Statins in conditions other than hypocholesterolemic effects for chronic subdural hematoma therapy, old drug, new tricks?

Zou, Hai; Ding, Ye; Zhang, Guobing; Yang, Geng; Huang, Dongsheng

doi:10.18632/oncotarget.15092

Cited by 9 publications

(3 citation statements)

References 52 publications

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“…Mechanisms of statins that are discussed as potentially promoting pleiotropic effects in CSDH include the inhibition of inflammation, promotion of blood vessel formation and maturation, an elevation of the number of endothelial precursor cells, and the suppression of vascular endothelial growth factor [27]. Preclinical studies suggest a biphasic effect of statins, whereby the aforementioned responses only occur with lower concentrations, while higher statin doses lead to an inhibition both of angiogenesis and of the growth and migration of endothelial precursor cells [21,23].…”

Section: Discussionmentioning

confidence: 99%

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

et al. 2021

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Background With chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. We therefore sought to determine whether statins reduce the rate of repeat surgery after CSDH drain. Methods We performed an analysis of all patients who underwent surgery for CSDH at our institution between 2012 and 2018. The patients were separated into those who received statins as part of their previous medication (statin group) and those who did not (control group). The medical records were reviewed for repeat surgeries and complications. Additionally, patients or their relatives were contacted via phone to obtain missing data and inquire about possible repeat surgeries at other institutions. Results We identified 407 patients who received CSDH evacuation via burr hole craniotomy. In total, 123 patients were treated with statins as part of their daily medication. Repeat surgery was performed in 26 patients in the statin group (21.1%) and 57 patients in the non-statin group (20.1%, p = 0.81). Upon multivariate logistic regression analysis, neither of the variables statins, age, antithrombotic medication, Charlson comorbidity index, or Markwalder grading score yielded a statistically significant effect upon the revision rate. Conclusions We found no evidence for the protective effect of statins in patients who underwent surgery for CSDH. We thus conclude that statin therapy is not warranted for CSDH perioperatively.

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Section: Discussionmentioning

confidence: 99%

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

et al. 2021

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“… 12 13 A recent trial of dexamethasone showed fewer recurrent cases, but less favorable outcomes and more adverse events. 14 Studies of atorvastatin use in rodents 15 16 and humans 17 18 19 20 21 found that it led to a reduction in CSDH volume without the requirement for surgery and showed no adverse effects. While all of these studies showed the efficacy of atorvastatin in reducing the need for surgical treatment, they did not show its efficacy in preventing recurrence in surgical cases.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of the Effect and Safety of Atorvastatin on the Recurrence of Chronic Subdural Hematoma after Burr Hole Surgery

Bumpetch,

Sitthinamsuwan,

Nunta-aree

2023

Asian J Neurosurg

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Introduction Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Recent studies showed efficacy of atorvastatin in reducing the requirement of surgical treatment. This study aimed to evaluate the efficacy and safety of atorvastatin in reducing the recurrence of CSDH after burr hole surgery. Methods This prospective study included patients with CSDH who underwent burr hole surgery. Atorvastatin at 20 mg per day was administered to all patients for 4 weeks postoperatively. The major outcome was the recurrence rate of CSDH at 8 weeks following the operation. Results Seventy-three patients who completed the 4-week course of atorvastatin were included. The mean age was 73.9 years. The most common cause of CSDH was falling. The mean hematoma volume was 106.3 mL. There was no adverse effect of atorvastatin in all of 73 patients. During the 8-week postoperative period, recurrent CSDH was found in 2 of 73 (2.7%) patients. In a comparison of the recurrence rate of CSDH between patients with use of atorvastatin from the present and previous studies (2.6–4.8%), and patients without use of atorvastatin from previous studies (9.8–19%), a marked reduction in recurrent CSDH after burr hole surgery was found in patients with use of atorvastatin. Conclusion An administration of atorvastatin of 20 mg daily for 4 weeks following burr hole surgery is safe and may be helpful in reducing the recurrence rate of CSDH after burr hole surgery.

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“…As a means of reducing recurrent cases, further therapeutic strategies have been developed. These range from pharmacological agents such as dexamethasone and tranexamic acid to MMA embolization as a way to stop angiogenesis [8,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Immunometabolic Profiling of Chronic Subdural Hematoma through Untargeted Mass Spectrometry Analysis: Preliminary Findings of a Novel Approach

Kipele,

Buchfelder,

Taudte

et al. 2023

Diagnostics

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Objective: Metabolomics has growing importance in the research of inflammatory processes. Chronic subdural hematoma (cSDH) is considered to be, at least in part, of inflammatory nature, but no metabolic analyses yet exist. Therefore, a mass spectrometry untargeted metabolic analysis was performed on hematoma samples from patients with cSDH. Methods: A prospective analytical cross-sectional study on the efficacy of subperiosteal drains in cSDH was performed. Newly diagnosed patients had the option of granting permission for the collection of a hematoma sample upon its removal. The samples were analyzed using liquid chromatography–mass spectrometry to obtain different types of metabolites from diverse biochemical classes. The statistical analysis included data cleaning, imputation, and log transformation, followed by PCA, PLS-DA, HCA, and ANOVA. The postoperative course of the disease was followed for 3 months. The metabolite concentrations in the hematoma fluid were compared based on whether a recurrence of the disease was recorded within this time frame. Results: Fifty-nine samples from patients who were operated on because of a cSDH were gathered. Among those, 8 samples were eliminated because of missing metabolites, and only 51 samples were analyzed further. Additionally, 39 samples were from patients who showed no recurrence over the course of a 3-month follow-up, and 12 samples were from a group with later recurrence. We recorded a noticeable drop (35%) in the concentration of acylcarnitines in the ”recurrence group“, where 10 of the 22 tested metabolites showed a significant reduction (p < 0.05). Furthermore, a noticeable reduction in different Acyl-CoA-dehydrogenases was detected (VLCAD-deficiency p < 0.05, MCAD-deficiency p = 0.07). No further changes were detected between both populations. Conclusions: The current study presents a new approach to the research of cSDH. The measurements presented us with new data, which, to date, are without any reference values. Therefore, it is difficult to interpret the information, and our conclusions should be considered to be only speculative. The results do, however, point in the direction of impaired fatty acid oxidation for cases with later recurrence. As fatty acid oxidation plays an important role in inflammatory energy metabolism, the results suggest that inflammatory processes could be aggravated in cases with recurrence. Because our findings are neither proven through further analyses nor offer an obvious therapy option, their implications would not change everyday practice in the management of cSDH. They do, however, present a further possibility of research that might, in the future, be relevant to the therapy.

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Statins in conditions other than hypocholesterolemic effects for chronic subdural hematoma therapy, old drug, new tricks?

Cited by 9 publications

References 52 publications

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

Do statins reduce the rate of revision surgery after chronic subdural hematoma drain?

A Prospective Study of the Effect and Safety of Atorvastatin on the Recurrence of Chronic Subdural Hematoma after Burr Hole Surgery

Immunometabolic Profiling of Chronic Subdural Hematoma through Untargeted Mass Spectrometry Analysis: Preliminary Findings of a Novel Approach

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