Background and Purpose:
Intracerebral hemorrhage (ICH) is a severe form of stroke with limited medical and surgical treatment. Similarly to clinical trials in acute stroke, none of the medications that appeared promising in preclinical testing have panned out in human clinical trials. HMG-CoA reductase inhibitors (e.g. statins) show promise as a therapy for ICH in both animal and human studies. Our aim is to review and assess the quality of preclinical studies on the role of statins in ICH recovery.
Methods:
We identified preclinical trials assessing the efficacy of statins in ICH via a systematic review of the literature according to PRISMA guidelines. In total, 16 studies were identified that described the use of statins in an animal model of ICH and assessed changes in histological outcomes, behavioral scores, or both. Design characteristics were analyzed using Stroke Therapy Academic Industry Roundtable (STAIR) criteria modified for ICH.
Results:
Behavioral outcomes were assessed in 12 of the studies with 100% (n=12) reporting statins significantly improved ICH recovery. Histological hematoma volume and histological Brain Water Content (BWC) outcomes were analyzed in 10 of the studies with 50% (n=5) reporting significant improvement. There was no correlation between STAIR Quality Score and behavioral, histological hematoma volume, and histological BWC outcomes across all studies (n=16), (p=0.75, p-value=0.49, p=0.44).
Conclusions:
Behavioral outcomes in ICH were found to consistently improve with administration of statins suggesting that this medication may be suitable for randomized clinical trials in humans. In addition, the STAIR criteria can be modified to effectively evaluate preclinical studies in ICH.
Key words:
Intracerebral hemorrhage, Intraparenchymal hemorrhage, ICH, stroke, statins, neuroprotection, animal, preclinical trials, review, systematic review