Preadmission use of benzodiazepines not neuroprotective
Preadmission use of benzodiazepines does not appear to positively influence outcomes in patients with acute ischaemic stroke and could even contribute to increased poststroke mortality at 90 days, a study reports.
The prospective cohort study included 336 patients, among whom 62 (18.5 percent) were receiving benzodiazepines but not any other psychotropic drug when stroke occurred. Outcomes such as mortality, functional outcomes and cognition were evaluated at 8 and 90 days after stroke. Researchers applied propensity score methods to reduce the effects of potential confounding factors in the between-group comparisons.
Compared with nonusers, benzodiazepine users were older (73.1 vs 65.4 years; p=0.0002), more likely to be women (62.9 percent vs 42.7 percent; p=0.004), have arterial hypertension (77.4 percent vs 56.6 percent; p=0.002), lower body mass index (25.6 vs 27.0 kg/m2; p=0.042) and lower levels of alanine aminotransferase (18 vs 21 U/L; p=0.029).
The mortality rate was markedly higher in benzodiazepine users vs nonusers both at day 8 (2.2 percent vs 8.1 percent; p=0.034) and day 90 (8.1 percent vs 25.9 percent; p=0.0001). However, only the difference in mortality rate at day 90 was of borderline of significance after controlling for baseline differences using propensity-score matching (odds ratio [OR], 3.93; 95 percent CI, 0.91–16.98). This difference remained significant with a similar treatment effect size in propensity score-adjusted cohort (adjusted OR, 3.50; 1.57–7.76).
In addition, more benzodiazepine users than nonusers had poor functional outcome at days 8 and 90, as defined by modified Rankin scale (mRS) ≥2 or by the Barthel index <95. Only the difference in mRS ≥2 at day 90 remained significant in propensity score-adjusted cohort (adjusted OR, 1.89; 1.02–3.48). Survivors at days 8 and 90 showed no significant difference in cognitive evaluation.
The present data do not support the putative neuroprotective effect of γ-aminobutyric acidA receptor agonists and should alert clinicians of their potential risks, researchers said.