Benzodiazepine use during the early recovery period after acute ischemic stroke (AIS) is associated with a significantly higher risk for falls or fall-related injuries (FRIs) in older adults, according to study findings published in Neurology: Clinical Practice.

Benzodiazepines are commonly prescribed in hospitals to address post-stroke complications, including agitation, anxiety, insomnia, and seizure prevention. However, their safety in older individuals with a history of stroke remains unclear. To better understand the risks, researchers investigated the short-term likelihood of falls or FRIs associated with benzodiazepines use in this vulnerable population.

In this retrospective, population-based cohort study, the researchers used data from the Get With The Guidelines–Stroke Registry and Mass General Brigham’s electronic health records. The study included 3059 adults aged 65 and older hospitalized with AIS between 2014 and 2021, excluding patients with prior stroke or recent benzodiazepine use. Patients were grouped based on whether they initiated benzodiazepines within 3 days of hospital admission (n=495) or did not (n=2564).

Baseline characteristics were comparable between groups in age (mean [SD] 78 [8.65] years), but those who initiated benzodiazepines were more likely to be women (57.2% vs 49.3%) and have anxiety (6.9% vs 4.1%). Stroke severity, measured by the National Institutes of Health Stroke Scale (NIHSS), showed that compared with 50.2% of individuals who did not initiate benzodiazepines, 43% of those who did had mild strokes (NIHSS ≤4).

BZDs can be detrimental to the poststroke recovery period because these may reinduce neurologic deficits and enhance GABAergic inhibition in the brain…

The primary outcome was the incidence of falls or FRIs within 10 days of AIS admission. After adjusting for confounding and immortal time bias using inverse probability weighting, the standardized 10-day risk of falls or FRIs was 694 per 1000 patients in the benzodiazepines group, compared with 584 per 1000 in the non- benzodiazepines group, an excess of 110 events per 1000 patients (95% CI, 89-125).

Subgroup analyses revealed greater risk among those aged 65 to 74 years (risk difference, 142 per 1000; 95% CI, 111-165) compared with those 75 and older (risk difference, 85 per 1000; 95% CI, 64-107). Patients with mild strokes also faced substantially higher risk (risk difference, 187 per 1000; 95% CI, 159-206), compared with those with more severe strokes (risk difference, 32 per 1000; 95% CI, 10-58).

The study was limited by its single-center design, missing data on frailty and ambulation, and reliance on natural language processing to identify fall-related events.

“[Benzodiazepines] can be detrimental to the poststroke recovery period because these may reinduce neurologic deficits and enhance GABAergic inhibition in the brain, which can impede neuroplasticity and the brain’s ability to reorganize and make new connections after a stroke,” the researchers concluded.

This research was supported by the National Institutes of Health. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

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