(1) Gadjah Mada University
(2) Gadjah Mada University
(3) Gadjah Mada University
(*) Corresponding Author


Ischemic stroke is one of the main causes of death and disability in Indonesia and in the world whose prevalence continues to increase. One of the factors that increase disability in ischemic stroke patients is poor stroke management, and the incidence of DRPs plays a role in it. This study was conducted to determine whether there is a significant relationship between the incidence of DRPs in ischemic stroke patients, and the patient's clinical outcome, which is described by the patient's NIHSS status. It is known that NIHSS is an outcome parameter with the best accuracy and sensitivity compared to other outcome parameters. The study was conducted with a retrospective cross-sectional design, involving 111 samples sourced from the medical records of patients who met the inclusion criteria in the April-October 2021 period. The DRPs analyzed in this study were medication errors, the need for additional drugs, too low drug doses, and drug side effects occur. In this study, DRPs occurred in 88.2% of patients, with the most common type being the need for additional drugs in patients. This study found that the presence of DRPs in ischemic stroke patients, has the potential to increase the risk of patients experiencing clinical outcomes that do not improve as described by the NIHSS status (OR 3,714; p-value<0,05).


DRPs, ischemic stroke, clinical outcome, NIHSS


Khaku AS, Tadi P. Cerebrovascular Disease. In: StatPearls. StatPearls Publishing; 2021. Accessed July 20, 2021.

Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9

Viswam S, Nair G, Thomas B, Shivashankar V. A Prospective Observational Study on Polypharmacy in Geriatrics at A Private Corporate Hospital. Journal of Applied Pharmaceutical Science. 2017;7:162-167. doi:10.7324/JAPS.2017.71024

Nahrowi NS, Ong PA, Adam A. Cognitive and Functional Outcome of Patients with Ischemic Stroke at Dr. Hasan Sadikin Hospital Bandung. Althea Medical Journal. 2018;5(2):82-86. doi:10.15850/amj.v5n2.1173

Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;2018. doi:10.1155/2018/3238165

Zhang L, Li X, Wolfe CDA, O’Connell MDL, Wang Y. Diabetes As an Independent Risk Factor for Stroke Recurrence in Ischemic Stroke Patients: An Updated Meta-Analysis. Neuroepidemiology. 2021;55(6):427-435. doi:10.1159/000519327

Yang Y, Shi YZ, Zhang N, et al. The Disability Rate of 5-Year Post-Stroke and Its Correlation Factors: A National Survey in China. PLOS ONE. 2016;11(11):e0165341. doi:10.1371/journal.pone.0165341

Hsu WT, Shen LJ, Lee CM. Drug-related problems vary with medication category and treatment duration in Taiwanese heart failure outpatients receiving case management. Journal of the Formosan Medical Association. 2016;115(5):335-342. doi:10.1016/j.jfma.2015.11.014

Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg. 2000;191(2):123-130. doi:10.1016/s1072-7515(00)00352-5

Tasaka Y, Tanaka A, Yasunaga D, Asakawa T, Araki H, Tanaka M. Potential drug-related problems detected by routine pharmaceutical interventions: safety and economic contributions made by hospital pharmacists in Japan. J Pharm Health Care Sci. 2018;4:33. doi:10.1186/s40780-018-0125-z

Niquille A, Bugnon O. Relationship between drug-related problems and health outcomes: a cross-sectional study among cardiovascular patients. Pharm World Sci. 2010;32(4):512-519. doi:10.1007/s11096-010-9401-1

DiPiro JT, Yee GC, Posey M, Haines ST, Nolin TD, Ellingrod V, eds. Stroke. In: Pharmacotherapy: A Pathophysiologic Approach, 11e. 11th ed. McGraw-Hill Education; 2020:38. Accessed March 10, 2021.

Kose E, Maruyama R, Okazoe S, Hayashi H. Impact of Polypharmacy on the Rehabilitation Outcome of Japanese Stroke Patients in the Convalescent Rehabilitation Ward. Journal of Aging Research. 2016;2016:1-8. doi:10.1155/2016/7957825

Kanagala VS, Anusha A, Rao BS, Challa SR, Nalla KS, Gadde RS. A study of medication-related problems in stroke patients: A need for pharmaceutical care. J Res Pharm Pract. 2016;5(3):222-225. doi:10.4103/2279-042X.185750

Hohmann C, Neumann-Haefelin T, Klotz JM, Freidank A, Radziwill R. Drug-related problems in patients with ischemic stroke in hospital. Int J Clin Pharm. 2012;34(6):828-831. doi:10.1007/s11096-012-9690-7

Nurhaini R, Jatiningrum A, Akrom. GAMBARAN DRUG RELATED PROBLEMS (DRPs) PADA PASIEN STROKE RAWAT INAP RUMAH SAKIT X DI YOGYAKARTA. Universitas Ahmad Dahlan Press. Published online 2017:9.

