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Impact of treatment with pravastatin on delayed ischemic disease and mortality after aneurysmal subarachnoid hemorrhage

Introduction

Statins have neuroprotective properties including improved vasomotor reactivity, reduced platelet activation and anti-inflammatory effects [1]. A prospective observational controlled study was conducted to evaluate the impact of pravastatin on the development of delayed ischemic disease (DID) and ICU mortality after aneurysmal subarachnoid hemorrhage (aSAH).

Methods

A total of 98 patients (20–80 years old) with aSAH were randomized to receive either pravastatin 40 mg (n = 40) or nonstatin treatment (n = 58) within 24 hours after the ictus. Primary endpoints, incidence of DID and extent of disability measured by the Glasgow Outcome Scale; secondary endpoint, ICU mortality.

Results

Groups were comparable with respect to age (54.2 (50.3–58.3) vs 53.2 (49.8–56.7) 95% CI), grade of aSAH (Hess/Hunt) (2.6 (2.17–3.03) vs 3.06 (3.00–3.80) 95% CI) and stroke severity (Glasgow Coma Scale 10.9 (9.4–12.4) vs 10.5 (9.3–11.8) 95% CI). There was a trend towards less DID in the statin group (37.5% vs 60.3% nonstatin; standard error of the difference of the means 9.8 (3.64–28.00) 95% CI). The extent of disability between the groups, however, was not different (Glasgow Outcome Scale 3.65 (3.16–4.14) statin vs 3.39 (3.00–3.80) nonstatin 95% CI). Mortality was unchanged as well (22.5% statin vs 22.4% nonstatin).

Conclusion

These results are in line with a recently published study demonstrating reduced vasospasm-related DID in patients treated with pravastatin after aSAH [2]. We could not confirm the benefit of statin treatment regarding mortality as mentioned in the cited trial since our study was not powered to detect a difference in mortality. So it is to be hoped that the Statins for Aneurysmal Hemorrhage STASH trial will clarify this topic.

References

  1. 1.

    Topcuoglu MA: Expert Opin Drug Saf. 2006, 5: 57. 10.1517/14740338.5.1.57

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    Tseng MY: Stroke. 2007, 38: 1545. 10.1161/STROKEAHA.106.475905

    PubMed  CAS  Article  Google Scholar 

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Jaschinski, U., Scherer, K., Lichtwarck, M. et al. Impact of treatment with pravastatin on delayed ischemic disease and mortality after aneurysmal subarachnoid hemorrhage. Crit Care 12, P112 (2008). https://doi.org/10.1186/cc6333

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Keywords

  • Statin
  • Secondary Endpoint
  • Pravastatin
  • Platelet Activation
  • Glasgow Coma Scale