guidelines. DUE is important in hospital settings because it can identify irrational prescribing, unnecessary drug use, potential drug interactions, and other drug-related problems. Clinical pharmacists play an important role in this process through medication review, identification of drug-related problems, dose adjustment recommendations, monitoring of adverse reactions, patient counselling, and communication with physicians and other healthcare professionals.

The present prospective observational study was conducted in the General Medicine Department and Emergency Ward of BMC and RC, Ballari, Karnataka. The study included 200 inpatients aged above 18 years who were diagnosed with CVA and met the inclusion criteria. Data were collected from patient case sheets, medication charts, laboratory reports, patient interviews, and interactions with patient representatives. The study assessed demographic details, stroke subtype, social habits, comorbidities, medications prescribed, polypharmacy, drug-drug interactions, and pharmacist interventions.

Among the 200 patients studied, 125 patients (62.5%) were male and 75 patients (37.5%) were female, showing a higher occurrence of stroke among males. The most commonly affected age group was 50-59 years, accounting for 24.5% of cases. This was followed by the 60-69 years age group (20.5%) and the 70-79 years age group (19.5%). Regarding social habits, 61.5% of patients had no history of smoking, alcohol use, or tobacco chewing. However, alcohol use was present in 15% of patients, combined smoking and alcohol use in 12%, smoking alone in 8.5%, and tobacco chewing in 3%. These habits are important modifiable risk factors because they can contribute to atherosclerosis, vascular damage, platelet aggregation, and an increased risk of stroke recurrence.

Ischemic stroke was the most frequently observed subtype, occurring in 147 patients (73.5%). Haemorrhagic stroke was observed in 42 patients (21%), while TIA was found in 11 patients (5.5%). The predominance of ischemic stroke explains the frequent use of antiplatelet agents and statins for acute care and secondary prevention. Hypertension was the most common comorbidity, accounting for 41.57% of recorded comorbid conditions, followed by diabetes mellitus (14.34%), seizures (7.53%), cardiovascular diseases (7.53%), aspiration pneumonia (3.58%), and renal disorders (3.58%). These findings highlight the need for strict control of blood pressure, blood glucose, lipid levels, and other cardiovascular risk factors in patients with stroke.

A major finding of this study was the very high prevalence of polypharmacy. Out of 200 patients, 198 patients (99%) received more than five medications during hospitalization. Polypharmacy is often clinically necessary in stroke patients because of the need to treat the acute event, comorbid conditions, and complications. However, it also raises the risk of adverse effects, medication errors, non-adherence, and clinically significant drug interactions. The study identified major drug-drug interactions in 96 cases (45.93%), moderate interactions in 64 cases (30.6%), and minor interactions in 17 cases (8.13%). Commonly identified major interactions included combinations involving aspirin with clopidogrel, heparin, acitrom, furosemide, or spironolactone; alteplase with antiplatelets; and phenytoin with sodium valproate. These findings demonstrate the importance of regular medication review and careful monitoring in hospitalized CVA patients.

The most frequently prescribed drug classes were proton pump inhibitors (94%), statins, mainly atorvastatin (92.5%), osmotic diuretics, mainly mannitol (62.5%), antihypertensives (55%), antiemetics (47.5%), antibiotics (44%), single antiplatelet therapy (43%), and dual antiplatelet therapy (35.5%). Antidiabetic drugs, anticonvulsants, anticoagulants, intravenous fluids, and fibrinolytic agents were also used according to the clinical condition of patients. The high use of antiplatelets and statins was appropriate for ischemic stroke prevention, while antihypertensives were important for controlling the leading modifiable risk factor, hypertension.

Clinical pharmacist interventions were performed in 158 patients (79%). These interventions included identifying potential drug interactions, reviewing medication appropriateness, recommending dose or schedule modifications, suggesting alternative therapy, discontinuing unnecessary medicines, monitoring adverse drug reactions, and providing patient counselling. The high proportion of interventions shows that clinical pharmacists can make a meaningful contribution to medication safety and rational prescribing in stroke care.

In summary, this study shows that ischemic stroke, hypertension, polypharmacy, and potential drug-drug interactions are highly prevalent among hospitalized CVA patients. DUE was useful for identifying prescribing patterns and medication-related problems. The active involvement of clinical pharmacists improved the detection and prevention of drug-related problems and supported safer, more rational pharmacotherapy. Routine DUE, medication review, and pharmacist participation as part of a multidisciplinary stroke-care team can help improve patient safety, therapeutic outcomes, and the overall quality of care.