TY - JOUR
T1 - Drugs associated with ischemic stroke
T2 - a review for clinicians
AU - Marto, João Pedro
AU - Strambo, Davide
AU - Livio, Francoise
AU - Michel, Patrik
N1 - Funding Information:
Dr Michel reports grants from the Swiss National Science Foundation and Swiss Heart Foundation and personal fees from Medtronic (used for research and education) outside the submitted work. The other authors report no conflicts.
Publisher Copyright:
© 2021 American Heart Association, Inc.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Certain drugs may increase the risk of ischemic stroke (IS). Our goal was to review associations between frequently used drugs and IS. We created an initial list of frequently used drugs to search Pubmed/MEDLINE from 1966 to 2020 and reviewed phase III and IV data, case series, and drug authorities' safety warnings to assess a potential association with IS. Drugs were grouped according to the World Health Organization Anatomical Therapeutic Chemical Classification System. Predefined criteria were applied to establish a level of evidence for an association, from A (high level of evidence of association) to E (high level of evidence of absence of association). In addition, we assessed relative risks and reviewed potential mechanisms of IS facilitation. We assessed 81 drugs or drug classes from 11 World Health Organization Anatomical Therapeutic Chemical Groups. We identified a high level of association for erythropoietin, combined contraceptives, oral estrogen replacement therapy, bevacizumab, tamoxifen, and antipsychotics and a moderate level for ponatinib, nilotinib, darunavir, and gonadotropin-releasing hormone agonists. Drug dose and treatment duration may modify the risk. For a substantial number of drugs, we found no association, and for others, there were insufficient data to categorize risk. We identified a high level of association of IS with a limited number of drugs, a potential association with some, and a lack of data for others. The summarized information may help clinicians to estimate the contribution of a drug to an IS, to better assess drug benefit-risk ratios, and to support decisions about using specific drugs.
AB - Certain drugs may increase the risk of ischemic stroke (IS). Our goal was to review associations between frequently used drugs and IS. We created an initial list of frequently used drugs to search Pubmed/MEDLINE from 1966 to 2020 and reviewed phase III and IV data, case series, and drug authorities' safety warnings to assess a potential association with IS. Drugs were grouped according to the World Health Organization Anatomical Therapeutic Chemical Classification System. Predefined criteria were applied to establish a level of evidence for an association, from A (high level of evidence of association) to E (high level of evidence of absence of association). In addition, we assessed relative risks and reviewed potential mechanisms of IS facilitation. We assessed 81 drugs or drug classes from 11 World Health Organization Anatomical Therapeutic Chemical Groups. We identified a high level of association for erythropoietin, combined contraceptives, oral estrogen replacement therapy, bevacizumab, tamoxifen, and antipsychotics and a moderate level for ponatinib, nilotinib, darunavir, and gonadotropin-releasing hormone agonists. Drug dose and treatment duration may modify the risk. For a substantial number of drugs, we found no association, and for others, there were insufficient data to categorize risk. We identified a high level of association of IS with a limited number of drugs, a potential association with some, and a lack of data for others. The summarized information may help clinicians to estimate the contribution of a drug to an IS, to better assess drug benefit-risk ratios, and to support decisions about using specific drugs.
KW - Adverse drug event
KW - Drugs
KW - Ischemic stroke
KW - Odds ratio
KW - Prescription drugs
KW - Risk
UR - http://www.scopus.com/inward/record.url?scp=85116590391&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.033272
DO - 10.1161/STROKEAHA.120.033272
M3 - Review article
C2 - 34404236
AN - SCOPUS:85116590391
SN - 0039-2499
VL - 52
SP - E646-E659
JO - Stroke
JF - Stroke
IS - 10
ER -