Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis

Abstract

Background For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. Methods Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. Results The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS < = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). Conclusion For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

Low-dose statins improve prognosis of patients with ischaemic stroke undergoing intra-arterial thrombectomy: A prospective cohort study

“…Statin use was related to an improved short-term NIHSS score in this study, and the effect was signi cant in most subgroups. These results are consistent with study involving ischaemic stroke patients with thrombolysis 7,11 and with other studies of ischaemic stroke populations 12 . The LDL value in the statin group after admission was opposite to that before admission, lower than that in the control group, and the proportion of patients with an LDL level reaching the guideline standard was also higher than that in the control group.…”

“…But the results was a subgroup analysis and the study included a lesser patients. In our previous studies, low-dose statins were associated with good functional outcomes in patients with recurrent stroke or thrombolysis treatment, but patients with thrombectomy were not included 6,7 . Overall, in patients with ischaemic stroke undergoing intra-arterial thrombectomy, it is unknown whether low-dose statin is related to prognosis.…”

Statin Use and Outcomes of Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Systematic Review and Meta-Analysis

“…Among the included 22 studies ( 23 – 44 ), there were 2 post-hoc analyses of RCTs ( 35 , 40 ), 13 prospective cohort studies ( 24 , 27 – 29 , 31 , 33 , 34 , 37 – 39 , 42 – 44 ), and 7 retrospective cohort studies ( 23 , 25 , 26 , 30 , 32 , 36 , 40 ). The 22 included studies were published from 2007 to 2021, with sample sizes ranging from 55 to 4,012 participants and a total of 17,554 participants.…”

“…Nine studies ( 24 – 27 , 30 , 31 , 35 , 38 , 41 ) involving 4,115 patients reported outcomes according to in-hospital statin use. The pooled estimates showed that in-hospital statin use was associated with a lower likelihood of symptomatic ICH (five studies, OR 0.46; 95% CI 0.21–1.00; p = 0.045; p for Cochran Q statistic = 0.88, I 2 = 0%; Figure 3A ; Table 3 ), any ICH (three studies, OR 0.51; 95% CI 0.27–0.98; p = 0.04; p for Cochran Q statistic = 0.53, I 2 = 0%; Figure 3B ; Table 3 ), and 3-month mortality (five studies, OR 0.42; 95% CI 0.29–0.62; p < 0.001; p for Cochran Q statistic = 0.44, I 2 = 0%; Figure 3C ; Table 3 ).…”

Low-to-moderate dose statins improve the functional outcome of acute ischemic stroke with conventional medication treatment

“…Evidence has demonstrated that the efficacy of LMDS for cardiovascular disease (CVD) patients in Asia, such as GOALLS study, STATT study, and RAEL-CAD study ( 9 , 13 - 15 ). Similarly, in regards to AIS, our previous studies have indicated that AIS patients after reperfusion therapies treated with a low-dose statin (LDS) in west China had a better prognosis compared with non-statin ( 16 - 18 ). However, the correlation between LMDS use and prognosis has not been evaluated in AIS patients with conventional medication treatment alone.…”