Statins significantly improve 30-day outcomes in ICH study

Patients on statins had a 4.25 times greater 30-day survival rate following intracranial hemorrhage (ICH) than patients who were not on statins in a study published online Sept. 22 in JAMA: Neurology. Statin use also had a significant impact on whether or not patients were sent home or to a rehabilitation facility.

On the opposite end of the spectrum, odds of mortality in the 30 days post-ICH were significant if the patient discontinued statin use in the hospital, noted Alexander C. Flint, MD, PhD, of Kaiser Permanente Northern California’s Department of Neuroscience in Redwood City, and colleagues.

The research team retrospectively looked at 3,481 patients who were admitted to one of 20 Kaiser Permanente hospitals in northern California over a 10-year span. Medical records for each patient were reviewed for statin use before, during and after ICH and the outcomes of 30-day survival and discharge home or to a rehabilitation facility.

Flint et al hoped to understand how statins might impact ICH outcomes, building on an earlier study from the same group on the effect of statin use on ischemic stroke outcomes.

“In ischemic stroke, the cessation of statin use during hospitalization has been associated with worsened outcomes,” wrote Flint et al. “Statins affect an array of molecular pathways that may play a role in both ischemic stroke and ICH.”

They determined that statins had a significant impact on survival at 30 days and in discharge rates. Continuity of statin use through hospitalization had an 18 percent mortality rate, however, patients whose statin use was discontinued had a mortality rate of 57.8 percent. The increased odds of mortality among patients who were taken off statins in the hospital post-ICH remained even after adjusting for severity and resuscitation preferences.

Patients given statins through hospitalization were also more likely (49.8 percent) than patients who were not (22.3 percent) to be released to home or inpatient rehabilitation care.

Whether patients were previously on statins or not, best results occurred when the patient was administered statins within 24 hours of ICH.

“The controversy regarding statin use and ICH is far from settled,” wrote Marco A. Gonzalez-Castellon, MD, of Columbia University Medical Center in New York, and colleagues. However, they noted that “Flint et al provide compelling evidence that treatment with statins after acute ICH is safe and improves outcomes, at least in the short term.”

Flint et al, however, advised, based on their findings, that the risks and benefits of discontinuing statin use post-hemorrhage should be carefully considered, even in acute settings. They also recommended early statin use to improve outcomes.