Kasner SE. Clinical interpretation and use of stroke scales. The Lancet Neurology. 2006;5(7):603-612. doi:10.1016/S1474-4422(06)70495-1

Chalos V, van der Ende NAM, Lingsma HF, et al. National Institutes of Health Stroke Scale. Stroke. 2020;51(1):282-290. doi:10.1161/STROKEAHA.119.026791

Young FB, Weir CJ, Lees KR. Comparison of the National Institutes of Health Stroke Scale With Disability Outcome Measures in Acute Stroke Trials. Stroke. 2005;36(10):2187-2192. doi:10.1161/01.STR.0000181089.41324.70

Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S. What Change in the National Institutes of Health Stroke Scale Should Define Neurologic Deterioration in Acute Ischemic Stroke? J Stroke Cerebrovasc Dis. 2013;22(5):675-682. doi:10.1016/j.jstrokecerebrovasdis.2012.04.012

Siegler JE. The Utility of Quantifiable Neurologic Assessments After Stroke. Neurohospitalist. 2016;6(3):95-96. doi:10.1177/1941874416641469

Lemeshow S, World Health Organization, eds. Adequacy of Sample Size in Health Studies. Published on behalf of the World Health Organization by Wiley ; Distributed in the U.S.A., Canada, and Japan by Liss; 1990.

PERDOSSI. Guideline Stroke. Perhimpunan Dokter Spesialis Saraf Indonesia; 2011.


Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12). doi:10.1161/STR.0000000000000211

Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. European Stroke Journal. 2021;6(1):I-LXII. doi:10.1177/2396987321989865

Fonseca AC, Merwick Á, Dennis M, et al. European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack. European Stroke Journal. Published online March 16, 2021:239698732199290. doi:10.1177/2396987321992905

Dawson J, Merwick Á, Webb A, et al. European Stroke Organisation expedited recommendation for the use of short-term dual antiplatelet therapy early after minor stroke and high-risk TIA. European Stroke Journal. Published online March 11, 2021:239698732110008. doi:10.1177/23969873211000877

Sandset EC, Anderson CS, Bath PM, et al. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. European Stroke Journal. Published online May 11, 2021:239698732110121. doi:10.1177/23969873211012133

Lexicomp. Lexicomp’s DrugID and Drug Interaction Checker. Wolters Kluwer; 2022.

Ekker MS, de Leeuw FE. Higher Incidence of Ischemic Stroke in Young Women Than in Young Men. Stroke. 2020;51(11):3195-3196. doi:10.1161/STROKEAHA.120.032062

Sudha S, A B, M KH, et al. The lifetime risk of stroke: estimates from the Framingham Study. Stroke. 2006;37(2). doi:10.1161/01.STR.0000199613.38911.b2

Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation. 2022;145(8):e153-e639. doi:10.1161/CIR.0000000000001052

Setyopranoto I, Bayuangga HF, Panggabean AS, et al. Prevalence of Stroke and Associated Risk Factors in Sleman District of Yogyakarta Special Region, Indonesia. Stroke Res Treat. 2019;2019:2642458. doi:10.1155/2019/2642458

Zheng S, Yao B. Impact of risk factors for recurrence after the first ischemic stroke in adults: A systematic review and meta-analysis. J Clin Neurosci. 2019;60:24-30. doi:10.1016/j.jocn.2018.10.026

Yimama M, Jarso H, Desse TA. Determinants of drug-related problems among ambulatory type 2 diabetes patients with hypertension comorbidity in Southwest Ethiopia: a prospective cross sectional study. BMC Res Notes. 2018;11. doi:10.1186/s13104-018-3785-8

Wajngarten M, Silva GS. Hypertension and Stroke: Update on Treatment. Eur Cardiol. 2019;14(2):111-115. doi:10.15420/ecr.2019.11.1

Ishitsuka K, Kamouchi M, Hata J, et al. High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes. Hypertension. 2014;63(1):54-60. doi:10.1161/HYPERTENSIONAHA.113.02189

Nascimento Y, Carvalho W, Acurcio F. Drug-related problems observed in a pharmaceutical care service, Belo Horizonte, Brazil. Brazilian Journal of Pharmaceutical Sciences - BRAZ J PHARM SCI. 2009;45. doi:10.1590/S1984-82502009000200018


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