Association of Statin Therapy Strategies and Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage :An Bayesian Network Meta-analysis (Preprint)

2021 ◽  
Author(s):  
Tao Liu ◽  
Shiyu Zhong ◽  
Huiquan Jing ◽  
Qingqing Zhai ◽  
Tingzhong Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Bayesian Network ◽  
Statin Therapy ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Favorable Outcome ◽  
Cochrane Central Register ◽  
Short Term

BACKGROUND The exacerbation of neurological outcome is critical in aneurysmal Subarachnoid Hemorrhage (aSAH) patients. Statin has been used to treat patents with aSAH, however, the conventional meta-analyses in the previous studies have shown the inconsistent results for efficacy of statin on these patients. OBJECTIVE In clinical applications, the dosage and type of statins are varied, and their effects need to be further verified. Therefore, we compared the prognostic effects of different dosages and types of statins commonly used in clinical practice on aSAH with Bayesian network meta analysis. METHODS The databases of PubMed, Web of science, Embase, and the Cochrane Central Register of Controlled Trials were searched until January 27, 2021. The primary outcome was the favorable outcome of statin treatment after aSAH. Secondary outcomes included mortality and recurrent stroke. RESULTS Fourteen studies, including a combined total of 2591 patients, were included for systematic review and Bayesian network analysis. In patients with aSAH, statins were more efficacious than placebos with respect to short-term favorable outcome (OR, 0.69; 95% confidence interval [CI], 0.52–0.93), The use of statins significantly reduced the morbidity of ischemic stroke compared with placebo (OR, 0.5; 95% CI, 0.35–0.71). For all-cause recurrence strokes, statins effected a significant reduction compared with controls (OR, 0.60; 95% CI, 0.43–0.82). No statistically significant effect was observed with respect to death (OR, 1.08; 95% CI, 0.79–1.47). Pravastatin (40 mg/day) is suggested to be efficient in preventing recurrent stroke. (OR, 0.16; 95% CI, 0.02–0.71). CONCLUSIONS Statin significantly reduced the incidence of ischemic stroke and overall stroke in patients with aSAH. Moreover, statin therapy improved short-term outcome (≤ 3 months). In all probability pravastatin (40 mg/day) is superior to other types and dosages of statin in the prevention of recurrent stroke. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42020219234.

Short-Term Antifibrinolytic Therapy Before Early Aneurysm Treatment in Subarachnoid Hemorrhage: Effects on Rehemorrhage, Cerebral Ischemia, and Hydrocephalus

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 935-940 ◽  
Author(s):  
Mark R Harrigan ◽  
Kiran F Rajneesh ◽  
Agnieszka A Ardelt ◽  
Winfield S Fisher
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aminocaproic Acid ◽  
Neurological Deficits ◽  
Short Term ◽  
Symptomatic Vasospasm ◽  
Term Administration ◽  
Ischemic Complications

Abstract BACKGROUND: Long-term administration of the antifibrinolytic agent epsilon aminocaproic acid (EACA) reduces the rate of rehemorrhage in patients with aneurysmal subarachnoid hemorrhage (SAH), but is associated with cerebral ischemia. OBJECTIVE: To evaluate short-term administration of EACA before early surgery in patients with SAH. METHODS: Retrospective review of 356 patients admitted between June 2002 and December 2007 with a diagnosis of aneurysmal SAH. Medical records were reviewed to determine SAH risk factors, clinical grade at the time of admission, and incidence of rehemorrhage, permanent new-onset focal neurological deficits, computed tomography evidence of cerebral infarction, symptomatic vasospasm, and hydrocephalus. RESULTS: Patients underwent treatment of the ruptured aneurysm an average of 47.4 hours after admission and received an average total dose of 40.6 g of EACA. The mean length of time of administration of EACA was 35.6 hours. There was a total of 5 rehemorrhages, for an overall rebleeding rate of 1.4% and a rate of rehemorrhage per 24-hour period of 0.71%. Overall, the rates of symptomatic vasospasm and permanent neurological deficits attributable to ischemic stroke were 11.5% and 7.2%, respectively, and the incidence of shunt-dependent hydrocephalus was 42.3%. Patients who were treated with coiling had higher rates of symptomatic vasospasm and ischemic complications than patients who had surgery. CONCLUSION: Short-term administration of EACA is associated with rates of rehemorrhage, ischemic stroke, and symptomatic vasospasm that compare favorably with historical controls. The rate of hydrocephalus is relatively high and may be attributable to EACA treatment.

