Delirium REduction after administration of melatonin in acute ischemic stroke (DREAMS): A propensity score–matched analysis

Background and purpose Poststroke delirium (PSD) comprises a common severe complication after stroke. However, treatment options for PSD remain insufficient. We investigated whether prophylactic melatonin supplementation may be associated with reduced risk PSD. Methods Consecutive patients admitted to the Tübingen University Stroke Unit, Tübingen, Germany, acute ischemic stroke (AIS), who underwent standard care between August 2017 December 2017, additionally received (2 mg per day at night) within 24 h of symptom onset 2018 were included. Primary outcomes (i) prevalence in AIS (ii) PSD-free survival cerebral infarction compared propensity score–matched (PSM) controls. Secondary included time duration. Results Out 465 (81.2%) 108 (18.8%) transient attack (TIA) patients, 152 (26.5%) developed (median [IQR]: 16 [8–32] h; duration [8–40] h). Higher age, rather than TIA, higher National Institutes Health Scale score aphasia on admission significant predictors After PSM (164 melatonin-treated versus 164 matched controls), 42 (25.6%) 60 (36.6%) controls (odds ratio, 0.597; 95% confidence interval, 0.372–0.958; p = 0.032). differed significantly groups (p 0.027), favoring patients. In PSD, no between-group differences noted. Conclusions Patients prophylactically treated had lower undergoing care. Prospective randomized trials are warranted corroborate these findings.