title: Statin pretreatment may increase the risk of symptomatic intracranial haemorrhage in thrombolysis for ischemic stroke: results from a case-control study and a meta-analysis.
abstract: The influence of statins on the results of intravenous thrombolysis for ischemic stroke is controversial. We studied the risks and benefits of statin pretreatment (SP) in patients treated with intravenous alteplase (t-PA) at our institution, and included our data to a meta-analysis of previous related studies. We reviewed prospectively collected data from consecutive patients with acute ischemic stroke treated with IV rt-PA at our institution over the past 9 years. We compared symptomatic intracranial haemorrhage (SICH), favourable short-term outcome (decrease of ≥4 points on the NIHSS score after 24 h from baseline assessment), favourable long-term outcome (mRS score ≤2 at 3 months) and mortality rates between statin-pretreated (SPP) and nonstatin-pretreated patients (NSPP). We performed a systematic search through MEDLINE/PubMed and Embase datasets to identify similar English language studies. A total of 182 patients were included (mean age 68.3 ± 11.4 years, 54.3% men). There were no significant differences between SPP and NSPP regarding SICH (3.3 vs. 1.7%, p = 0.47), favourable short-term outcome (44.8 vs 56%, p = 0.31) and favourable long-term outcome rates (40 vs 44.1%, p = 0.84). In a meta-analysis of 1,055 patients, SP was neither related to long-term functional outcome nor mortality, but it was a risk factor for SICH (OR 1.99, 95% CI 1.03-3.84, p = 0.04). Statin pretreatment may increase the risk of SICH in patients receiving IV t-PA for ischemic stroke, though it does not influence the 3 months outcome. Prospective studies are needed to confirm this safety concern.
authors.affiliation: Neurology Department, Hospital de la Santa Creu i Sant Pau, 167 Sant Antoni Maria Claret st., 08025 Barcelona, Spain. smartinezr@santpau.cat
authors.forename: Sergi
authors.initials: S
authors.lastname: Martinez-Ramirez
authors.forename: Raquel
authors.initials: R
authors.lastname: Delgado-Mederos
authors.forename: Rebeca
authors.initials: R
authors.lastname: Marín
authors.forename: Marc
authors.initials: M
authors.lastname: Suárez-Calvet
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Sáinz
authors.forename: Aída
authors.initials: A
authors.lastname: Alejaldre
authors.forename: Ángela
authors.initials: Á
authors.lastname: Vidal-Jordana
authors.forename: Josep Lluís
authors.initials: JL
authors.lastname: Martí-Vilalta
authors.forename: Joan
authors.initials: J
authors.lastname: Martí-Fàbregas
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007275:Injections, Intravenous; D020300:Intracranial Hemorrhages / Q000150:complications / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality / Q000628:therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator