Study finds benefits of statin use in patients hospitalised for intracerebral haemorrhage

Study results published in JAMA Neurology suggest that the use of statins in patients hospitalised for intracerebral haemorrhage (ICH) is associated with improved outcomes, including survival. "If a patient is taking a statin when they come into a hospital with a haemorrhagic stroke, they should strongly consider not stopping the statin immediately in the hospital," said lead author Alexander Flint, adding "the cessation of statin use is associated with worsened outcomes after [ICH]."

The retrospective analysis, which included 3481 patients who were hospitalised with an ICH over a 10-year period, looked at both survival and discharge 30 days after the stroke. Results showed that for patients who weren't already taking statins, but were given the medication in hospital after an ICH, 18 percent were dead after 30 days, compared with 39 percent of those who didn’t receive a statin at all. In addition, those given statins were discharged to home or a rehabilitation facility more than half the time, versus 35 percent of those not given the drugs.

The analysis also showed that patients already taking statins who stopped after being admitted to hospital following a stroke had a 58 percent chance of dying within 30 days, versus 19 percent for those whose statin therapy was continued. Further, those whose therapy was continued were discharged home or to a rehabilitation facility about half the time, compared with 22 percent of those whose statin medicine was stopped.

"The particular association between cessation of statin use and worsened outcomes merits careful consideration of the risk-benefit balance of discontinuing statin therapy in the acute setting of intracerebral haemorrhage," Flint remarked. He noted that future studies need to look at how long patients with an ICH need to remain on statins.

Randolph Marshall, author of an accompanying editorial, said that while the primary use for statins is to lower cholesterol, the drugs can also improve blood flow and reduce inflammation, which may be beneficial in stroke patients. "It is a new concept for most clinicians that statins are actually safe to use and actually beneficial in the setting of ischaemic stroke and haemorrhagic stroke," Marshall commented, adding "my hope is that doctors will take this to heart and understand the potential benefits of statins moving forward."

Marshall and Marco Gonzalez-Castellon cautioned in the editorial that there may still be certain kinds of stroke where statins may be harmful but "for now, however, it provides sufficient evidence to recommend at least the continuation of statin therapy after nonamyloid [ICH] for at least 30 days after the initial event." Marshall and Gonzalez-Castellon also noted that the study did not record what other drugs the patients were taking, which might have affected the outcome.

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