To evaluate the effect of initiating in-patient benzodiazepines within 3 days of post-acute ischemic stroke (AIS) on 30-day falls and fall-related injuries in patients aged 65 and older.

While benzodiazepine use after AIS is common in older adults, its safety regarding falls and fall-related injuries in this population is unexplored in clinical trials.

We conducted an observational study using American Heart Association's Get With The Guidelines stroke registry data, focusing on patients aged 65 and older admitted for a new AIS between 2014 and 2021, with no documented prior benzodiazepine use. We applied inverse-probability weights and standardization to address potential confounding.

The study included 497 patients initiating in-patient benzodiazepines within 3 days and 2,562 who did not. The crude 30-day risk of falls and fall-related injuries was 572 events per 1000 patients among benzodiazepine initiators and 626 events per 1000 patients among non-initiators. After standardization, the estimated risk was 663 events per 1000 (95% CI, 647-681) for initiators and 612 events per 1000 (95% CI, 601-623) for non-initiators, with a risk difference of 51 events per 1000 patients (95% CI, 36-67). Subgroup analyses showed risk differences of 78 (95% CI, 53-101) and 28 (95% CI, 5-48) for patients aged 65 to 74 years and those aged 75 years or older, respectively. Furthermore, risk differences were 80 (95% CI, 53-101) for patients with minor AIS and 34 (95% CI, 11-59) for those with moderate-to-severe AIS.

Initiating in-patient benzodiazepines within 3 days of AIS is associated with an elevated 30-day risk of falls and fall-related injuries, particularly in patients aged 65 to 74 years and those with minor strokes. This study underscores the need for caution when using benzodiazepines, especially among individuals likely to be ambulatory during the acute and sub-acute post-stroke period, as it increases the risk of falls.