Introduction

Stroke is In India, a significant non-communicable disease (NCD) is to blame for 3.5% of the disability-adjusted life years. The occurrence of stroke is on the rise as a result of changes in lifestyle, behaviour, demographics, socio-cultural norms, and technology 1, 2. Generally speaking, people can prevent the disease by making little modifications to the way they live. A stroke is a sudden loss of brain function brought on by an interruption in the blood flow to the brain. A stroke is referred to as a "BRAIN ATTACK" when the blood supply to a particular area of the brain is cut off 3. 8, 00,000 primary (first-time) and secondary (recurrent) cases, respectively. Strokes occur annually in the United States, with the majority being primary strokes (about 6, 00,000), 87% being ischemic violations, 10% being main haemorrhages, and 3% subarachnoid hemorrhages 4. Per year 17 million strokes were noted. For every 2 seconds, one stroke was noted. For every Year 6.5 million deaths were observed global estimations indicates that primary hemorrhage For 10% to 25% of all strokes, people of Asian, African, as well as Latin American ancestry tend to experience primary haemorrhage more frequently than people of European ancestry 5. Additionally, primary haemorrhage causes 10 to 17% of all strokes, and its prevalence doubles every ten years after age 55. Stroke incidence ranges from 30 to 120 per 100,000 adults aged 35 to 44 and from 670 to 970 per 100,000 adults aged 65 to 74 per year 6. Based on the cause of the stroke, it can be categorised as either ischemic (87%) or hemorrhagic (13%).

Ischaemic Stroke:

It is caused by the blocking of a cerebral artery (50%) by thrombus or atherosclerotic plaque, 25% by embolism, and 25% by micro-artery blockage, or "lacunar stroke") 7. The most frequent type of stroke, an ischemic stroke, occurs when a brain artery is blocked. Ischemic stroke can come in two different forms 8.

Embolic Stroke

A blood clot or plague fragment usually develops in the heart or the major arteries that supply the brain during an embolic stroke and travels via the arteries to the brain. A stroke results from the clot blocking a blood artery in the brain 9.

Thrombotic Stroke

A blood clot inside an artery that supplies blood to the brain is known as a thrombotic stroke. The clot prevents blood flow, which results in a stroke 10.

Transient Ischemic Attack:

Blood flow slows or ceases if a brain artery or one that goes to the brain is temporarily stopped. A brief ischemia attack sometimes referred to as a "MINI STROKE" can result from this. When a TIA occurs, the artery either becomes unblocked quickly or a new channel opens up, restoring normal blood flow 11. The symptoms only stay a short while before going away. A TIA is a severe indication that you could be having a stroke.

Hemorrhagic Stroke:

When a blood artery in the brain bursts, blood leaks into or around the brain, causing a hemorrhagic stroke. Blood vessels can become weak enough to explode due to aneurysms and high blood pressure 12. There are two types:

Intracerebral Hemorrhage:

A ruptured blood artery that bleeds into the brain tissue results in this particular type of stroke. As a result of the bleeding, the brain cells die and the damaged area of the brain becomes dysfunctional. The most frequent cause of this kind of stroke is hypertension 13.

Subarachnoid Hemorrhage:

A blood vessel close to the surface of the brain bursts in this form of stroke, allowing blood to flow into the gap between the brain and the skull. The pressure from the blood that builds up in this area puts strain on the brain's tissue and causes blood vessels to spasm. Aneurysms are typically the cause of this type of stroke 14.

Aneurysm:

It is a weak point of the artery's wall that protrudes into a thin bubble. As it grows, the wall could become weak as well as crack.

The goals of treatment of acute stroke are

The first is to lessen the ongoing brain damage, as well as to lower death and long-term disability.

Prevent complications brought on by neurological dysfunction and immobility.

Prevent stroke reoccurrence

Life Style Measures:

All patients who smoke should be encouraged to give up and to stay away from smoke-filled environments.

Everyone who is able to exercise regularly should be encouraged to do so for at least 30 minutes each day. It should be suggested to them that they begin with low-intensity exercise and build it gradually to moderate levels 15.

All patients should be urged to practise yoga, consume low-fat dairy products, foods made from vegetables, fruits, whole grains and plant oils, cut back on sweets and steer clear of red meat 16.

Diabetes should be checked for in all patients, and treatment should aim for an HbA1C of less than 6.5%.

It should be suggested to all patients to consume less salt.

