The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study

Abstract

Chronic subdural haematoma (CSDH) is a common neurosurgical condition. Burr-hole for drainage is an effective treatment. However, recurrence can be up to 8-33% and is associated with morbidities and mortalities. The underlying pathogenesis was postulated to be localised inflammation and pathological aberrant vessels formation. Atorvastatin, an HMG-CoA reductase inhibitor, is a type of lipid-lowering medication. In animal studies and a preliminary clinical trial, Atorvastatin was shown to be effective in the treatment of CSDH. It was found to inhibit inflammation and promote vascular maturation at the neomembrane of CSDH. Our study aimed to investigate the efficacy of Atorvastatin in CSDH. During the study period from January to December 2014, Atorvastatin was used in 12 CSDH patients with Glasgow Coma Scale (GCS) 13-15 or Markwalder's Grading Scale (MGS) Grade 0-2. They were retrospectively compared with GCS-and MGS-matched controls who had not used statin. Improvement with haematoma resolution at 3 months was 75% (9/12) for the Atorvastatin group, versus 42% (5/12) for the Control group (p ¼ 0.0977). The risk of deterioration requiring burr-hole drainage was 16.7% (2/12) in the Atorvastatin group, versus 58.3% (7/12) in the Control group (p ¼ 0.0447). The Odds Ratio (OR) of deterioration requiring burr-hole drainage with Atorvastatin was 0.143 (95%CI: 0.021-0.958), which favours the use of Atorvastatin in CSDH (p ¼ 0.0451). The Number needed to treat (NNT) was 2.4 (p ¼ 0.0447; 95%CI: 1.31-14.93). In conclusion, this retrospective cohort comparison study has shown that CSDH with Atorvastatin had a lower rate of deterioration and burr-hole drainage.ARTICLE HISTORY

Effects of atorvastatin on chronic subdural hematoma

“…1). Of the included studies, 2 studies were retrospective studies [18,19] and the other 1 [13] was a prospective study, and 2 studies [13,18] were performed in China, the rest 1 [19] was in Hong Kong, China. More relevant information was shown in Table 1.…”

“…In addition, another retrospective study showed that the improvement rate of hematoma at third months after atorvastatin administration was 75% for the atorvastatin group versus 42% for the control group; however, the result did not have any statistically significant difference ( P  = .0977). [19] …”

“…The odds ratio (OR) of burr-hole drainage was 0.143 (95% confidence interval [CI]: 0.021–0.958) with atorvastatin intervention. [19] Atorvastatin produced beneficial effects as an adjunct drug to surgery. The postoperative improvement rate was 97.4% (38/39) in atorvastatin group versus 80.9% (51/63) in control group.…”

“…[13,18,19] A total of 21.7% (5/23) CSDH patients had a history of aspirin treatment, whereas radiological resolution showed that all the hematomas in those patients were absorbed completely 3 months later after atorvastatin treatment. [13] In Xu et al [18] study, the history of antiplatelet or anticoagulant did not increase the risk of uncured CSDH, and the OR was 0.329 (95% CI = 0.040–2.696).…”

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

“…Preliminary studies have suggested efficacy of atorvastatin as a conservative treatment option in CSDH with complete haematoma resolution within 6 months in two studies, although patient numbers only totaled 31 [122, 123]. Reduced need for surgical intervention with atorvastatin was also identified by Chan et al in a study on 24 patients [124]. 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].…”