title: IV thrombolysis and statins.
abstract: OBJECTIVE
  To examine whether prior statin use affects outcome and intracranial hemorrhage (ICH) rates in stroke patients receiving IV thrombolysis (IVT).
  
  
  METHODS
  In a pooled observational study of 11 IVT databases, we compared outcomes between statin users and nonusers. Outcome measures were excellent 3-month outcome (modified Rankin scale 0-1) and ICH in 3 categories. We distinguished all ICHs (ICH(all)), symptomatic ICH based on the criteria of the ECASS-II trial (SICH(ECASS-II)), and symptomatic ICH based on the criteria of the National Institute of Neurological Disorders and Stroke (NINDS) trial (SICH(NINDS)). Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals were calculated.
  
  
  RESULTS
  Among 4,012 IVT-treated patients, 918 (22.9%) were statin users. They were older, more often male, and more frequently had hypertension, hypercholesterolemia, diabetes, coronary heart disease, and concomitant antithrombotic use compared with nonusers. Fewer statin users (35.5%) than nonusers (39.7%) reached an excellent 3-month outcome (OR(unadjusted) 0.84 [0.72-0.98], p = 0.02). After adjustment for age, gender, blood pressure, time to thrombolysis, and stroke severity, the association was no longer significant (0.89 [0.74-1.06], p = 0.20). ICH occurred by trend more often in statin users (ICH(all) 20.1% vs 17.4%; SICH(NINDS) 9.2% vs 7.5%; SICH(ECASS-II) 6.9% vs 5.1%). This difference was statistically significant only for SICH(ECASS-II) (OR = 1.38 [1.02-1.87]). After adjustment for age, gender, blood pressure, use of antithrombotics, and stroke severity, the OR(adjusted) for each category of ICH (ICH(all) 1.15 [0.93-1.41]; SICH(ECASS-II) 1.32 [0.94-1.85]; SICH(NINDS) 1.16 [0.87-1.56]) showed no difference between statin users and nonusers.
  
  
  CONCLUSIONS
  In stroke patients receiving IVT, prior statin use was neither an independent predictor of functional outcome nor ICH. It may be considered as an indicator of baseline characteristics that are associated with a less favorable course.
authors.affiliation: Department of Neurology, University Hospital Basel, Basel, Switzerland. sengelter@uhbs.ch
authors.forename: S T
authors.initials: ST
authors.lastname: Engelter
authors.forename: L
authors.initials: L
authors.lastname: Soinne
authors.forename: P
authors.initials: P
authors.lastname: Ringleb
authors.forename: H
authors.initials: H
authors.lastname: Sarikaya
authors.forename: R
authors.initials: R
authors.lastname: Bordet
authors.forename: J
authors.initials: J
authors.lastname: Berrouschot
authors.forename: C
authors.initials: C
authors.lastname: Odier
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: G A
authors.initials: GA
authors.lastname: Ford
authors.forename: A
authors.initials: A
authors.lastname: Pezzini
authors.forename: A
authors.initials: A
authors.lastname: Zini
authors.forename: K
authors.initials: K
authors.lastname: Rantanen
authors.forename: A
authors.initials: A
authors.lastname: Rocco
authors.forename: L H
authors.initials: LH
authors.lastname: Bonati
authors.forename: L
authors.initials: L
authors.lastname: Kellert
authors.forename: D
authors.initials: D
authors.lastname: Strbian
authors.forename: A
authors.initials: A
authors.lastname: Stoll
authors.forename: N
authors.initials: N
authors.lastname: Meier
authors.forename: P
authors.initials: P
authors.lastname: Michel
authors.forename: R W
authors.initials: RW
authors.lastname: Baumgartner
authors.forename: D
authors.initials: D
authors.lastname: Leys
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: P A
authors.initials: PA
authors.lastname: Lyrer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors