{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:20:20Z","timestamp":1787854820300,"version":"build-2784847793"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82104142"],"award-info":[{"award-number":["82104142"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82371255"],"award-info":[{"award-number":["82371255"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Shanghai Neurological Rare Disease Biobank and Precision Diagnostic Technical Service Platform, Shanghai Science and Technology Innovation Action Plan","award":["23DZ2291500"],"award-info":[{"award-number":["23DZ2291500"]}]},{"name":"2025 Shanghai Youth Innovation Project in Pharmaceutical Services","award":["SPAYXFW2025A12"],"award-info":[{"award-number":["SPAYXFW2025A12"]}]},{"name":"Talent Project established by Chinese Pharmaceutical Association Hospital Pharmacy department","award":["CPA-Z05-ZC-2025-003"],"award-info":[{"award-number":["CPA-Z05-ZC-2025-003"]}]},{"name":"Ministry of Science and Technology of China, National Key Laboratory of Neuro-Oncology Drug Development, Youth Program","award":["SKLSIM-20250349"],"award-info":[{"award-number":["SKLSIM-20250349"]}]},{"name":"Shanghai Magnolia Talent Program","award":["25PJD096"],"award-info":[{"award-number":["25PJD096"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objective<\/jats:title>\n Polypharmacy involving cerebrovascular agents is common in acute ischemic stroke, but its clinical and economic value remains unclear. This study evaluated the impact of a pharmacist-led Stroke Pharmacotherapy Optimization Strategy (SPOS) in reducing polypharmacy, drug-related costs, and adverse events while preserving neurological recovery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A pre-post study was conducted at a tertiary hospital from June 2024 to April 2025. The control cohort included patients admitted from June to October 2024, and the SPOS cohort included patients admitted from December 2024 to April 2025. SPOS followed the \u201c3-2-1\u201d principle (\u22643 non-recanalization cerebrovascular drugs, [NR-CVDs];\u2009\u2264\u20092 cerebrovascular-related traditional Chinese medicines, [CR-TCMs]) to simplify pharmacotherapy and integrated pharmacist-led medication monitoring, patient education, and individualized adjustments.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 416 patients were included (204 control, 212 SPOS). The SPOS group received significantly fewer NR-CVDs (SPOS group: 3.03\u2009\u00b1\u20091.18 vs control group: 4.62\u2009\u00b1\u20091.15;\n P<\/jats:italic>\n \u2009<\u20090.001) and CR-TCMs (SPOS group: 1.04\u2009\u00b1\u20090.90 vs control group: 1.93\u2009\u00b1\u20091.02;\n P<\/jats:italic>\n \u2009<\u20090.001), without difference in \u0394NIHSS or overall neurological recovery. Although the length of hospital stay was similar between groups, total hospitalization costs, drug costs, and the proportion of drug-related expenditures were markedly reduced in the SPOS group (all\n P<\/jats:italic>\n \u2009<\u20090.001), and the incidence of adverse events was lower in the SPOS group (P\u2009=\u20090.034), with no evident safety signal associated with medication simplification during hospitalization.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Pharmacist-led SPOS in acute ischemic stroke reduced unnecessary cerebrovascular medications and drug costs and was associated with a lower incidence of in-hospital adverse events, without compromising short-term neurological recovery.<\/jats:p>\n 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