Dose-Dependent Effects of Statins for Patients with Aneurysmal Subarachnoid Hemorrhage: Meta-Regression Analysis

To, Minh‐Son; Prakash, Shivesh; Poonnoose, Santosh; Bihari, Shailesh

doi:10.1016/j.wneu.2018.01.184

Cited by 6 publications

(4 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even with a big sample size, Kirkpatrick et al couldn't prove a statistical effect of simvastatin with a dose of 40 mg per day. Similarly, a meta regression found a dose-dependent reduction in DIND with acute statin in aSAH [47].Early administration of statin within 48 to 72 hours showed in subgrouping analysis a signi cant bene t in patients with aSAH, in compared to within 96 hours. In addition to, a duration of 14 days was signi cant than a duration of 21 days in subgrouping meta-analysis.…”

Section: Discussionmentioning

confidence: 88%

Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

Radwan

2022

Preprint

View full text Add to dashboard Cite

Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a serious neurological disease and is associated with early and delayed unfavourable consequences. Vasospasm and delayed cerebral ischemia are reasonable for mortality and permanent disability. Using statin therapy may improve neurological outcomes. The aim of this systematic review is to assess the benefits of statin agents in improving the clinical outcomes in patients with aSAH. Methods: A search was done electronically using a search strategy (December 2021), combing free– text and medical subject heading (MeSH) terms in five databases: Medline, PubMed, Scopus, Web of Science, and the Cochrane library, with no restriction on language or publication date. This study protocol was registered with PROSPERO, number CRD42022296336. Main Results: nine randomized controlled studies (RCTs) are eligible and included in meta– analysis. The meta– analyses show significant effects of the statins by reduction in the incidences of vasospasm, delayed neurological ischemic deficits, and delayed cerebral ischemia. The pooled MH odds ratios were 0.55 (95% CI 0.39– 0.81), 0.71 (95% CI 0.54– 0.92) and 0.7(95% CI 0.53– 0.94), respectively. The poor outcome and mortality are not statistically different between statins and placebo. The pooled MH odds ratios were 0.97 (95% CI 0.77– 1.22) and 0.85 (95% CI 0.57– 1.26). No significant adverse effects were reported. Also, subgrouping shows that early administration of statins (within 48– 72 hours) of aSAH onset has significant benefits by decreasing the incidence rate of vasospasm, DIND, and DCI. Conclusion: The statin has a beneficial effect and is safe in patients with aSAH to avoid vasospasm and associated neurological deficits.

show abstract

Section: Discussionmentioning

confidence: 88%

Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

Radwan

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Finally, not only the type of statin but also its dose could be important for its effect on VS and outcome. A meta-analysis found weak evidence that a higher total statin dose reduced the risk for VS, DIND, and mortality [ 52 ]. They reported heterogeneity among the individual studies and suggested a better dosing strategy in future RCTs.…”

Section: Discussionmentioning

confidence: 99%

“…Preload with statins, i.e., pre-ictal statin use may have a different effect on the development of VS and outcome than initiation of statins at ictus as some studies found that the length and dose of administration were crucial for the effect of statins [52]. Some studies have investigated the effect of pre-ictal statin use on VS and outcome [36,40]; however, these were underpowered with regard to the number of statin users (all less than 50 patients) and hence failed to detect a significant impact on VS or outcome.…”

Section: Introductionmentioning

confidence: 99%

The impact of pre-ictal statin use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage

