Statins After Ischemic Stroke Not Linked To Hemorrhagic Complications

Treatment with statins before stroke and initiation of statins after stroke were not associated with hemorrhagic complications, according to research published in Neurology.

Although there is data supporting the benefits of statins after stroke, previous studies have also linked statins to an increased risk of intracranial hemorrhage (ICH).

To compare the risk of ICH and 90 day mortality in patients treated with statins before and within 3 days after an acute ischemic stroke, Jan Scheitz, MD, of the Center for Stroke Research in Berlin, Germany and colleagues analyzed retrospective data from the Virtual International Stroke Trials Archive.

Data from a cohort of 8535 patients (54% men, mean age of 70 years) was analyzed. The 1309 participants (15.3%) with a history of prior statin use were more likely to be older, male, have a higher NIH Stroke Scale on admission, treatment with thrombolysis and oral anticoagulation, and comorbidities such as hypertension, diabetes, and a previous myocardial infarction.

In total, 221 participants developed a symptomatic intracranial hemorrhage (sICH). After univariate analysis, an association was found in those with prior statin use (3.9% vs 2.4%, P=.002, OR 1.56, 95% CI: 1.13-2.15). However, after multiple regression analysis and adjusting for confounders, this association was no longer significant. Likewise, there was not a significant association between prior statin use and sICH in the match cohort (OR 1.33, 95% CI: 0.83-2.14).  

Although it failed to reach significance, there was a trend towards hemorrhagic complications and potent prior statin use (OR 1.59, 95% CI: 0.99-2.55, P=.06).

Within the cohort, 2583 of the participants (30.3%) received thrombolysis, and of those, 4.6% (N=120) developed sICH. The use of thrombolysis was independently associated with development of sICH (OR 2.65, 95% CI: 1.91-3.66). Further, patients with prior statin use and thrombolysis were found to have a 3-fold risk of sICH in the unmatched cohort (aOR 3.24, 95% CI: 2.06-5.09). However, the authors noted this was mostly related to thrombolysis treatment alone. 

Within the 90 day follow up, 52 participants (0.7%) developed a post-acute ICH, but this was not significantly higher in patients with new statin use (1.1% vs 0.7%, P=.23). Further, Cox regression analysis that adjusted for demographics and risk factors did not find a strong association between post-acute ICH and new statin use (aHR 1.60, 95% CI: 0.70-3.65). In the match cohort, prior statin use was associated with a lower 90-day mortality rate (19.7% vs 24.2%, P=.005). However, this association was not observed after multiple Cox regression analysis (aHR 0.84, 95% CI: 0.70-1.0).  

Finally, initiation of statins early after a stroke was associated with a lower 90-day mortality (aHR 0.49, 95% CI: 0.38-0.62) with higher potency statins tied to a reduction in mortality (P=.04).

“Taken together, prior statin use was not associated with early poststroke hemorrhagic complications,” the authors wrote. “There was no evidence of excess risk of sICH in the setting of treatment with IV thrombolysis, which supports overall safety of thrombolysis among prevalent statin users.”

Reference

Scheitz JF, Mac Isaac RL, Abdul-Rahim AH, et al. Statins and risk of poststroke hemorrhagic complications. Neurology. 2016; 10.1212/WNL.0000000000002606.