Benzodiazepine initiation post stroke associated with increased falls risk

1. In older adults post-acute ischemic stroke, benzodiazepine initiation was associated with an increase in 10-day fall and fall-related injury risk.

2. The highest risk increase was seen in patients aged 65-74 years old and those with minor acute ischemic stroke.

Evidence Rating Level: 2 (Good)

This study examined the association between benzodiazepine initiation and the risk of falls or fall-related injuries (FRIs) in older adults following acute ischemic stroke (AIS). Given that benzodiazepines are frequently prescribed for poststroke insomnia, anxiety, and agitation but have known adverse effects, including sedation and impaired balance, this study aimed to quantify their short-term risks. Using a target trial emulation approach with data from the “Get With The Guidelines”-Stroke Registry and Mass General Brigham electronic health records, 3,059 AIS patients aged 65 years and older were analyzed. Patients with prior benzodiazepine use or a history of stroke within the past year were excluded. Among them, 495 initiated benzodiazepines within three days of admission, while 2,564 did not. Standardized analyses revealed that benzodiazepine initiation was associated with an increased 10-day fall/FRI risk (694 vs. 584 events per 1,000 patients; risk difference: 110 per 1,000, 95% CI 89–125). The highest risk was observed in patients aged 65–74 years (risk difference: 142 per 1,000) and those with minor AIS (risk difference: 187 per 1,000). These findings highlight the need for caution when prescribing benzodiazepines in the acute poststroke period, particularly for ambulatory patients at higher fall risk. Alternative approaches, including non-pharmacological interventions and safer pharmacologic options, should be considered to mitigate these risks.

Click to read the study in Neurology

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