Association of Statins and Statin Discontinuation With Poor Outcome and Survival After Intracerebral Hemorrhage

Dowlatshahi, Dar; Demchuk, Andrew M.; Fang, Jiming; Kapral, Moira K.; Sharma, Mukul; Smith, Eric E.

doi:10.1161/strokeaha.111.645978

Cited by 67 publications

(80 citation statements)

References 26 publications

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“…For example, in the study by Dowlatshahi et al, the effect of cessation of statins was markedly attenuated after exclusion of patients treated with palliative strategy in the hospital. 10 Nevertheless, even if the magnitude of statin discontinuation effect is smaller than what is indicated by observational studies, there is no evidence that its cessation within the first days after an acute cerebrovascular event would be beneficial (even in patients suffering from ICH).…”

Section: May 2013mentioning

confidence: 99%

“…1.30-3.04). 10 One might argue that most clinical data originate from observational studies, which are prone to confounding by indication. Hence, statins might have been continued only in those patients expected intuitively by physicians to benefit from them.…”

Section: May 2013mentioning

confidence: 99%

“…On the contrary, there is strong evidence that discontinuation of statin therapy during acute vascular events, including ischemic as well as hemorrhagic stroke, impairs vascular function and dramatically decreases the chances of good outcome and survival. [7][8][9][10] In this opinion article, we would like to make a strong case that preexisting statin treatment should not be paused or abruptly discontinued, either in acute ischemic stroke patients receiving rt-PA or in patients with acute ICH.…”

mentioning

confidence: 99%

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Should Statins Be Paused or Discontinued After Thrombolysis or Acute Intracerebral Hemorrhage? No!

Scheitz

Nolte²,

Endres³

2013

Stroke

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Section: May 2013mentioning

confidence: 99%

Section: May 2013mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Should Statins Be Paused or Discontinued After Thrombolysis or Acute Intracerebral Hemorrhage? No!

Scheitz

Nolte²,

Endres³

2013

Stroke

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“…In ICH patients there was revealed relationship between in-hospital statin discontinuation and stroke severity and 30-day mortality [32] (see Table 1) Q4 . Previous studies indicate possible beneficial effect of statin use in acute phase in animal models.…”

Section: Intracerebral Hemorrhagementioning

confidence: 99%

Potential role of statins in the intracerebral hemorrhage and subarachnoid hemorrhage

Kotlęga

Gołąb-Janowska

Masztalewicz

et al. 2015

Neurologia i Neurochirurgia Polska

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Statins are used in primary and secondary prevention of cardiovascular episodes. Most of recent studies regard ischemic stroke. There are more emerging results of studies suggesting usefulness of these drugs in the other types of stroke e.g. intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Searching for new methods of treatment is important, because both ICH and SAH lead to poor prognosis and severe psychomotor disability. The unquestionable role of inflammatory factors in the pathogenesis of these disorders justifies considering statin treatment. Previous results are contradictory, thus in present study we review results of studies and try to explain the potential pathomechanism of statin use in hemorrhagic strokes.

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“…2015) or continuing (discontinuing) statin therapy (Dowlatshahi et al. 2012; Bustamante and Montaner 2013; Goldstein 2013; Scheitz et al. 2013; Tapia‐Perez et al.…”

Section: Introductionmentioning

confidence: 99%

Statin use after intracerebral hemorrhage: a 10‐year nationwide cohort study

et al. 2016

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IntroductionAlthough statin therapy is beneficial to patients with ischemic stroke, statin use, and intracerebral hemorrhage (ICH) remain a concern. ICH survivors commonly have comorbid cardiovascular risk factors that would otherwise warrant cholesterol‐lowering medication, thus emphasizing the importance of assessing the characteristics of statin therapy in this population.MethodsWe performed a cohort study by using 10 years of data collected from the National Health Insurance Research Database in Taiwan. We enrolled 726 patients admitted for newly diagnosed ICH from January 1, 2001 to December 31, 2010. The patients were categorized into high‐ (92), moderate‐ (545), and low‐intensity (89) statin groups, and into hydrophilic (295) and lipophilic (431) statin groups. The composite outcomes included all‐cause mortality, recurrent ICH, ischemic stroke, transient ischemic attack, and acute coronary events.ResultsThe patients in the low‐intensity group did not differ significantly from the patients in the high‐intensity group in risk of all‐cause mortality (adjusted hazard ratio [aHR] = 0.65, 95% confidence interval [CI] = 0.28–1.55) and recurrent ICH (aHR = 0.66, 95% CI = 0.30–1.44). In contrast, the patients in the hydrophilic group had a significantly lower risk of recurrent ICH than did those in the lipophilic group (aHR = 0.69, 95% CI = 0.48–0.99). We determined no significant differences in other composite endpoints between hydrophilic and lipophilic statin use.ConclusionHydrophilic statin therapy is associated with a reduced risk of recurrent ICH in post‐ICH patients. The intensity of statin use had no significant effect on recurrent ICH or other components of the composite outcome. Additional studies are required to clarify the biological mechanisms underlying these observations.

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Association of Statins and Statin Discontinuation With Poor Outcome and Survival After Intracerebral Hemorrhage

Cited by 67 publications

References 26 publications

Should Statins Be Paused or Discontinued After Thrombolysis or Acute Intracerebral Hemorrhage? No!

Should Statins Be Paused or Discontinued After Thrombolysis or Acute Intracerebral Hemorrhage? No!

Potential role of statins in the intracerebral hemorrhage and subarachnoid hemorrhage

Statin use after intracerebral hemorrhage: a 10‐year nationwide cohort study

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