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

Macedo, S; Bello, Y Brum; Silva, A; Siqueira, CM Primo de; Siqueira, S; Brito, Lara Bonani de Almeida

doi:10.1186/cc7267

Cited by 20 publications

(61 citation statements)

References 1 publication

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“…Of these 17 studies included in the meta-analysis, 5 were concerned with the biological effects of statins, 5 were controlled trials that enrolled 930 patients to study clinical efficacy, and 7 were RCTs that enrolled 347 patients and that met the inclusion criteria (2,4,7,13,14,23,25).…”

Section: Zhang Bf Et Al: Statins For Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

“…Figure 1 shows the risk of bias for included studies, and Figure 2 represents the overall bias of every study aspect. Five trials (2,4,13,23,25) were randomized, double-blind, placebo-controlled trials; 2 trials (7,14) were randomized only in the choice of statin or nonstatin treatment, without a blinding method. Four trials (2,13,23,25) included an intention-to-treat analysis.…”

Section: Characteristics Of Included Trials and Quality Evaluationmentioning

confidence: 99%

“…Two RCTs defined CVS on TCD as mean flow velocities >120 cm/s with a Lindegaard ratio (LR) >3 in MCA (23,25); another 2 RCTs defined CVS as velocities >160 cm/s (4, 13); 1 RCT chose velocities >200 cm/s with LR >3 (2); and 2 RCTs did not report on the definition (7,14). Because it differs from a more objective indicator, CVS on TCD could have influenced the judgment of patient outcomes.…”

Section: Zhang Bf Et Al: Statins For Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

“…In contrast, Vergouwen et al (24) included 4 RCTs (2, 13, 23, 25) whose RRs did not lend statistically significant support to the finding of a beneficial effect of statins in patients with aSAH. In addition, 3 trials addressed this topic during 2009 to 2013, which were necessary to include in another meta-analysis, but Jaschinski et al (7) and Macedo et al (14) published only the abstracts, and these had lower methodological quality than comparable studies.…”

Section: Zhang Bf Et Al: Statins For Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

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Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Zhang¹,

Song²,

Wang³

et al. 2014

Turkish Neurosurgery

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AIm:The role of statins for treating aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. In this study, the relevance of different end points was evaluated in order to clarify the action and efficacy of statins. mAterIAl and methOds: A systematic literature retrieval was carried out to obtain randomized controlled trials (RCTs) from before March 2013 on the use of statins for aSAH. Data extraction and quality evaluation of the studies were performed by 2 investigators. A meta-analysis was performed using Review Manager (RevMan) software version 5.2.3. results:Seven randomized controlled trials comprising 347 patients that met the inclusion criteria were included in this meta-analysis. Results showed that, in aSAH, statins did not reduce vasospasm on transcranial Doppler (RR=0.80; 95% CI, 0.53-1.21; p=0.29) or improve outcomes (RR=0.92; 95% CI, 0.71-1.20; p=0.54). However, statins were able to decrease delayed ischemic neurological deficits (RR=0.56; 95% CI, 0.41-0.75; p=0.0001) and mortality (RR=0.54; 95% CI, 0.32-0.91; p=0.02) compared with placebo.COnClusIOn: Acute statin treatment might not be a good choice for cerebral vasospasm after aSAH. Further large-scale, well-designed RCTs on this topic are still needed. BulGulAr: Bu meta analize çalışmaya alma kriterlerini karşılayan 347 hastalık yedi randomize kontrollü çalışma dahil edilmiştir. Sonuçlar aSAK durumunda statinlerin transkraniyal Doppler'de vazospazmı azaltmadığını (RR=0,80; %95 GA, 0,21; p=0,29) veya sonuçları daha iyi hale getirmediğini (RR=0,92; %95CI, 0,20; p=0,54) göstermiştir. Ancak statinler plaseboyla karşılaştırıldığında gecikmiş iskemik nörolojik defisitleri (RR=0,56; %95 GA, 0,41-0,75; p=0,0001) ve mortaliteyi (RR=0,54; %95 GA, 0,32-0,91; p=0,02) azaltmıştır. sOnuÇ: Akut statin tedavisi aSAK sonrasında serebral vazospazm için iyi bir tercih olmayabilir. Bu konuda daha büyük ölçekli ve iyi tasarlanmış randomize kontrollü çalışmalar gereklidir.

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Section: Zhang Bf Et Al: Statins For Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

Section: Characteristics Of Included Trials and Quality Evaluationmentioning

confidence: 99%

Section: Zhang Bf Et Al: Statins For Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

Section: Zhang Bf Et Al: Statins For Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

See 2 more Smart Citations

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Zhang¹,

Song²,

Wang³

et al. 2014

Turkish Neurosurgery

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“…Multiple retrospective studies, and 6 small, prospective, randomized controlled studies (4 of which were published in peer-reviewed journals, 2 of which were published as abstracts) investigated the use of statins in aSAH [88][89][90][91][92][93]. Study results were inconsistent.…”

Section: Statinsmentioning

confidence: 99%

Treatment Options for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Athar

Levine

2012

Neurotherapeutics

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Cholesterol-reducing agents for aneurysmal subarachnoid haemorrhage

Liu

Zhang

et al. 2013

Cochrane Database of Systematic Reviews

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BackgroundCerebral vasospasm and related delayed ischaemic deficits (DIDs) occur in about 17% to 40% of patients with aneurysmal subarachnoid haemorrhage (SAH) and lead to a poor outcome. Cholesterol-reducing agents might improve unfavourable outcomes. ObjectivesTo assess the effects of cholesterol-reducing agents for improving outcomes in patients with aneurysmal SAH. Search methodsWe searched the Cochrane Stroke Group Trials Register (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), MEDLINE (1948 to May 2012) and EMBASE (1980 to May 2012. We also searched three Chinese databases: SinoMed, CNKI and VIP (May 2012). In an effort to identify further published, ongoing and unpublished trials we searched relevant clinical trials and research registers (May 2012), contacted pharmaceutical companies and investigators known to be involved in previous trials and screened the reference lists of all relevant articles identified. Selection criteriaWe included randomised controlled trials (RCTs) that compared cholesterol-reducing agents with control or placebo treatment in participants with aneurysmal SAH. Data collection and analysisTwo review authors independently applied the inclusion criteria, reviewed the relevant trials and extracted data. We did not perform meta-analysis as we only included one RCT in the review. Main resultsWe included one study in which 39 patients received either simvastatin (80 mg daily; n = 19) or placebo (n = 20) for 14 days. The incidence of DIDs (secondary outcome) was 26% (5/19) in the simvastatin group versus 60% (12/20) in the placebo group (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.19 to 1.01, P = 0.05). This means that, in this study, simvastatin had no effect on DIDs. 1 Cholesterol-reducing agents for aneurysmal subarachnoid haemorrhage (Review)

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

Cited by 20 publications

References 1 publication

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Effect of statins on aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials

Treatment Options for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Cholesterol-reducing agents for aneurysmal subarachnoid haemorrhage

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