title: The use of atorvastatin for chronic subdural haematoma: a retrospective cohort comparison study.
abstract: Chronic subdural haematoma (CSDH) is a common neurosurgical condition. Burr-hole for drainage is an effective treatment. However, recurrence can be up to 8-33% and is associated with morbidities and mortalities. The underlying pathogenesis was postulated to be localised inflammation and pathological aberrant vessels formation. Atorvastatin, an HMG-CoA reductase inhibitor, is a type of lipid-lowering medication. In animal studies and a preliminary clinical trial, Atorvastatin was shown to be effective in the treatment of CSDH. It was found to inhibit inflammation and promote vascular maturation at the neomembrane of CSDH. Our study aimed to investigate the efficacy of Atorvastatin in CSDH. During the study period from January to December 2014, Atorvastatin was used in 12 CSDH patients with Glasgow Coma Scale (GCS) 13-15 or Markwalder's Grading Scale (MGS) Grade 0-2. They were retrospectively compared with GCS- and MGS-matched controls who had not used statin. Improvement with haematoma resolution at 3 months was 75% (9/12) for the Atorvastatin group, versus 42% (5/12) for the Control group (p = 0.0977). The risk of deterioration requiring burr-hole drainage was 16.7% (2/12) in the Atorvastatin group, versus 58.3% (7/12) in the Control group (p = 0.0447). The Odds Ratio (OR) of deterioration requiring burr-hole drainage with Atorvastatin was 0.143 (95%CI: 0.021-0.958), which favours the use of Atorvastatin in CSDH (p = 0.0451). The Number needed to treat (NNT) was 2.4 (p = 0.0447; 95%CI: 1.31-14.93). In conclusion, this retrospective cohort comparison study has shown that CSDH with Atorvastatin had a lower rate of deterioration and burr-hole drainage.
authors.affiliation: a Division of Neurosurgery , Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong , Hong Kong.
authors.forename: David Yuen Chung
authors.initials: DY
authors.lastname: Chan
authors.affiliation: a Division of Neurosurgery , Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong , Hong Kong.
authors.forename: Danny Tat Ming
authors.initials: DT
authors.lastname: Chan
authors.affiliation: a Division of Neurosurgery , Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong , Hong Kong.
authors.forename: Tin Fung David
authors.initials: TF
authors.lastname: Sun
authors.affiliation: a Division of Neurosurgery , Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong , Hong Kong.
authors.forename: Stephanie Chi Ping
authors.initials: SC
authors.lastname: Ng
authors.affiliation: a Division of Neurosurgery , Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong , Hong Kong.
authors.forename: George Kwok Chu
authors.initials: GK
authors.lastname: Wong
authors.affiliation: a Division of Neurosurgery , Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong , Hong Kong.
authors.forename: Wai Sang
authors.initials: WS
authors.lastname: Poon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000069059:Atorvastatin / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014207:Trephining
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069059:Atorvastatin
keywords: Chronic Subdural Haematoma; elderly trauma; head injury; head trauma; manuscript; statin