Abstract
Background and PurposeIt has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use.MethodsWe conducted a nationwide, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003–2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching.ResultsCurrent users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users of antipsychotics (adjusted odds ratios, 1.43; 95% CI, 1.29–1.58). Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0% vs. 21.9%). Antipsychotics was associated with an increased 30-day post-stroke mortality among current users (adjusted mortality rate ratios, 1.42; 95% CI, 1.29–1.55), but not among former users (adjusted mortality rate ratios, 1.05; 95% CI, 0.98–1.14).ConclusionsPreadmission use of antipsychotics was associated with a higher risk of severe stroke, a longer duration of hospital stay, and a higher post-stroke mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.
Highlights
It has recently been suggested that antipsychotic medication provides a neuroprotective effect and reduces post-stroke mortality in humans [1]
Animal studies of acute stroke have indicated that antipsychotic medication may have neuroprotective effects that are related to their antiserotonergic and antidopaminergic mechanisms of action leading to reduced effects of glutamate [2,3,4,5]
The adjusted odds ratios (ORs) for the risk of having a severe or very severe stroke were higher for current users (1.43; 95% confidence interval [CI] 1.29–1.58) and former users (1.12; 95% CI, 1.05–1.21) of antipsychotics compared to never users (Table 2)
Summary
It has recently been suggested that antipsychotic medication provides a neuroprotective effect and reduces post-stroke mortality in humans [1]. Antipsychotics are used in a broad range of diseases other than schizophrenia. Such diseases include psychotic and affective disorders, personality and anxiety disorders, and agitation in dementia [14,15]. Long-term use of antipsychotics reduces overall mortality in schizophrenia [16], but not in dementia [17]. It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use
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