Author response: Association of statin use with spontaneous intracerebral hemorrhage: A cohort study

Background: The safety of statin use in patients with intracerebral hemorrhage (ICH) is an unsettled issue of critical importance during stroke management. To assess the benefits and risks of statin use in ICH patients, we analyzed the big data from the Taiwan National Health Insurance Research Database (NHIRD) collected from a population known to have a higher ICH incidence than the Westerners. Methods and Results: A random sample of 1,000,000 subjects representative of the 23-million population registered in the NHIRD from 1997 to 2010 was used for this retrospective cohort study. The cumulative risks of ICH, ischemic stroke, and transient ischemic attack (TIA) were analyzed among three ICH cohorts: non-statin (NS; no statin use before or after ICH), statin (S; continued or initiated statin use after ICH), and statin-withdrawal (SW; statin use discontinued after ICH). A total of 2408 ICH patients (age 63.4±14.2 years, 62.5% male) were identified between 2000 and 2005 and followed for an average of 7.0 years. A Cox proportional hazard regression model was applied to estimate the hazard ratios (HRs) with adjustment for potential confounders. Compared to NS, S had a 71% (HR 0.29, CI 0.19-0.43; P<0.001) reduction in ICH recurrence (Figure). The risk of ICH recurrence decreased as a function of the increment of cumulative defined daily doses (P trend <0.0001). In contrast, SW had a 1.5-fold increase in ICH recurrence (HR 1.55, CI 1.09-2.22; P=0.016) and a 2-fold increase in ischemic stroke or TIA development (HR 2.01,CI 1.30-3.11; P=0.002). Conclusions: Based on this large database, continuation or initiation of stain use in ICH patients is associated with a reduced risk of ICH recurrence in a dose-dependent manner; discontinuation of statin use confers significant risks for both ICH recurrence and ischemic stroke/TIA development. Mechanistic studies are warranted to further validate the significance of this observation.

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Statin use in spontaneous intracerebral hemorrhage: a systematic review and meta-analysis

International Journal of Stroke ◽

10.1111/ijs.12624 ◽

2015 ◽

Vol 10 (SA100) ◽

pp. 10-17 ◽

Cited By ~ 15

Author(s):

Jin-Man Jung ◽

Jeong-Yoon Choi ◽

Hyun Jung Kim ◽

Woo-Keun Seo

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Spontaneous Intracerebral Hemorrhage ◽

Statin Use

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Surgical treatment for antiplatelet intracerebral hemorrhage (SAP-ICH): protocol for a prospective cohort study of emergency surgery for severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet treatment

Chinese Neurosurgical Journal ◽

10.1186/s41016-020-00225-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jun Wu ◽

Xinguo Sun ◽

Qingyuan Liu ◽

Maogui Li ◽

Shanwen Chen ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Intracerebral Hemorrhage ◽

Prospective Cohort Study ◽

Emergency Surgery ◽

Prospective Cohort ◽

Spontaneous Intracerebral Hemorrhage ◽

Antiplatelet Treatment ◽

Spontaneous Intracranial Hemorrhage

Abstract Background Despite the capability of emergency surgery to reduce the mortality of severe spontaneous intracranial hemorrhage (SSICH) patients, the effect and safety of surgical treatment for severe spontaneous intracranial hemorrhage (SSICH) patients receiving long-term oral antiplatelet treatment (LOAPT) remains unclear. In consideration of this, the cohort study is aimed at figuring out the effect and safety of emergency surgery for SSICH patients on LOAPT. Methods As a multicenter and prospective cohort study, it will be conducted across 7 representative clinical centers. Starting in September 2019, the observation is scheduled to be completed by December 2022, with a total of 450 SSICH patients recruited. The information on clinical, radiological, and laboratory practices will be recorded objectively. All of the patients will be monitored until death or 6 months after the occurrence of primary hemorrhage. Results In this study, two comparative cohorts and an observational cohort will be set up. The primary outcome is the effect of emergency surgery, which is subject to assessment using the total mortality and comparison in the survival rate of SSICH patients on LOAPT between surgical treatment and conservative treatment. The second outcome is the safety of surgery, with the postoperative hemorrhagic complication which is compared between the operated SSICH patients on and not on LOAPT. Based on the observation of the characteristics and outcome of SSICH patients on LOAPT, the ischemic events after discontinuing LOAPT will be further addressed, and the coagulation function assessment system for operated SSICH patients on LOAPT will be established. Conclusions In this study, we will investigate the effect and safety of emergency surgery for SSICH patients on LOAPT, which will provide an evidence for management in the future. Ethics and dissemination The research protocol and informed consent in this study were approved by the Institutional Review Board of Beijing Tiantan Hospital (KY2019-096-02). The results of this study are expected to be disseminated in peer-reviewed journals in 2023. Trial registration Name: Effect and safety of surgical intervention for severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet treatment. ChiCTR1900024406. Date of registration is July 10, 2019.

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