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Comparative Effectiveness and Safety of Seizure Prophylaxis Among Adults after Acute Ischemic Stroke
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2 2023
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Source: Stroke. 54(2):527-536
[PDF-1.62 MB]
Details:
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Alternative Title:Stroke
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Personal Author:
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Description:Background:
Older adults occasionally receive seizure prophylaxis in an acute ischemic stroke (AIS) setting, despite safety concerns. There are no trial data available about the net impact of early seizure prophylaxis on post-AIS survival.
Methods:
Using a stroke registry (American Heart Association’s Get With The Guidelines) individually linked to electronic health records (EHR), we examined the effect of initiating seizure prophylaxis (i.e., epilepsy-specific ASDs) within seven days of an AIS admission versus not initiating in patients ≥65 years admitted for a new, non-severe AIS (NIH-Stroke Severity Score ≤ 20) between 2014–2021 with no recorded use of epilepsy-specific ASDs in the previous three months. We addressed confounding by using inverse-probability weights. We performed standardization accounting for pertinent clinical and healthcare factors (e.g., NIH Stroke Severity scale, prescription counts, seizure-like events).
Results:
The study sample included 151 patients who received ASDs and 3,020 who did not. The crude 30-day mortality risks were 219 deaths per 1000 patients among epilepsy-specific ASDs initiators and 120 deaths per 1000 among non-initiators. After standardization, the estimated mortality was 251 (95% CI, 190–307) deaths per 1000 among initiators and 120 (95% CI, 86 to 144) deaths per 1000 among non-initiators, corresponding to a risk difference (RD) of 131 (95% CI, 65– 200) excess deaths per 1000 patients. In the prespecified subgroup analyses, the RD was 52 (CI, 11–72) among patients with minor AIS and 138 (CI, 52–222) among moderate-to-severe AIS patients. Similarly, the RDs were 86 (95% CI 18–118) and 157 (95% CI 57–219) among patients aged 65–74 years and ≥75 years, respectively.
Conclusions:
There was a higher risk of 30-day mortality associated with initiating vs. not initiating seizure prophylaxis within seven days post-AIS. This study does not support the role of seizure prophylaxis in reducing 30-day post-stroke mortality.
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Pubmed ID:36544249
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Pubmed Central ID:PMC9870933
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