Shuo Sun, Victor Lomachinsky, Louisa H Smith, Joseph P Newhouse, M Brandon Westover, Deborah Lynne Blacker, Lee H Schwamm, Sebastien Haneuse, Lidia M V R Moura
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引用次数: 0
Abstract
Background and objectives: Benzodiazepine (BZD) use in older adults after acute ischemic stroke (AIS) is common. We aimed to assess the risk of falls or fall-related injuries (FRIs) in older adults after the use of BZDs during the acute poststroke recovery period.
Methods: We emulated a hypothetical randomized trial of BZD use during the acute poststroke recovery period using linked data from the Get With the Guidelines Stroke Registry and Mass General Brigham's electronic health records. Our cohort included patients aged 65 years and older with an AIS admission between 2014 and 2021, no documented previous stroke, and no BZD prescriptions in the 3 months before admission. The potential for immortal time and confounding bias was addressed separately using inverse probability weighting.
Results: We analyzed data from 495 patients who initiated inpatient BZDs within 3 days of admission and 2,564 who did not. After standardization, the estimate was 694 events per 1,000 (95% CI 676-709) for the BZD initiation strategy and 584 events per 1,000 (95% CI 575-595) for the noninitiation strategy. Subgroup analyses showed risk differences of 142 events per 1,000 (95% CI 111-165) and 85 events per 1,000 (95% CI 64-107) for patients aged 65-74 years and 75 years and older, respectively. Risk differences were 187 events per 1,000 (95% CI 159-206) for patients with minor (NIH Stroke Severity Scale score 4) AIS and 32 events per 1,000 (95% CI 10-58) for those with moderate-to-severe AIS.
Discussion: Initiating BZDs within 3 days of an AIS is associated with an elevated ten-day risk of falls or FRIs, particularly for patients aged 65-74 years and for those with mild stroke. This underscores the need for caution when initiating BZDs, especially among individuals likely to be ambulatory during the acute and subacute poststroke period.
背景和目的:急性缺血性卒中(AIS)后老年人使用苯二氮卓类药物(BZD)是常见的。我们的目的是评估老年人在急性卒中后恢复期使用BZDs后跌倒或跌倒相关损伤(FRIs)的风险。方法:我们模拟了脑卒中后急性恢复期BZD使用的一项假设随机试验,使用来自Get With the Guidelines卒中登记处和Mass General Brigham的电子健康记录的相关数据。我们的队列纳入了年龄在65岁及以上的患者,他们在2014年至2021年期间入住AIS,之前没有记录的中风,并且在入院前3个月内没有服用BZD。使用逆概率加权分别处理了不朽时间和混杂偏差的可能性。结果:我们分析了495例入院3天内开始BZDs的住院患者和2564例未开始BZDs的住院患者的数据。标准化后,BZD起始策略估计为每1000例694例事件(95% CI 676-709),非起始策略估计为每1000例584例事件(95% CI 575-595)。亚组分析显示,65-74岁和75岁及以上患者的风险差异分别为142 / 1000 (95% CI 111-165)和85 / 1000 (95% CI 64-107)。轻度AIS (NIH卒中严重程度量表评分≤4)患者的风险差异为187 / 1000 (95% CI 159-206),中度至重度AIS患者的风险差异为32 / 1000 (95% CI 10-58)。讨论:AIS后3天内启动bzd与10天内跌倒或fri风险升高相关,特别是65-74岁患者和轻度卒中患者。这强调了在启动bzd时需要谨慎,特别是在急性和亚急性脑卒中后期间可能走动的个体。
期刊介绍:
Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.