Waimei Tai, MD

 

In a recent article published in Stroke, Chróinín et. al. looked at the benefit of statins across all patients with ischemic stroke using a meta-analysis method, looking at both retrospective and prospective cohorts, and randomized controlled trials. The vast majority of patients (99%) were from cohort studies that followed patients with ischemic stroke, with one very large registry of 86 thousand patients (76% of the entire data set) heavily weighted in this data analysis. The results, including this large registry or excluding this large registry, were both in favor of statin use for improving 90 day clinical outcome.

Looking specifically at statin use thrombolysis-treated patients, the story is murkier. Here all the studies were observational, and statin therapy at time of stroke onset was associated with higher odds of all cause death at 90 days.

Caution should be taken as this meta-analysis is predominately from observational studies and there may have patient selection bias where generally sicker patients were less likely to take oral statins soon after stroke.

This study bolsters current practice of initiating or continuing statin therapy when possible for ischemic stroke patients with the hope improve long term outcomes in ischemic stroke patients.

Defining best practices and following guidelines for acute stroke therapy and prevention is important to ensuring all stroke patients get the best care possible.  Protocols based in science can help streamline care and improve workflow while ensuring that patients are getting the appropriate treatments. This study and others similar to it can help provide the scientific support for current best practices.