Statin Use Was Not Associated With Less Vasospasm or Improved Outcome After Subarachnoid Hemorrhage

Kramer, Andreas H.; Gurka, Matthew J.; Nathan, Bart; Dumont, Aaron S.; Kassell, Neal F.; Bleck, Thomas P.

doi:10.1227/01.neu.0000316009.19012.e3

Cited by 88 publications

(60 citation statements)

References 34 publications

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“…However, other studies have shown that simvastatin does not exert a beneficial effect on patients with aSAH (8,9). Kramer et al (11) pointed out that if there is a benefit to statin use, it may be smaller than suggested by previous studies.…”

Section: Introductionmentioning

confidence: 92%

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Zhang¹,

Song²,

Wang³

et al. 2014

Turkish Neurosurgery

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AIm:The role of statins for treating aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. In this study, the relevance of different end points was evaluated in order to clarify the action and efficacy of statins. mAterIAl and methOds: A systematic literature retrieval was carried out to obtain randomized controlled trials (RCTs) from before March 2013 on the use of statins for aSAH. Data extraction and quality evaluation of the studies were performed by 2 investigators. A meta-analysis was performed using Review Manager (RevMan) software version 5.2.3. results:Seven randomized controlled trials comprising 347 patients that met the inclusion criteria were included in this meta-analysis. Results showed that, in aSAH, statins did not reduce vasospasm on transcranial Doppler (RR=0.80; 95% CI, 0.53-1.21; p=0.29) or improve outcomes (RR=0.92; 95% CI, 0.71-1.20; p=0.54). However, statins were able to decrease delayed ischemic neurological deficits (RR=0.56; 95% CI, 0.41-0.75; p=0.0001) and mortality (RR=0.54; 95% CI, 0.32-0.91; p=0.02) compared with placebo.COnClusIOn: Acute statin treatment might not be a good choice for cerebral vasospasm after aSAH. Further large-scale, well-designed RCTs on this topic are still needed. BulGulAr: Bu meta analize çalışmaya alma kriterlerini karşılayan 347 hastalık yedi randomize kontrollü çalışma dahil edilmiştir. Sonuçlar aSAK durumunda statinlerin transkraniyal Doppler'de vazospazmı azaltmadığını (RR=0,80; %95 GA, 0,21; p=0,29) veya sonuçları daha iyi hale getirmediğini (RR=0,92; %95CI, 0,20; p=0,54) göstermiştir. Ancak statinler plaseboyla karşılaştırıldığında gecikmiş iskemik nörolojik defisitleri (RR=0,56; %95 GA, 0,41-0,75; p=0,0001) ve mortaliteyi (RR=0,54; %95 GA, 0,32-0,91; p=0,02) azaltmıştır. sOnuÇ: Akut statin tedavisi aSAK sonrasında serebral vazospazm için iyi bir tercih olmayabilir. Bu konuda daha büyük ölçekli ve iyi tasarlanmış randomize kontrollü çalışmalar gereklidir.

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Section: Introductionmentioning

confidence: 92%

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Zhang¹,

Song²,

Wang³

et al. 2014

Turkish Neurosurgery

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“…Furthermore, statins have been shown to enhance fibrinolysis and inhibit blood coagulation (Krysiak et al, 2003). However, a recent retrospective cohort study showed that after implementation of the routine use of statin treatment in SAH patients, the incidence of vasospasm, DCI, cerebral infarction, and poor outcome did not change (Kramer et al, 2008). Therefore, more randomized studies are needed to investigate the effect of acute statin treatment in patients with SAH, and whether statins exert cholesterol-dependent or independent effects in this group of patients.…”

Section: Studies Investigating Drugs To Prevent Delayed Cerebral Ischmentioning

confidence: 99%

Microthrombosis after Aneurysmal Subarachnoid Hemorrhage: An Additional Explanation for Delayed Cerebral Ischemia

Vergouwen

Vermeulen

Coert

et al. 2008

J Cereb Blood Flow Metab

289

195

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Patients with aneurysmal subarachnoid hemorrhage (SAH) who experience delayed cerebral ischemia (DCI) have an increased risk of poor outcome. Delayed cerebral ischemia is considered to be caused by vasospasm. However, not all patients with DCI have vasospasm. Inversely, not all patients with vasospasm develop clinical symptoms and signs of DCI. In the past, treatments aiming at vasospasm were not successful in preventing ischemia. The purpose of this review is to give an overview of clinical data showing that DCI cannot always be attributed to vasospasm, and to present an in-depth analysis of clinical and autopsy studies on the role of microthrombosis in the pathogenesis of DCI. Clinical studies show that DCI is associated with an activation of the coagulation cascade within a few days after SAH, preceding the time window during which vasospasm occurs. Furthermore, impaired fibrinolytic activity, and inflammatory and endotheliumrelated processes, lead to the formation of microthrombi, which ultimately result in DCI. The presence of microthrombi is confirmed by autopsy studies. Insight in the pathophysiology of DCI is crucial for the development of effective therapies against this complication. Because multiple pathways are involved, future research should focus on drugs with pleiotropic effects.

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“…It is strongly stimulated by interleukin-6 [1][2][3]6,7,[20][21][22][23] . Additionally, IL-1, which has been implicated in the pathogenesis of cerebral vasospasm, also provides a strong stimulus for CRP synthesis 1,[3][4][5] . Therefore, elevated CRP concentrations may well be associated with an increased possibility of developing cerebral vasospasm and subsequently a delayed ischemic neurological deficit (DIND) 1,3,[24][25][26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Serum C-reactive protein levels predict neurological outcome after aneurysmal subarachnoid hemorrhage

Romero

Bertolini²,

Figueiredo

et al. 2012

Arq. Neuro-Psiquiatr.

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OBJECTIVES: Our aim was to evaluate the relationship between serum C-reactive protein (CRP) levels and the neurological prognosis and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Eighty-two adult patients with aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital subtraction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily between admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. RESULTS: Serum CRP levels were related to severity of aSAH. Patients with lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patients with higher serum CRP levels had a less favorable prognosis. CONCLUSIONS: Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.

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Statin Use Was Not Associated With Less Vasospasm or Improved Outcome After Subarachnoid Hemorrhage

Cited by 88 publications

References 34 publications

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Microthrombosis after Aneurysmal Subarachnoid Hemorrhage: An Additional Explanation for Delayed Cerebral Ischemia

Serum C-reactive protein levels predict neurological outcome after aneurysmal subarachnoid hemorrhage

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