title: The Role of Statin Therapy in Hemorrhagic Stroke.
abstract: The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the most widely utilized class of cholesterol-lowering agents, carrying multiple indications for both primary and secondary cardiovascular risk reduction. Concern was raised by previously published post hoc analyses and observational studies that noted an increased risk of hemorrhagic stroke in patients receiving a statin. Subsequent studies have demonstrated conflicting results regarding the role of statin therapy on hemorrhagic stroke risk and patient outcomes. New evidence suggests that statins taken prior to or continued during admission for intracerebral hemorrhage (ICH) may be associated with positive outcomes. Evidence also suggests deleterious outcomes resulting from the abrupt discontinuation of statins upon hospital admission for multiple disease states including ICH. Conflicting data also exist for the use of statins following aneurysmal subarachnoid hemorrhage (aSAH). Recent evidence suggests statins started during admission for aSAH confer no additional benefit in reducing delayed ischemic neurologic deficits despite initial positive results. Larger scale evaluation of the role of statin therapy following hemorrhagic stroke is warranted. The available literature is reviewed to provide guidance for therapeutic decision making.
authors.affiliation: Department of Pharmacy, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sikora Newsome
authors.affiliation: Department of Pharmacy, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Casciere
authors.affiliation: UNC Medical Center Neuroscience Intensive Care Unit, Division of Neurocritical Care, Departments of Neurology and Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
authors.forename: J Dedrick
authors.initials: JD
authors.lastname: Jordan
authors.affiliation: Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina.
authors.forename: Denise H
authors.initials: DH
authors.lastname: Rhoney
authors.affiliation: Department of Pharmacy, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina.|Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Sullivan
authors.affiliation: Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Morbitzer
authors.affiliation: Department of Pharmacy, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Moore
authors.affiliation: Department of Pharmacy, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina.|Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Durr
mesh_terms: D002543:Cerebral Hemorrhage; D003661:Decision Support Techniques; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: HMG-CoA-reductase inhibitor; intracerebral hemorrhage; statin; stroke; subarachnoid hemorrhage