Vivek Rai, MD

Scheitz JF, Seiffge DJ, Tütüncü S, Gensicke H, Audebert HJ, Bonati LH, et al. Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke. Stroke. 2013.

Statins have been shown to have beneficial effect on outcomes after stroke. However, there is conflicting data suggesting increased risk of symptomatic intra-cerebral hemorrhage (sICH) after intravenous thrombolysis (IVT) with prior use of statins. Also, there is no data about whether this effect is dose-dependent. Scheitz et al conducted this retrospective data analysis from two large prospective thrombolysis registries from University Hospital Charité Berlin, Germany (2005-2012) and University Hospital Basel, Switzerland (1998-2012) to study whether statins have dose-dependent effects on risk of sICH and outcome after IVT for ischemic stroke.

Authors stratified satin doses in three groups, low-dose – simvastatin 20 mg or equivalent, medium-dose – simvastatin 40 mg or equivalent and high-dose – simvastatin 80 mg or equivalent or higher. They report that among 1446 patients analyzed, sICH occurred in 4% (n=53) and frequency of sICH was 2%, 6% and 13% in patients with low-, medium- and high-dose statin treatment, respectively (p<0.01) suggesting increased dose-dependent risk of sICH with prior statin use. On the other hand, Statin users more often achieved favorable outcome (mRS 0-2) compared to non- statin users (58% versus 51%, p=0.03).
In my view, this study adds to the current body of evidence suggesting that statin use is associated with improved outcomes after stroke, although it may increase the risk of sICH after thrombolysis. In addition, the increased risk of sICH could be dependent on multiple factors, such as extent of LDL lowering with statins, imaging parameters like lesion volume and pre-existing leukoaraiosis to name a few, but this information is not available in this study. Although, the study will not change my clinical practice but I will be using this information in discussions about benefits and risks of statin use.