Andersen,

Western,

Sorteberg

et al. 2023

Acta Neurochir

View full text Add to dashboard Cite

Background Pleiotropic effects of statins may be beneficial in alleviating cerebral vasospasm (VS) and improving outcome after aneurysmal subarachnoid hemorrhage (aSAH). Initiation of statin treatment at aSAH is not recommended; however, the effect of pre-ictal and continued statin use is not fully investigated. Methods Retrospective study comparing aSAH patients admitted in 2012 to 2021 with pre-ictal statin use versus those not using statins. Patient entry variables, radiological/sonological VS, symptomatic VS, and radiologically documented delayed cerebral ischemia (DCI) were registered. Outcome was scored in terms of mortality, modified Rankin score, Glasgow outcome score extended, and levels of fatigue. Patients were compared on group level and in a case–control design. Results We included 961 patients, with 204 (21.2%) statin users. Statin users were older and had more often hypertension. Severe radiological/sonological VS, symptomatic VS, and DCI were less frequent in statin users, and their length of stay was shorter. Mortality, functional outcome, and levels of fatigue were similar in both groups. When analyzing 89 pairs of statin users and non-statin users matched for age, aSAH severity, gender, and hypertension, we confirmed decreased radiological/sonological and symptomatic VS as well as shorter length of stay in statin users. They also had more often a favorable functional outcome and lower levels of fatigue. Conclusions Patients with pre-ictal and continued use of statins have a reduced occurrence of radiological/sonological and symptomatic VS, shorter length of stay, and more often favorable functional outcome, whereas mortality is similar to non-statin users. Even though larger multicenter studies with common, strict protocols for prevention, diagnosis, and treatment of vasospasm are needed to finally establish the value of statins in aSAH, continuation of pre-ictal statin use seems worthwhile.

show abstract

“…This timepoint of drug administration differed from the latest clinical trials but was applied in a previous pilot trial. In a meta-regression analysis, there was weak evidence supporting a dose-dependent reduction in cerebral vasospasm, delayed cerebral ischemia, and mortality associated with the application of statin after SAH [ 91 ]. Simvastatin application of 40mg or 80mg per day within 96 hours after SAH was proven to be ineffective in improving delayed cerebral ischemia and clinical outcome, but the potential benefits of statin treatment cannot be dismissed.…”

Section: Introductionmentioning

confidence: 99%

The Updated Role of the Blood Brain Barrier in Subarachnoid Hemorrhage: From Basic and Clinical Studies

Chen

Fang

et al. 2020

View full text Add to dashboard Cite

: Subarachnoid hemorrhage (SAH) is a type of hemorrhagic stroke associated with high mortality and morbidity. The blood-brain-barrier (BBB) is a structure consisting primarily of cerebral microvascular endothelial cells, end feet of astrocytes, extracellular matrix, and pericytes. Post-SAH pathophysiology included early brain injury and delayed cerebral ischemia. BBB disruption was a critical mechanism of early brain injury, and was associated with other pathophysiological events. These pathophysiological events may propel the development of secondary brain injury, known as delayed cerebral ischemia. Imaging advancements to measure BBB after SAH primarily focused on exploring innovative methods to predict clinical outcome, delayed cerebral ischemia, and delayed infarction related to delayed cerebral ischemia in acute periods. These predictions are based on detecting abnormal changes in BBB permeability. The parameters of BBB permeability are described by changes in computed tomography (CT) perfusion and magnetic resonance imaging (MRI). Kep seems to be a stable and sensitive indicator in CT perfusion, whereas Ktrans is a reliable parameter for dynamic contrast-enhanced MRI. Future prediction models that utilize both the volume of BBB disruption and stable parameters of BBB may be a promising direction to develop practical clinical tools. These tools could provide greater accuracy in predicting clinical outcome and risk of deterioration. Therapeutic interventional exploration targeting BBB disruption is also promising, considering the extended duration of post-SAH BBB disruption.

show abstract

Dose-Dependent Effects of Statins for Patients with Aneurysmal Subarachnoid Hemorrhage: Meta-Regression Analysis

Cited by 6 publications

References 57 publications

Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

Statin for patients with aneurysmal subarachnoid hemorrhage (aSAH): A systematic review and meta-analysis

The impact of pre-ictal statin use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage

The Updated Role of the Blood Brain Barrier in Subarachnoid Hemorrhage: From Basic and Clinical Studies

Contact Info

Product

Resources

About