Outcomes after thrombolysis in AIS according to prior statin use

Meseguer, Elena; Mazighi, Mikaël; Lapergue, Bertrand; Labreuche, Julien; Gaia, Silvia; Gonzalez‐Valcarcel, Jaime; Lavallée, Philippa C.; Cabrejo, Lucie; Guidoux, Céline; Klein, Isabelle; Olivot, Jean‐Marc; Rouchaud, Aymeric; Desilles, Jean‐Philippe; Amarenco, Pierre

doi:10.1212/wnl.0b013e318270400b

Cited by 24 publications

(26 citation statements)

References 29 publications

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“…Detailed material and methods have been previously reported. 17 All patients underwent a magnetic resonance angiography or CT angiography before treatment to document arterial occlusion. Patients eligible for intravenous thrombolysis were treated with conventional intravenous thrombolysis in case of no documented arterial occlusion and with a systematic intravenous-intra-arterial approach in case of documented arterial occlusion.…”

Section: Bichat Stroke Programmentioning

confidence: 99%

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Impact of Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score on the Success of Endovascular Reperfusion Therapy

Inoue

Olivot

Labreuche

et al. 2014

Stroke

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We have recently shown that the occurrence of a complete Background and Purpose-In acute ischemic stroke patients treated by intravenous thrombolysis, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an independent factor of functional outcomes. Our aim was to assess the impact of pretreatment DWI-ASPECTS on outcomes after endovascular therapy, with a specific emphasis on recanalization. Methods-We analyzed data collected between April 2007 and March 2013 in a prospective clinical registry of acute ischemic stroke patients treated by endovascular approach. Every patient with a documented internal carotid artery or middle cerebral artery occlusion who underwent an acute DWI-MRI before treatment was eligible for this study. The primary outcome was a favorable outcome defined by modified Rankin Scale of 0 to 2 at 90 days. Results-Two hundred ten patients were included and median DWI-ASPECTS was 7 (interquartile range, 4-8). DWI-ASPECTS ≥5 was the optimal threshold to predict a favorable outcome (area under the curve=0.69; sensitivity, 90%; specificity, 38%). In a multivariate analysis including confounding variables, the adjusted odds ratio for favorable outcomes associated with a DWI-ASPECTS of ≥5 was 5.06 (95% confidence interval, 1.86-13.77; P=0.002). Nonetheless, the occurrence of a complete recanalization was associated with an increased rate of favorable outcomes in patients with DWI-ASPECTS under 5 (50% versus 3%, P<0.001). Conclusions-DWI-ASPECTS ≥5 seems to be the optimal threshold to predict favorable outcomes among patients undergoing endovascular reperfusion within 6 hours. Selected patients with a DWI-ASPECTS of <5 may still benefit when a complete reperfusion is achieved. (Stroke. 2014;45:1992-1998.)

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Section: Bichat Stroke Programmentioning

confidence: 99%

“…17 The severity of the ischemic stroke was assessed using the National Institutes of Health Stroke Scale score at admission, 1, 3, and 24 hours …”

Section: Data Collectionmentioning

confidence: 99%

Impact of Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score on the Success of Endovascular Reperfusion Therapy

Inoue

Olivot

Labreuche

et al. 2014

Stroke

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“…3 However, studies on patients receiving intravenous thrombolysis (IVT) reported conflicting results, and the effects on outcome seemed to be attenuated. [3][4][5] Rather, there has been a discussion that patients with previous statin use might be more likely to develop symptomatic intracerebral hemorrhage (sICH) after IVT. [5][6][7] A recently published meta-analysis showed a positive association of statins with IVT-related sICH, but the statistical significance was lost if only studies with adjusted analyses were included.…”

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confidence: 99%

“…4,5 It has been discussed that baseline characteristics of statin users might indicate an unfavorable prestroke morbidity, leading to a higher chance of developing sICH after IVT. 4 As shown in our study, these unfavorable characteristics seem to accumulate in high-dose statin users.…”

mentioning

confidence: 99%

“…[5][6][7] A recently published meta-analysis showed a positive association of statins with IVT-related sICH, but the statistical significance was lost if only studies with adjusted analyses were included. 5 Previous studies investigating the impact of statins on outcome and sICH after IVT lacked information about statin dose. Using pooled data from 2 large European thrombolysis registries, we aimed to analyze the effects of statin dose on risk of sICH and outcome after IVT.…”

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confidence: 99%

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Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Scheitz