Intravenous thrombolysis:

Poor prognostic indicators include the persistence of proximal arterial blockage following IV thrombolysis, which is frequently observed in patients with baseline NIHSS scores >10. Additionally, the rate of partial or complete recanalization of the occluded proximal middle cerebral artery (MCA) with IV alteplase is only about 25%, as opposed to the higher rates of 50–60% that are frequently reported following intra-arterial (IA) therapy. In certain patients with acute strokes, IV rt PA showed a definite benefit, according to the National Institute of Neurological Disorders and Stroke (NINDS). In ischemic stroke within three hours of onset, the NINDS research utilised IV rt PA (0.9 kg to a 90 mg max; 10% as bolus, then the remaining over 60 min). Within 90 minutes, one-half of the patients received care 17.

Rehabilitation of Stroke Patients

A multidisciplinary team approach to stroke rehabilitation involves a doctor, a physiotherapist, an occupational therapist, a nurse, a speech and language therapist, a clinical psychologist, an orthotist, and a social worker 18.

Physiotherapeutic Management of Stroke Patients

Physical therapy after a stroke seeks to enhance motor coordination, upper extremity functions, gait, and daily living skills while promoting self-care and social inclusion.

General Recommendations

The first stroke Within the first 48 hours of admission, patients must be seen and evaluated by a physiotherapist. The assessment must be revisited every two weeks up to the time of discharge, every week for the first month, every month for the first six months, and then every two years after that, until the patient has reached maximum functional recovery 19.

Throughout the healing process, the patient and carers should be involved in choosing the goals and course of treatment.

At all phases of rehabilitation, functional use of the afflicted side should be promoted as much as feasible.

Patients and their carers should get education and encouragement to ensure that the skills they learn in therapy sessions are also practised at home.

Avoid aggressive stretching near joints that are more susceptible to flaccid muscles (shoulder, knee, wrist, as well as hand).

Every stroke patient should receive at least 45 minutes of supervised physical therapy five days a week until the patient meets the assessment's predetermined goals 10, 19.

Materials and Methods

Place of study

The study “Long Term Management of Stroke Patients With Drug Associated Problems", Which Was Carried out in the Department of Neurology of a tertiary care teaching hospital.

Study Design

The research was a prospective observational study carried out in the field of neuroscience and Neurosurgery ward of territory care teaching hospital.

Study Population

This study was done in 150 Patients who are suffering with stroke.

Study Duration

This study was conducted for 6 months.

Study Criteria /Patient enrollment

According to the study’s inclusion and exclusion criteria, patients are enrolled.

Inclusion Criteria:

• All the patients suffering with different types of stroke.

• Patients age in between 35 – 70 years.

• Patients of both sexes.

• Patients with Comorbid conditions.

• Who are willing to give Information?

• History of trauma.

• Patient with alcohol and Smoking habits.

Exclusion Criteria:

• Pregnancy women.

• Lack of Interest to give information.

• Pediatrics.

• Whose verbal communication was poor?

• Unconsciousness patients.

Study Materials:

• Patient informed consent form.

• Patient Information data form.

Study Method:

The study will be initiated after obtaining the permission from the Head of the Institution and Head of Department of Neurology. Patients are considered into the study, after taking informed consent form from them or from the attendants. Patients are considered for the study based on inclusion and exclusion criteria 20.

The "Chart Review Method" will be used to gather the data for this study, as it is well suited to identifying all the necessary and relevant baseline information. The data will be collected on a specially designed patient data collection proforma, which includes patient demographics like age, socio-economic status, family income, educational level, high-risk factors, past and present medical/medication history, lab investigation data, radiographic data, physician information, and patient demographics like age 21.