scholarly journals Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

2017 ◽  
Vol 127 (2) ◽  
pp. 291-301 ◽  
Author(s):  
Jian Shen ◽  
Kai-Yuan Huang ◽  
Yu Zhu ◽  
Jian-Wei Pan ◽  
Hao Jiang ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Cohort Studies ◽  
Cerebral Vasospasm ◽  
Prospective Cohort ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Statin Treatment ◽  
Favorable Outcome ◽  
Prospective Cohort Studies

OBJECTIVEThe efficacy of statin therapy in treating aneurysmal subarachnoid hemorrhage (SAH) remains controversial. In this meta-analysis, the authors investigated whether statin treatment significantly reduced the incidence of cerebral vasospasm and delayed neurological deficits, promoting a better outcome after aneurysmal SAH.METHODSA literature search of the PubMed, Ovid, and Cochrane Library databases was performed for randomized controlled trials (RCTs) and prospective cohort studies investigating the effect of statin treatment. The end points of cerebral vasospasm, delayed ischemic neurological deficit (DIND), delayed cerebral infarction, mortality, and favorable outcome were statistically analyzed.RESULTSSix RCTs and 2 prospective cohort studies met the eligibility criteria, and a total of 1461 patients were included. The meta-analysis demonstrated a significant decrease in the incidence of cerebral vasospasm (relative risk [RR] 0.76, 95% confidence interval [CI] 0.61–0.96) in patients treated with statins after aneurysmal SAH. However, no significant benefit was observed for DIND (RR 0.88, 95% CI 0.70–1.12), delayed cerebral infarction (RR 0.66, 95% CI 0.33–1.31), mortality (RR 0.69, 95% CI 0.39–1.24) or favorable outcome, according to assessment by the modified Rankin Scale or Glasgow Outcome Scale (RR 0.99, 95% CI 0.92–1.17).CONCLUSIONSTreatment with statins significantly decreased the occurrence of vasospasm after aneurysmal SAH. The incidence of DIND, delayed cerebral infarction, and mortality were not affected by statin treatment. Future research should focus on DIND and how statins influence DIND.

Interaction of neurovascular protection of erythropoietin with age, sepsis, and statin therapy following aneurysmal subarachnoid hemorrhage

2010 ◽  
Vol 112 (6) ◽  
pp. 1235-1239 ◽  
Author(s):  
Ming-Yuan Tseng ◽  
Peter J. Hutchinson ◽  
Peter J. Kirkpatrick
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Statin Therapy ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Controlled Trial ◽  
Potential Interaction ◽  
Repeated Measurements ◽  
Unfavorable Outcome ◽  
Phase Iii ◽  
Neurovascular Protection ◽  
Phase Iii Trials

Object In a previous randomized controlled trial, the authors demonstrated that acute erythropoietin (EPO) therapy reduced severe vasospasm and delayed ischemic deficits (DIDs) following aneurysmal subarachnoid hemorrhage. In this study, the authors aimed to investigate the potential interaction of neurovascular protection by EPO with age, sepsis, and concurrent statin therapy. Methods The clinical events of 80 adults older than 18 years and with < 72 hours of aneurysmal subarachnoid hemorrhage, who were randomized to receive 30,000 U of intravenous EPO-β or placebo every 48 hours for a total of 3 doses, were analyzed by stratification according to age (< or ≥ 60 years), sepsis, or concomitant statin therapy. End points in the trial included cerebral vasospasm and impaired autoregulation on transcranial Doppler ultrasonography, DIDs, and unfavorable outcome at discharge and at 6 months measured with the modified Rankin Scale and Glasgow Outcome Scale. Analyses were performed using the t-test and/or ANOVA for repeated measurements. Results Younger patients (< 60 years old) or those without sepsis obtained benefits from EPO by a reduction in vasospasm, impaired autoregulation, and unfavorable outcome at discharge. Compared with nonseptic patients taking EPO, those with sepsis taking EPO had a lower absolute reticulocyte count (nonsepsis vs sepsis, 143.5 vs. 105.8 × 109/L on Day 6; p = 0.01), suggesting sepsis impaired both hematopoiesis and neurovascular protection by EPO. In the EPO group, none of the statin users suffered DIDs (p = 0.078), implying statins may potentiate neuroprotection by EPO. Conclusions Erythropoietin-related neurovascular protection appears to be attenuated by old age and sepsis and enhanced by statins, an important finding for designing Phase III trials.

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