Abstract TP286: The Use Of Benzodiazepines In Patients With Acute Ischemic Stroke
Background and Purpose: The effect of benzodiazepines in patients with acute ischemic stroke is controversial. In experimental studies, benzodiazepines can reduce neuronal damage and improve neurological outcome after focal cerebral ischemia. Conversely, patients whose initial stroke syndrome had substantially improved clinically can show transient reemergence of their initial focal syndrome after benzodiazepine use. We assessed the hypothesis that benzodiazepine use can have a negative impact upon functional outcome and increase the risks of complication in patients with acute ischemic stroke.
Patients and methods: We performed a post-hoc analysis of prospectively collected data of consecutive patients admitted to a Brazilian tertiary hospital with acute ischemic stroke from February 2009 to April 2012. The use of benzodiazepines including drugs, doses, and frequencies were obtained from the electronic pharmacy records. A benzodiazepine equivalence table was used to calculate the equivalent doses to 10mg of diazepam.
Results: We evaluated 424 patients with acute ischemic stroke (mean age: 72.5 +/-15.2 yo, 58.7% males). Of those, 102 patients (24.1%) received at least one dose of benzodiazepine during hospital admission. The median cumulative dose of benzodiazepine used was 4 [2,11] (1 equivalent=10mg of diazepam). Patients who received benzodiazepines were similar to those who did not receive in age, gender and stroke severity measured by the NIHSS. The cumulative dose of benzodiazepine was an independent predictor of in-hospital pneumonia (OR= 1.03, 95% CI 1.02-1.06, p=0.03 for each unit of diazepam equivalent (1 equivalent=10mg of diazepam) when adjusted for age, gender, stroke severity (NIHSS) and smoking status. The modified Rankin scale at discharge was not different in patients who received or not benzodiazepines.
Conclusions: In conclusion, exposure to benzodiazepine is associated with in-hospital pneumonia in patients with acute ischemic stroke. Alternative approaches to treat anxiety, insomnia and agitation in such patients are warranted.
- © 2012 by American Heart Association, Inc.