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

Scheitz, Jan F.; Nolte, Christian H.; Endres, Matthias

doi:10.1161/strokeaha.111.000001

Cited by 14 publications

(17 citation statements)

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“…25 Several previous studies reported a positive, but not significant, association of statins with sICH after IVT. 7 For instance, pooled data from 11 European stroke centers and a recent meta-analysis indicated an increased risk of sICH in patients with previous statin use, which closely failed to reach statistical significance after multivariable adjustment. 4,5 It has been discussed that baseline characteristics of statin users might indicate an unfavorable prestroke morbidity, leading to a higher chance of developing sICH after IVT.…”

Section: Discussionmentioning

confidence: 99%

“…It was shown that discontinuation of statins or reduction in statin dose during hospitalization and after hospital discharge has been associated with unfavorable outcome and mortality. 7,30 Fourth, we did not collect information about imaging predictors of sICH, such as severity of leukoaraiosis and stroke lesion volume. 31 Fifth, despite multiple adjustments, additional but unrecorded covariates might have influenced our findings.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Rather, there has been a discussion that patients with previous statin use might be more likely to develop symptomatic intracerebral hemorrhage (sICH) after IVT. [5][6][7] A recently published meta-analysis showed a positive association of statins with IVT-related sICH, but the statistical significance was lost if only studies with adjusted analyses were included. 5 Previous studies investigating the impact of statins on outcome and sICH after IVT lacked information about statin dose.…”

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Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Scheitz

Seiffge

Tütüncü³

et al. 2014

Stroke

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H MG-CoA reductase inhibitors (ie, statins) constitute a cornerstone in primary and secondary prevention of ischemic stroke.1 In addition to dose-dependent cholesterol-lowering effects, statins have dose-dependent pleiotropic effects, including antithrombotic properties, and were shown to modify fibrinolytic balance toward a more profibrinolytic state.2 These properties may contribute to the beneficial impact of statins on outcome after ischemic stroke, which was recently confirmed in a large meta-analysis. 3 However, studies on patients receiving intravenous thrombolysis (IVT) reported conflicting results, and the effects on outcome seemed to be attenuated. [3][4][5] Rather, there has been a discussion that patients with previous statin use might be more likely to develop symptomatic intracerebral hemorrhage (sICH) after IVT. [5][6][7] A recently published meta-analysis showed a positive association of statins with IVT-related sICH, but the statistical significance was lost if only studies with adjusted analyses were included. 5Previous studies investigating the impact of statins on outcome and sICH after IVT lacked information about statin dose. Using pooled data from 2 large European thrombolysis registries, we aimed to analyze the effects of statin dose on risk of sICH and outcome after IVT.Background and Purpose-The aim of our study was to assess whether statins have dose-dependent effects on risk of symptomatic intracerebral hemorrhage (sICH) and outcome after intravenous thrombolysis for ischemic stroke. Methods-We pooled data from 2 European intravenous thrombolysis registries. Statin doses were stratified in 3 groups according to the attainable lowering of cholesterol levels (low dose: simvastatin 20 mg or equivalent; medium dose: simvastatin 40 mg or equivalent; and high dose: simvastatin 80 mg or equivalent). sICH was defined according to the European Cooperative Acute Stroke Study. Modified Rankin Scale score 0 to 2 at 3 months was considered a favorable outcome. Results-Among 1446 patients analyzed (median age, 75 years; median initial National Institutes of Health Stroke Scale score, 11; 54% men), 317 (22%) used statins before intravenous thrombolysis. Of them, 120 patients had low-dose, 134 medium-dose, and 63 high-dose statin therapy. sICH occurred in 4% of patients (n=53). Frequency of sICH was 2%, 6%, and 13% in patients with low-, medium-, and high-dose statin treatment, respectively (P<0.01). Adjusted odds ratio (OR) for sICH was 2. 4,9,10 All patients were treated in a specialized stroke unit for ≥24 hours. The registries were approved by the respective ethics committees.Baseline characteristics, including age, sex, and medical history (atrial fibrillation, coronary artery disease, current smoking, diabetes mellitus, hypertension, and previous stroke), were collected. Stroke severity was assessed via the National Institutes of Health Stroke Scale (NIHSS) by certified raters. Moreover, onsetto-treatment time and blood pressure on admission were recorded. Laboratory measures included glucose l...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Scheitz

Seiffge

Tütüncü³

et al. 2014

Stroke

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“…2012; Bustamante and Montaner 2013; Goldstein 2013; Scheitz et al. 2013; Tapia‐Perez et al. 2013) and the outcomes after a diagnosis of ICH.…”

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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“…24 A recent opinion article supported that statin treatment should not be paused or abruptly discontinued either in patients with acute ischemic stroke receiving rtPA thrombolysis or in patients with acute ICH. 25 It was argued that the analyses of HPS and SPARCL linking statins to ICH were post hoc with a relatively low number of ICH events. 25 Discontinuation of statins after acute stroke means withholding a drug that improves the chance of good functional outcome.…”

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Thrombolysis May Reduce the Incidence/Extent of Postprocedural Ischemic Strokes Associated With Carotid Artery Stenting

Paraskevas

Veith

2014

Angiology

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

Cited by 14 publications

References 51 publications

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

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

Thrombolysis May Reduce the Incidence/Extent of Postprocedural Ischemic Strokes Associated With Carotid Artery Stenting

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