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Effects of simvastatin in prevention of vasospasm in nontraumatic subarachnoid hemorrhage: preliminary data
Critical Care volume 13, Article number: P103 (2009)
Vasospasm is the main cause of death and cognitive deficits in patients with subarachnoid hemorrhage after rupture of an aneurysm (aSAH). Some trials have shown that statins in the acute phase of aSAH reduce the incidence, morbidity and mortality of cerebral vasospasm . The purpose of this study is to evaluate the potential of simvastatin (SVT) as prevention against vasospasm.
We realized a prospective, randomized, nonblind study with the use of 80 mg SVT (night) in the first 72 hours of the beginning of bleeding, and a control group that did not use SVT, for 21 days between January and December 2008. Informed consent was obtained for all patients. CT scans were performed as a control and another CT scan was performed in patients with altered neurological signals. In the presence of changes suggestive of vasospasm or correlation in clinical conditions and CT scans, the patients were taken for a cerebral arteriography examination followed by an angioplasty procedure if necessary. Liver and renal function and LDL cholesterol were evaluated weekly, and total creatine kinase was evaluated every 3 days. Exclusion criteria: liver and renal disease, pregnant elevation of serum transaminases (three times normal value), creatinine ≥ 2.5, rhabdomyolysis or total creatine kinase ≥ 1,000 U/l.
We excluded two patients with bleeding for more than 72 hours. There was no significant change in the levels of total creatine kinase, and renal or liver function. We included 21 patients, 11 in the SVT group and 10 in the control group. Mortality was eight patients (38%), six patients in the control group and two of the SVT group. Vasospasm was confirmed by cerebral arteriography examination in four patients in the control group and one patient in the SVT group. All the patients who died showed Fisher scale IV.
SVT at a dose of 80 mg was effective in reducing the mortality (18.1% against 60%) compared with the group that did not use SVT, and also decreased the incidence of cerebral vasospasm despite the APACHE II score being higher in the group that used SVT (14.3 vs. 10.7). Less morbidity occurred in the SVT group, with an average Glasgow outcome score of 3.25 vs. 2.1.
Lynch JR, Wang H, et al.: Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke 2005, 36: 2024-2026. 10.1161/01.STR.0000177879.11607.10
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Macedo, S., Bello, Y., Silva, A. et al. Effects of simvastatin in prevention of vasospasm in nontraumatic subarachnoid hemorrhage: preliminary data. Crit Care 13, P103 (2009). https://doi.org/10.1186/cc7267
- Creatine Kinase
- Cognitive Deficit
- Subarachnoid Hemorrhage