Suboptimal lipid management in patients with acute ischemic stroke.

OBJECTIVE: Lipid-lowering drugs are among the most widely used drugs in cardiovascular prevention. Statins are often abandoned due to side effects, or under dosed, leading to unreached LDL-cholesterol goals and increased occurrence of cardiovascular events. METHODS: We included hospitalized patients with an ischemic stroke or transient ischemic attack. Of 92 patients, low density lipoprotein cholesterol (LDL-C) levels and lipid lowering therapy at admission and discharge were assessed. Based on their cardiovascular risk before the current event according to the most recent European guidelines, LDL-C targets were determined. Low, moderate, high and very high risk corresponded with LDL-C targets below 116, 100, 70 and 55 mg/dL respectively. RESULTS: Before current event, 59 (64%) were very high, 21 (23%) high, 11 (12%) moderate and 1 low risk patients and eight patients were treated with low, 23 moderate, and 21 high intensity lipid-lowering therapy. Upon admission, 75 patients had insufficiently managed LDL-cholesterol levels, yet 39 of them were taking lipid lowering therapy. Only eight of the 21 patients on high intensity lipid lowering therapy reached their LDL-C target. During hospitalization 40 patients were switched to a high-intensity statin. Thirty-three patients switched from no treatment or a lower-intensity to a moderate-intensity lipid lowering therapy. Three were dismissed with low-intensity lipid lowering therapy, and five in association with Ezetimibe. Three patients had documented statin-intolerance. CONCLUSION: In this study, LDL-cholesterol was insufficiently managed according to international guidelines for prevention of ischemic stroke. Further optimization of lipid management in primary and secondary prevention and the use of higher intensity lipid lowering therapy in clinical practice is mandatory.

[(Added) Value of a clinical pharmacist in the oncology department and optimalisation of the applicability of geriatric tools assessing potential inappropriate medication use in geriatric patients (Drug Burden Index and de Beers criteria)]. / Valeur (ajoutée) du pharmacien clinicien dans le service d'oncologie et optimalisation de l'applicabilité d'outils gériatriques évaluant l'utilisation potentiellement inadéquate de médicaments chez les patients gériatriques (Drug Burden Index et critères de Beers).

In a pilot project, the value of a clinical pharmacist in the oncology department is examined. There is special attention given to two clinical pharmaceutical criteria concerning use of potential inappropriate drugs in this population. First of all, the Drug Burden Index (DBI), a measurement of the individual exposure to anticholinergic and sedative drugs. Second of all, the Beers criteria, an explicit criterion of potential inappropriate use of drugs by the geriatric patient. Criteria are adapted for application in Belgian practice. It can be concluded that the clinical pharmacist can be used to support the multidisciplinary approach to cancer patients. The use of the two criteria mentioned above in the estimation of the clinical impact of drugs on functional outcome and cognition on the (oncolgeriatric patient and the correlation with hard endpoints, still need to be investigated.