Does statin in the acute phase of ischemic stroke improve outcome after intravenous thrombolysis? A retrospective study
Introduction
In the last years, the medical literature has demonstrated that, in addition to risk reduction of first and recurrent stroke, statins may also improve outcome after acute ischemic stroke [1], [2], [3].
A recent systematic review has indicated that pre-treatment with statins was associated with a favorable outcome in acute ischemic stroke [1]. Moreover, a clinical trial has shown that the statin therapy withdrawal in the acute phase of ischemic stroke is associated with increased risk of death and dependency at 90 days [4].
In the only study which assessed the effect and safety of statin treatment during the acute phase on stroke outcome, Montaner et al. reported that statin use between 3 and 12 h after stroke was associated with neurological improvement at 3 days of ischemia, suggesting a rapid mechanism of action on coagulation or the fibrinolysis system [2].
Retrospective studies investigating a possible association between statin use before stroke and functional outcome after thrombolysis have reported controversial results [3], [5], [6]. Àlvarez-Sabin et al. reported that statin treatment before stroke was associated with good functional outcome in subjects who received intravenous (IV) recombinant tissue plasminogen activator (rt-PA) within 3 h after symptom onset [3]. Instead, both Uyttenboogaart et al. and Meier et al. found no association between prior statin use and functional outcome in patients treated up to 4.5 or 6 h from stroke onset with IV rt-PA or intra-arterial (IA) fibrinolysis [5], [6].
The possible effect of statins in the acute phase of ischemic stroke has never been assessed in patients treated with thrombolysis. In this regard, an experimental study on animal models demonstrated that statin use during the acute phase of stroke in combination with rt-PA was associated with the early improvement of the neurological outcome and the maintaining of the fragile balance of fibrinolysis and coagulation, whereas either rt-PA or statin use alone was not [7].
The aim of the present study was to assess whether statin treatment started in the acute phase of stroke (within 24 h) or before stroke and continued during the acute phase may influence functional outcome at 3 months, neurological improvement between 24 and 72 h and symptomatic intracerebral hemorrhage within 72 h in patients receiving IV thrombolysis.
Section snippets
Methods
We conducted a retrospective analysis reviewing the medical records of 250 consecutive acute ischemic stroke patients admitted to the Stroke Unit of the Division of Neurology, Verona General Hospital, recruited from December 2004 to February 2010, receiving IV thrombolysis after informed consent. One hundred thirty-eight patients were treated according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) protocol [8], 66 were treated between 3 and 4.5 h after stroke
Results
The definitive analysis was performed on 178 patients. Sixty-three patients started statin treatment within 24 h after stroke (atorvastatin 80 mg/day in 36 patients, rosuvastatin 10 mg/day in 17, atorvastatin 40 mg/day in 6, pravastatin 20 mg/day in 4). The mean time interval between thrombolysis and statin treatment onset was 11.5 ± 6.7 h. Forty-two patients who used statin before stroke continued the same type and dosage of treatment in the acute phase (atorvastatin 20 mg/day in 15 patients,
Statin use, functional outcome and neurological improvement
The results of the present study show that, in patients treated with IV thrombolysis, statin treatment started within 24 h after stroke is associated with both good functional outcome at 3 months and NI between 24 and 72 h, whereas no statin use is associated with poor functional outcome and has negatively influenced NI. No significant association was observed between statin treatment started before stroke and continued in the acute phase and short- and long-term outcome.
These findings extend
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