Results and Discussion

Our Study was conducted in the department of neurology and neurosurgery, we have collected the data of the patients including all the demographic details of the stroke patients with inclusion and exclusion criteria of age group 66-70 ( 24.4%) having the highest out of 150 patients and 30-40 (6.2%) being the lowest, out of 150 (60%)male and (38%) female, with marital status of (97.3%) married and (9.3%)unmarried, The educational level of patients (52%) of primary (26%) of secondary and (22%)of tertiary with hygenic conditions of maximum were poor 73(48.6) and minimum were good 48(32%)and very less excellent 29(19.3%)was reported with surrounding environment was almost good and cleanliness is almost good 65(43.3%) was observed. The reasons for the admission were also analysed after collecting the data from the stroke patients 150(100%), hypertension 59(39.3%), diabetes 47(31.3%), recurrent CVA 23(15.3%), both hypertension and diabetes 106(70.6%), CAD 15(10%), UTI sepsis and AKI being(4%), Trauma and post-traumatic stroke being (0%). The symptoms mostly observed during the treatment and hospital stay were dysarthria 48(32%), Facial asymmetry 24 (16%), descend 34(22.6%), mental confusion 15(10%)and not obeying commands 12(8%). The symptoms observed during the admission is mostly of weakness of upper limbs and lower limbs 115(72%), slurring of speech 93(58%), deviation of mouth angle 78(49%), seizures 14(9%) including headache, loss of consciousness reported the least (Table 1, Table 2, Table 3, Table 4, Table 5).

The lab parameters performed to the patients in different conditions include complete blood profile, lipid profile and glycemic profile of 150(100%), and liver function tests, renal function test, urine analysis, thyroid profile and electrolytes were analysed with the least no of patients. In the study for the final confirmation differential diagnosis were done of which were mainly scans performed are CT, MRI 150(100%), carotid doppler 139(86.6%) were performed for evaluation of stroke (Table 6, Table 7, Table 8, Table 9, Table 10).

The treatment regimen provided for the patients with different class of drugs were mostly of anti platelet drug 146(97.3%), thrombolytic agents 150(100%), anti coagulant 120(80%), anticonvulsant 138(92%), antihyperlipidemic agents 65 (43.3%), anti diabetic drugs 47(31.3%) and multivitamin tablets are prescribed for the patients along with NSAIDS and antibiotics. The different types of treatment provided for stroke patients include mannitol, enoxaparin sodium 150(100%), aspirin 146(100%), clopidogrel62(38.7%), piperacillin and tazobactum 36(22.5%), insulin 30(18.75%), telmisartan 25 (15.62%), maximum use and metformin, amlodipine, ondansetron, pantoprazole were being minimum usage (Table 11, Table 12, Table 13, Table 14, Table 15).

The complications observed after the stroke therapy include recurrent seizures 05(3.1%), pain 126(78.7%), confusion 90(56.25%), anxiety 56(35%), emotional 28(17.5%), UTI 36(22.5%), mobility-related falls 76(47.5%) and deep vein thrombosis, chest infections are least observed. Our study also analysed the treatment complications in the patients suffering with stroke the maximum was pneumonia 23(14.3%), seizures 12(7.5%), decreased intracranial pressure 10(6.25%), and cerebral swelling, malnutrition reported the least.

The drugs that are used for stroke in long-term therapy involve the maximum use of ecosprin 150(100%), inj.alteplase 138(92%), aspirin 146(91%), clopidogrel 62(3.7%), acenocoumarol 24(16%) and heparin, dabigatran, dipyridamole and enoxaparin sodium of minimum usage observed. The duration of therapy in stroke patients include onset of stroke to 3 weeks 150(100%), 3 months 120(80%), 6 months 68(45.3%), 8 months 43(28.6%), 12 months 22(14.6%) and maximum patients with rehabilitation. The treatment showed better outcome in the patient suffering with stroke, the maximum number of patients were recovered 118(73.7%), and minimum not recovered 21(13.1%), and least for economic burden 21(13.1%). The overall criteria for the diagnosis in the hospital is by imaging 150(100%). Out of 150 patients, 150 are provided with the information by continuous monitoring of the patient and the data were analysed and evaluated with long-term complications and concluded the study.

Conclusion

Our study concluded that most of the patients under long-term treatment for stroke, caused several complications. These complications lead to permanent systemic complications. Therefore the long-term management of some drugs must be reviewed frequently to overcome the side effects in the patients. It should be considered that we should provide proper drug therapy to the patients based on physician advice in a proper mechanism. We the clinical pharmacist should provide the knowledge to the patient attendants about the drug usage and proper follow-up. We prepare the pamphlet and brochure about medical management to the patients. The healthcare system has to take measures throughout the world for better outcomes and quality of life with increased life expectancy.

Acknowledgement

All thanks and praises to god Almighty or his countless, abundant and never ending blessings in completing this work. It is a proud privileged honor or us to express our hateful thanks and gratefulness to all the persons who backed us directly or indirectly throughout o this research work as magnitude. Most importantly authors are thankful to patients and health care professionals.

Conflict of interest

Nil.

Funding

Self.