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While its short\u2010term effectiveness for preventing poststroke seizures is established, it is unclear whether prolonged use improves survival, particularly in older adults. We estimated the effect of continued levetiracetam use on 90\u2010day mortality among Medicare beneficiaries after AIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using Traditional Medicare claims data (2008\u20132021), we identified beneficiaries aged \u2265\u200965\u2009years hospitalized for AIS who initiated outpatient levetiracetam within 90\u2009days of discharge. After 1\u2009month of continued poststroke levetiracetam use (start of follow\u2010up), we compared 90\u2010day mortality between patients with a new levetiracetam dispensation within a 14\u2010day grace period post\u2010follow\u2010up and those without one. We performed cloning, censoring, and weighting to address immortal\u2010time bias and estimated standardized mortality risks, risk differences, and 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3212 eligible beneficiaries, 1779 (55.4%) received a new levetiracetam dispensation within the 14\u2010day grace period. After adjustment for demographics, hospitalization characteristics, timing of initiation, and comorbidities, continued use was associated with lower 90\u2010day mortality than discontinuation (53 vs. 62 deaths per 1000; risk difference \u22129 per 1000; 95% CI: \u221212, \u22125).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among older Medicare beneficiaries who initiated levetiracetam after AIS, continued outpatient use was associated with lower short\u2010term 90\u2010day mortality, particularly among patients aged \u2265\u200975\u2009years. These findings should not be interpreted as support for routine or indefinite continuation, because the claims\u2010based design cannot assess seizure recurrence, functional outcomes, quality of life, treatment indication, or potential neuropsychiatric harms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pds.70489","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:56:41Z","timestamp":1790744201000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post\u2010Discharge Antiseizure Medication Use and Poststroke Survival: An Emulated Target Trial in Older Adults"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4443-8484","authenticated-orcid":false,"given":"Madhav","family":"Sankaranarayanan","sequence":"first","affiliation":[{"name":"Department of Biostatistics Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Neurology, Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5217-7794","authenticated-orcid":false,"given":"Maria A.","family":"Donahue","sequence":"additional","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7624-2423","authenticated-orcid":false,"given":"Julianne D.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Department of Neurology, Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4170-9388","authenticated-orcid":false,"given":"Shuo","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences Weill Cornell Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5837-3203","authenticated-orcid":false,"given":"Joseph P.","family":"Newhouse","sequence":"additional","affiliation":[{"name":"Center for Global Health and Mongan Institute, Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Health Care Policy Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Health Policy and Management Harvard T.H. 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