Elaine Shanahan

266Prescribing Post Ischaemic Stroke and TIA: A Review of Compliance with Guidelines

Background: The Royal College of Physicians (RCP) published the National Clinical Guidelines for Stroke in 2016. They advise that patients who experience an ischaemic stroke or Transient Ischaemic Attack (TIA) should receive treatment with high dose statin and those that do not require anti-coagulation should be treated with long term clopidogrel. They also advise that pneumatic compression devices should be used for prophylaxis of venous thrombosis and that Low Molecular Weight Heparin (LMWH) should not be used. We aimed to assess our department’s compliance with these guidelines. Methods: Our department’s Electronic Patient Record System (ePMS) was used to identify all patients admitted under the Department of Medicine for the Elderly who had a discharge diagnosis of ischaemic stroke or TIA. Data was analysed for patients admitted between January and April 2017. We reviewed the discharge prescription for the use of clopidogrel and high dose statin. The medication kardex of inpatients in the acute stroke unit were also reviewed to look for the use of pneumatic compression devices or LMWH. Results: 57 patients with acute ischaemic stroke or TIA were identified. Of these 63% were on high dose statin on discharge. 18% of patients were commenced on anticoagulation. Of the patients who were appropriate for antiplatelet treatment 44% were discharged with a plan for long term aspirin and 66% were commenced on long term clopidogrel. Of the inpatients in the acute stroke unit 57% were on prophylactic LMWH. No patient was prescribed a pneumatic compression device. Conclusions: RCP guidelines are poorly complied with in acute stroke care. Patients are frequently discharged on inappropriately low doses of statin and on incorrect antiplatelet treatment. LMWH is over prescribed in the acute settling and pneumatic compression devices are not in use. Further education of acute stroke guidelines is required to ensure optimum stroke management.