Atorvastatin May Attenuate Recurrence of Chronic Subdural Hematoma

Abstract

Objective: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. Atorvastatin may reduce CSDH via its anti-inflammatory and pro-angiogenesis effects, but its effectiveness for preventing recurrent CSDH has never been explored. We hypothesized that atorvastatin is effective in reducing recurrence of CSDH after surgery and identified determining factors predictive of hematoma recurrence.Methods: A prospective study was conducted in 168 surgical cases of CSDH.All patients were randomly assigned to the group treated with atorvastatin or control group. Clinically relevant data were compared between two groups, and subsequently between the recurrence and non-recurrence patients. Multiple logistic regression analysis of the relationship between atorvastatin treatment and the recurrence using brain atrophy, septated and bilateral hematoma was performed.Results: Atorvastatin group conferred an advantage by significantly decreasing the recurrence rate (P = 0.023), and patients managed with atorvastatin also had a longer time-to-recurrence (P = 0.038). Admission brain atrophy and bilateral hematoma differed significantly between the recurrence and non-recurrence patients (P = 0.047 and P = 0.045). The results of logistic regression analysis showed that atorvastatin significantly reduced the probability of recurrence; severe brain atrophy and bilateral hematoma were independent risk factors for recurrent CSDH.Conclusions: Atorvastatin administration may decrease the risks of recurrence.Patients with severe brain atrophy and bilateral CSDH are prone to the recurrence.

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

“…A randomized control study showed that the oral administration of atorvastatin is safe and effective in treating CSDH, and promotes the resolution of hematoma [44]. A prospective study showed that atorvastatin administration may decrease the risks of CSDH recurrence [45]. However, in our study, atorvastatin did not reduce the rate of CSDH recurrence, nor did it reduce the incidence of postoperative AIH.…”

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

“…[44] A prospective study showed that atorvastatin administration may decrease the risks of CSDH recurrence. [45] However, in our study, atorvastatin did not reduce the rate of CSDH recurrence, nor did it reduce the incidence of postoperative AIH. We suspect that different research methods may lead to varying results.…”

Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy

“…This was supported by a prospective placebo-controlled trial on 80 CSDH patients showing reduction in surgical intervention in patients on atorvastatin; however, the paper was subsequently retracted with a damning admittance that the results were misleading and exaggerated with serious errors in data analysis [ 125 , 126 ]. Further to this, the same group published data suggesting atorvastatin could reduce CSDH recurrence after initial surgery but subsequently retracted this paper, leading to further uncertainty about the true efficacy of atorvastatin [ 127 , 128 ]. Results from a large-scale, multi-centre, randomised study are currently awaited and will hopefully provide a more robust answer [ 129 ].…”