Seiffge

Tütüncü³

et al. 2014

Stroke

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H MG-CoA reductase inhibitors (ie, statins) constitute a cornerstone in primary and secondary prevention of ischemic stroke.1 In addition to dose-dependent cholesterol-lowering effects, statins have dose-dependent pleiotropic effects, including antithrombotic properties, and were shown to modify fibrinolytic balance toward a more profibrinolytic state.2 These properties may contribute to the beneficial impact of statins on outcome after ischemic stroke, which was recently confirmed in a large meta-analysis. 3 However, studies on patients receiving intravenous thrombolysis (IVT) reported conflicting results, and the effects on outcome seemed to be attenuated. [3][4][5] Rather, there has been a discussion that patients with previous statin use might be more likely to develop symptomatic intracerebral hemorrhage (sICH) after IVT. [5][6][7] A recently published meta-analysis showed a positive association of statins with IVT-related sICH, but the statistical significance was lost if only studies with adjusted analyses were included. 5Previous studies investigating the impact of statins on outcome and sICH after IVT lacked information about statin dose. Using pooled data from 2 large European thrombolysis registries, we aimed to analyze the effects of statin dose on risk of sICH and outcome after IVT.Background and Purpose-The aim of our study was to assess whether statins have dose-dependent effects on risk of symptomatic intracerebral hemorrhage (sICH) and outcome after intravenous thrombolysis for ischemic stroke. Methods-We pooled data from 2 European intravenous thrombolysis registries. Statin doses were stratified in 3 groups according to the attainable lowering of cholesterol levels (low dose: simvastatin 20 mg or equivalent; medium dose: simvastatin 40 mg or equivalent; and high dose: simvastatin 80 mg or equivalent). sICH was defined according to the European Cooperative Acute Stroke Study. Modified Rankin Scale score 0 to 2 at 3 months was considered a favorable outcome. Results-Among 1446 patients analyzed (median age, 75 years; median initial National Institutes of Health Stroke Scale score, 11; 54% men), 317 (22%) used statins before intravenous thrombolysis. Of them, 120 patients had low-dose, 134 medium-dose, and 63 high-dose statin therapy. sICH occurred in 4% of patients (n=53). Frequency of sICH was 2%, 6%, and 13% in patients with low-, medium-, and high-dose statin treatment, respectively (P<0.01). Adjusted odds ratio (OR) for sICH was 2. 4,9,10 All patients were treated in a specialized stroke unit for ≥24 hours. The registries were approved by the respective ethics committees.Baseline characteristics, including age, sex, and medical history (atrial fibrillation, coronary artery disease, current smoking, diabetes mellitus, hypertension, and previous stroke), were collected. Stroke severity was assessed via the National Institutes of Health Stroke Scale (NIHSS) by certified raters. Moreover, onsetto-treatment time and blood pressure on admission were recorded. Laboratory measures included glucose l...

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Early Use of Statin in Patients Treated with Alteplase for Acute Ischemic Stroke

Geng

Song

et al. 2016

Acta Neurochirurgica Supplement

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Studies have reported that statin usage before stroke can increase the incidence of intracerebral hemorrhage after thrombolytic treatment. However, whether the administration of statin at an early stage of ischemic stroke increases hemorrhage occurrence is unknown. The aim of this study was to assess the effect of statin on neurological imaging and functional outcomes after intravenous alteplase treatment, within 24 h of acute ischemic stroke attack. A total of 119 consecutive acute ischemic stroke patients treated by intravenous alteplase were recruited, of which 71 patients (59.7 %) were given statin therapy within 24 h of stroke onset. The physiological parameters, including demography, vascular risk factors, and clinical characteristics were recorded. The occurrence of intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), 90-day functional outcomes, and mortality in the patients were further analyzed. There were 24 occurrences of ICH after alteplase treatment (20.2 %) and there was no difference when patients were treated with statin (p = 0.280). Multivariate logistic regression analysis showed no significant correlation between the administration of statin and the occurrence of ICH (p = 0.230) or sICH (p = 0.949). There was a trend toward better neurological function with higher statin dose. The use of statin in the early stage of ischemic stroke is safe and does not increase the risk of intracerebral hemorrhage after alteplase treatment, suggesting that a clinical trial of early statin treatment on a large scale following thrombolysis is needed for further evaluation.

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Outcomes after thrombolysis in AIS according to prior statin use

Abstract: These results suggest no beneficial or detrimental effect of prior statin use in acute stroke patients treated by IV thrombolysis, IA thrombolysis, or combined therapy, although the numbers of patients treated by IA thrombolysis or combined therapy are too small to exclude an effect.

Cited by 24 publications

References 29 publications

Impact of Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score on the Success of Endovascular Reperfusion Therapy

Impact of Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score on the Success of Endovascular Reperfusion Therapy

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Early Use of Statin in Patients Treated with Alteplase for Acute Ischemic Stroke

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