Effects of sinvastatin in prevention of vasospasm in nontraumatic subarachnoid hemorrhage: preliminary data

Introduction

Vasospasm is the main cause of death and cognitive deficits in patients with subarachnoid hemorrhage after rupture of the aneurysm (aSAH). Some trials have shown that statins in the acute phase of aSAH reduces the incidence, morbidity and mortality of cerebral vasospasm.

Methods

We realized a prospective, randomized, nonblind study, with the use of 80 mg SVT (at 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 was performed as control and another CT scan in patients with altered neurological signals. In the presence of changes suggestive of vasospasm or correlation in clinical and CT scans, the patients were taken for cerebral arteriography examination followed by an angioplasty procedure if necessary. Liver and renal function, LDL cholesterol evaluated weekly, and CK total evaluated every 3 days. Exclusion criteria: liver and renal disease, pregnant elevation of serum transaminases (three times the value of normal), creatinine ≥2.5, rhabdomyolysis or CK total ≥1,000 U/l.

Results

We excluded two patients with bleeding for more than 72 hours. There was no significant change in the levels of CK total, renal or liver function. We included 20 patients, 11 in the SVT group and nine in the control group. Mortality was eight patients (38%), six patients in the control group and two from 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 patients who died had Fisher scale IV.

Conclusions

SVT at a dose of 80 mg was effective in reducing the mortality (18.1% against 66%) compared with the group that did not use SVT, and also decreased the incidence of cerebral vasospasm despite higher APACHE II score in the group that used SVT (14.3 vs 10.7). There was less morbidity in the SVT group with an average of scale of Glasgow 3.25 vs 2.1.