Prophylactic Levetiracetam for the Prevention of Seizures in Acute Nontraumatic Intracerebral Hemorrhage: A Retrospective Propensity-matched Patient Outcome Analysis (P7-5.030)

Abstract

<h3>Objective:</h3> This study aims to determine if prophylactic levetiracetam in nontraumatic intracerebral hemorrhage (nt-ICH) decreases seizure risk and improves mortality. <h3>Background:</h3> Early seizures is a common morbidity in nt-ICH, often associated with worsening neurological outcome. There are conflicting data on the use of prophylactic antiepileptic drugs (AEDs) in the form of levetiracetam in this population. Current guidelines do not endorse prophylactic AED use due to limited evidence for clinical benefit; however, they are routinely prescribed in the acute setting. <h3>Design/Methods:</h3> This was a retrospective cohort study using data collected from TriNetX, a deidentified patient database collated from 71 healthcare organizations. Using ICD-10 codes, we identified nt-ICH patients excluding those with a history of seizure disorders. Patients were dichotomized based on prophylactic levetiracetam use or not. Propensity score adjustment matched cohorts on age, sex, race, significant comorbidities, complications of nt-ICH, location of nt-ICH, and NIHSS score. Associations with mortality; occurrence of seizure, acute kidney injury (AKI), transient ischemic attack (TIA), stroke, myocardial infarction; percutaneous endoscopic gastrostomy and tracheostomy placement at day 30 were measured between groups using unadjusted odds ratios (OR) with 95% confidence intervals (CI). <h3>Results:</h3> This study identified 1,571 patients with nt-ICH who received prophylactic levetiracetam and 9,570 patients who did not. After matching, 1,492 patients remained in each cohort. Our analysis showed that prophylactic levetiracetam in patients with nt-ICH was not associated with decreased seizure occurrence (OR, 1.21 [95% CI, 0.88, 1.68]) or mortality benefit (OR, 1.06 [95% CI, 0.90, 1.25]); was associated with decreased incidence of AKI (OR 0.552 [95% CI 0.344, 0.884]) and TIA [OR 0.496 (95% CI 0.304, 0.807)]. <h3>Conclusions:</h3> This data suggests that prophylactic levetiracetam does not provide a mortality benefit or decrease the occurrence of seizures in the acute setting of nt-ICH. Prospective studies are necessary to confirm these findings and assess the impact on longitudinal functional outcomes. <b>Disclosure:</b> Miss Nguyen has nothing to disclose. Ms. Bhanja has nothing to disclose. Dr. Hallan has nothing to disclose. Kevin Cockroft has received personal compensation in the range of $5,000-$9,999 for serving as an officer or member of the Board of Directors for Intersocietal Accreditation Commission. The institution of Kevin Cockroft has received research support from Intersocietal Accreditation Commission. The institution of Kevin Cockroft has received research support from Nico Corporation. The institution of Kevin Cockroft has received research support from Idorsia Pharmaceuticals . The institution of Kevin Cockroft has received research support from AstraZeneca . Dr. Rizk has nothing to disclose.