McGregor Ailsa L, Hoque Md Rashedul, Nickel Sophia, Smith Alesha J, Atiquzzaman Mohammad
School of Pharmacy, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
Drugs Real World Outcomes. 2022 Mar;9(1):165-173. doi: 10.1007/s40801-021-00280-5. Epub 2021 Sep 27.
Patients who develop seizures after stroke have disproportionately poorer outcomes and increased mortality.
Our objective was to investigate whether exposure to anti-epileptic medications influenced long-term functional status after stroke.
We used linked health administrative data from a cohort of adult stroke patients in New Zealand. Demographics and prescription information were obtained from the National Minimum Dataset and Pharmaceutical Collection, respectively. Activities of daily living (ADL) scores for the same patients were obtained using the International Resident Assessment Instrument. Beta regression was used to investigate the relationship between anti-epileptic drug (AED) exposure and functional status.
The study included 3606 patients with a single ischaemic stroke between 2012 and 2017. In total, 15% were dispensed an AED in the 3 months before or after stroke. The adjusted odds ratio (OR) for AED exposure was 1.29 (95% confidence interval [CI] 1.15-1.45). Overall AED exposure, categorical body mass index (BMI), ethnicity, length of hospital stay, and exposure to paracetamol, opioids, anti-psychotics, and anti-nausea medications were significantly associated with changes in the mean ADL score percentages. Considering the exposure timeframe, the ORs for AED exposure only after stroke and for exposure both before and after stroke were 1.52 (95% CI 1.31-1.78) and 1.09 (95% CI 0.93-1.27), respectively.
Stroke patients with AED exposure had greater odds of a higher ADL score, indicating a poorer long-term functional status than those unexposed to AEDs. The timeframe of exposure impacted on functional status, with patients exposed only after stroke having increased odds of higher ADL scores than those exposed both before and after stroke.
中风后发生癫痫的患者预后明显较差，死亡率增加。
我们的目的是调查使用抗癫痫药物是否会影响中风后的长期功能状态。
我们使用了来自新西兰一组成年中风患者的关联健康管理数据。人口统计学和处方信息分别从国家最低数据集和药品收集库中获取。使用国际居民评估工具获取同一患者的日常生活活动（ADL）评分。使用β回归研究抗癫痫药物（AED）暴露与功能状态之间的关系。
该研究纳入了2012年至2017年间发生单次缺血性中风的3606名患者。总共有15%的患者在中风前或中风后的3个月内被配给了AED。AED暴露的调整优势比（OR）为1.29（95%置信区间[CI]1.15 - 1.45）。总体AED暴露、分类体重指数（BMI）、种族、住院时间以及对扑热息痛、阿片类药物、抗精神病药物和抗恶心药物的暴露与平均ADL评分百分比的变化显著相关。考虑到暴露时间范围，仅中风后AED暴露和中风前后均暴露的OR分别为1.52（95%CI 1.31 - 1.78）和1.09（95%CI 0.93 - 1.27）。
暴露于AED的中风患者ADL评分较高的几率更大，这表明其长期功能状态比未暴露于AED的患者更差。暴露时间范围影响功能状态，仅在中风后暴露的患者ADL评分较高的几率高于中风前后均暴露的患者。
