Impact of benzodiazepines on functional outcome and occurrence of pneumonia in stroke: evidence from VISTA

Authors

  • Benedikt Frank,

    Corresponding author
    1. Department of Medicine and Therapeutics, Faculty of Medicine, University of Glasgow, Glasgow, UK
    2. Department of Neurology, University of Duisburg-Essen, Essen, Germany
    • Correspondence: Benedikt Frank*, Department of Neurology/University of Duisburg-Essen, Hufelandstr. 55/45122 Essen/Germany.

      E-mail: benedikt.frank@uni-due.de

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  • Rachael L. Fulton,

    1. Department of Medicine and Therapeutics, Faculty of Medicine, University of Glasgow, Glasgow, UK
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  • Kennedy R. Lees,

    1. Department of Medicine and Therapeutics, Faculty of Medicine, University of Glasgow, Glasgow, UK
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  • Robert D. Sanders,

    1. National Heart and Lung Institute, Imperial College London, London, UK
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  • and for the VISTA Collaborators

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    • VISTA Steering committee members: A. Alexandrov, P. W. Bath, E. Bluhmki, N. Bornstein, L. Claesson, J. Curram, S. M. Davis, G. Donnan, H. C. Diener, M. Fisher, B. Gregson, J. Grotta, W. Hacke, M. G. Hennerici, M. Hommel, M. Kaste, K. R. Lees P. Lyden, J. Marler, K. Muir, R. Sacco, A. Shuaib, P. Teal, N. G. Wahlgren, S. Warach, and C. Weimar

  • Conflict of interest: B. F. has reiceived modest honoraria for participation in clinical trials (Sanofi-Aventis). R. L. F has no conflicts of interest. K. R. L. has received research grants, modest honoraria for participation in clinical trials, and has a consultancy or advisory board relationship with manufacturers from drugs (including Boehringer Ingelheim and Genentech). R. D. S. has received speaker fees from Hospira to speak at the Canadian Society of Anesthesiologists meeting, 2011.

Abstract

Background

Benzodiazepines have been proposed both as a neuroprotectant and risk factor for pneumonia in acute stroke.

Aims

We assessed the impact of benzodiazepine exposure on the modified Rankin scale score distribution at 90 days as well as pneumonia rates among patients registered in a trials archive.

Method

We used an age, baseline National Institutes of Health Stroke Score, and thrombolysis-rate adjusted Cochran–Mantel–Haenszel test to test significance (P) followed by proportional odds logistic regression analysis to estimate the odds ratios for improved modified Rankin scale score, and binary logistic regression to estimate the odds ratio for developing pneumonia.

Results

Data were available for 5938 patients, of whom 1800 received benzodiazepines. No association of benzodiazepine use and overall stroke outcome could be found (odds ratio 0·90, 95% confidence interval 0·82–1·00, P = 0·121). Pneumonia occurred in 12·8% of patients treated with benzodiazepines and in 13·6% of the controls (odds ratio 0·99, 95% confidence interval 0·83–1·18, P = 0·904).

Conclusion

In this nonrandomized comparison, treatment with benzodiazepines as a concomitant medication had no independent impact on stroke outcome.

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