Cent Eur Neurosurg 2009; 70(1): 15-20
DOI: 10.1055/s-0028-1082064
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Use of Statins for the Treatment of Spontaneous Intracerebral Hemorrhage: Results of a Pilot Study

Einsatz von Statinen bei der Behandlung spontaner intrazerebraler Blutungen: Ergebnisse einer klinischen PilotstudieH. Tapia-Perez 1 , 2 , M. Sanchez-Aguilar 1 , J. G. Torres-Corzo 2 , I. Rodriguez-Leyva 3 , D. Gonzalez-Aguirre 1 , A. Gordillo-Moscoso 1 , C. Chalita-Williams 2
  • 1Faculty of Medicine, Department of Epidemiology, Universidad Autónoma de San Luis Potosí., San Luis Potosí, Mexico
  • 2Department of Neurosurgery, Hospital Central “Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
  • 3Department of Neurology, Hospital Central “Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
Further Information

Publication History

Publication Date:
05 February 2009 (online)

Abstract

Background and Study Aims: Spontaneous intracerebral hemorrhage (ICH) represents the most fatal kind of stroke, and there is still no treatment available that improves the outcome. Statins are cholesterol reducers, and during the last few years many additional effects have been demonstrated that might be neuroprotective. We designed a pilot clinical study in order to evaluate whether the administration of statins is associated with a better outcome.

Patients and Methods: From August to December 2006 we carried out a prospective/retrospective non-randomized clinical study. The prospective group was treated with rosuvastatin (20 mg) and the retrospective control group was taken from our clinical records with a relation of 1:3. We included patients of both sexes, aged ≥15 years with proven ICH in CT-scan. Exclusion criteria were a history of neoplasm, head injury four weeks before admission, non-hypertensive reasons, brainstem hemorrhage, steroid administration, cranial surgery, initial hydrocephalus, and NIHSS ≥30.

Results: We analyzed 18 patients treated with rosuvastatin and 57 controls with similar basic characteristics. The mortality rate during hospitalization was 1 (5.6%) patient in the statin group and 9 (15.8%) in the control group; the hazard ratio adjusted by the initial Glasgow Coma Scale (GCS), intubation, admission in intensive care unit, disruption into the subarachnoid space was 0.20 (95% CI 0.02–1.67). The odds ratio for NIHSS ≥15 at release was 0.04 (95% CI 0.003–0.93).

Conclusions: The use of statins during the acute phase of ICH could be associated with a better outcome. Further clinical trials are necessary to confirm a possible therapeutic effect and evaluate the toxicity of statins.

Zusammenfassung

Hintergrund: Hypertensive, spontane intracerebrale Blutungen (ICB) haben die höchste Mortalitätsrate zerebrovaskulärer Krankheiten. Bisher ist keine Behandlung verfügbar, die die Prognose statistisch nachweisbar verbessert. Statine sind Medikamente aus der Gruppe der Cholesterinsenker, für die jedoch in den letzten Jahren zusätzliche neuroprotektive Wirkungen beschrieben worden sind. Wir haben eine klinische Pilotstudie durchgeführt, um zu analysieren, ob ein Zusammenhang zwischen dem Einsatz von Statinen und einem besseren Outcome nach ICB besteht.

Patienten/Methode: Von August bis Dezember 2006 erfolgte eine prospektiv/retrospektive, nicht randomisierte klinische Studie. Einer prospektiven Serie von Patienten mit spontaner ICB, die mit Rosuvastatin (20 mg) behandelt wurden, wurde eine retrospektive Serie von Kontrollpatienten aus unserer Statistik gegenübergestellt (1:3 Relation). Einschlusskriterien waren ein Mindestalter von 15 Jahren sowie eine computertomografisch nachgewiesene spontane ICB. Ausschlusskriterien waren eine bekannte Krebserkrankung, minimal 4 Wochen zurückliegendes Schädel-Hirn-Trauma, nicht hypertensive Blutungsursache, Hirnstammhämorrhagie, Steroideinnahme, zurückliegende cranielle OP, bei Aufnahme bestehender Hydrocephalus und NIHSS ≥30.

Ergebnisse: Wir analysierten 18 Rosuvastatin behandelte Fälle und 57 Kontrollfälle mit vergleichbaren klinischen Parametern. Die Sterblichkeit lag bei 1 (5,6%) in der Statingruppe und bei 9 (15,8%) in der Kontrollgruppe. Die angepasste Hazard Ratio für Glasgow Coma Scale, Intubationspflichtigkeit, Intensivtherapie, Einbruch in den Subarachnoidalraum betrug 0,20 (95% CI=0,02–1,67). Die angepasste Odds Ratio (OR) für NIHSS ≥15 bei Entlassung betrug 0,04 (95% CI 0,003–0,93).

Schlussfolgerung: In der akuten Phase der ICB scheint der Einsatz von Statinen mit einem besseren klinischen Outcome assoziiert zu sein. Grössere prospektiv randomisierte klinische Studien zur weiteren Abklärung der möglichen neuroprotektiven Wirkungen gegenüber einer eventuellen Toxität sind notwendig.

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Correspondence

Dr. M. Sanchez-AguilarMD, MSc 

Faculty of Medicine

Department of Epidemiology

Universidad Autónoma de San Luis Potosí.

Av. Venustiano Carranza 2405

San Luis Potosí.

78210 Mexico

Phone: +52/444/826 23 45 ext 519

Fax: +52/444/826 23 52

Email: lehwand@hotmail.com

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