Use of Statin in Patients Treated with Alteplase for Acute Ischemic Stroke

Variable

Non-statin

Statin

Total

p-value

N = 48

N = 71

N = 119

Age, years, mean (SD)

64.5 ± 10.4

60.6 ± 10.9

62.2 ± 10.8

0.056^a

Male, %

33 (68.8 %)

51 (71.8 %)

84 (70.6 %)

0.717^b

Risk factors, %

Hypertension

26 (54.2 %)

43 (60.6 %)

69 (58.0 %)

0.488^b

Diabetes

8 (16.7 %)

18 (25.4 %)

26 (21.8 %)

0.261^b

Hyperlipidemia

25 (52.1 %)

31 (43.7 %)

56 (47.1)

0.367^b

Previous stroke or TIA

9 (18.8 %)

5 (7.0 %)

14 (11.8 %)

0.052^b

Smoking

23 (45.8)

31 (43.7 %)

53 (44.5 %)

0.815^b

Clinical measures

SBP before thrombolysis, mmHg, median (IQR)

147 (130–160)

149 (130–161)

149 (130–160)

0.741^a

DBP, before thrombolysis, mmHg, median (IQR)

87 (76–95)

85 (80–95)

86 (80–95)

0.728^a

Blood glucose level, before thrombolysis, mmol/L, median (IQR)

6.6 (5.4–7.3)

7.0 (5.9–8.7)

6.7 (5.7–7.8)

0.066^c

LDL, mmol/L, median (IQR)

2.9 (2.4–3.4)

2.9 (2.4–3.5)

2.9 (2.4–3.4)

0.993^a

TC, mmol/L, median (IQR)

4.6 (4.0–5.4)

4.1 (4.7–5.5)

4.6 (4.1–5.5)

0.800^a

Stroke severity

NIHSS, n (%)

0.989^b

≤5

9 (18.8 %)

13 (18.3 %)

22 (18.5 %)

6–13

23 (47.9 %)

35 (49.3 %)

58 (48.7 %)

≥14

16 (33.3 %)

23 (32.4 %)

39 (32.8 %)

TOAST ischemic stroke subtype

0.410^b

Large artery

29 (60.4 %)

36 (50.7 %)

65 (54.6 %)

Small vessel

8 (16.7 %)

19 (26.8 %)

27 (22.7 %)

Unknown etiology

11 (22.9 %)

16 (22.5 %)

27 (22.7 %)

Time from onset to thrombolysis, min, median (IQR)

168 (136–210)

170 (150–211)

170 (144–210)

0.533^a

Abbreviations: DBP diastolic blood pressure, SBP systolic blood pressure, LDL low density lipoprotein, TC total cholesterol, NIHSS National Institutes of Health Stroke Scale, TOAST Trial of Org 10172 in Acute Stroke Treatment, IQR interquartile range

^a t-test

^bChi-square test

^cWilcoxon signed-rank test

Effect of Statin Treatment on ICH

A total of 24 (20.2 %) patients had ICH: 12 (16.9 %) in the statin group and 12 (25.0 %) in the non-statin group. Of these 24 patients, 11 developed ICH within 36 h after thrombolytic treatment (6 [8.5 %] in the statin group and 5 [10.4 %] in the non-statin group); and 13 developed ICH between 36 h and 7 days (6 [8.5 %] and 7 [14.6 %], respectively). Six (5.0 %) patients had sICH: 3 (4.2 %) in statin group and 3 (6.2 %) in the non-statin group. Statin treatment was not associated with an increased likelihood of ICH (OR 0.610, 95 % CI 0.248–1.502, p = 0.280) or sICH (OR 0.662, 95 % CI 0.128–3.425, p = 0.684, Table 2). After multivariate logistic regression analysis, there was still no significant association between the use of statin and occurrence of ICH or sICH (Table 3).

Table 2

Univariate analyses regarding the intracerebral hemorrhage and functional outcome

Outcome	Non-statin	Statin	Total	OR (95 % CI)	p-value
Outcome	N = 48	N = 71	N = 119	OR (95 % CI)	p-value
ICH, n (%)	12 (25.0 %)	12 (16.9 %)	24 (20.2 %)	0.610 (0.248–1.502)	0.280
Early ICH^a	5 (10.4 %)	6 (8.5 %)	11 (9.2 %)	0.794 (0.228–2.765)	0.755
Later ICH^b	7 (14.6 %)	6 (8.5 %)	13 (10.9 %)	0.541 (0.170–1.722)	0.293
sICH n (%)^c	3 (6.2 %)	3 (4.2 %)	6 (5.0 %)	0.662 (0.128–3.425)	0.684
Good functional outcome n (%)^d	21 (43.8 %)	36 (50.7 %)	57 (47.9 %)	1.322 (0.634–2.761)	0.456
All-cause death	3 (6.0 %)	1 (1.4 %)	4 (3.3 %)	0.214 (0.022–2.124)	0.302

^aEarly ICHs (early intracerebral hemorrhage) defined as intracerebral hemorrhage within 36 h after thrombolytic treatment

^bLater ICHs (later intracerebral hemorrhage) defined as intracerebral hemorrhage that occurred from 36 h to 7 days

^csICH (Symptomatic intracerebral hemorrhage) defined as clinical neurologic deterioration (an increase of 4 or more points in the NIHSS score) in addition to any hemorrhage on the follow-up CT/MRI scan

^dGood outcome defined as 90-day mRS score of 0-1

Table 3

Adjusted ORs for the different outcome parameters

	Statin
	OR	p-value
Any ICH	0.525 (0.184–1.504)	0.230
sICH	0.915 (0.060–13.941)	0.949
Good functional outcome	1.278 (0.515–3.176)	0.597
All-cause deaths	0.259 (0.022–3.100)	0.286

As shown in Table 4, among statin-treated groups, 15 patients received 40 mg of atorvastatin daily and others received 20 mg of atorvastatin daily. Although there were no statistically significant differences in ICH types between the two statin subgroups and the control group, there was a trend toward a lower rate of ICH among those taking a higher statin dose. Moreover, none of the patients on the 40 mg statin treatment had later or severe ICH. All patients with ICH in this subgroup were of HI1 type within 36 h of stroke onset.

Table 4

Hemorrhagic transformation and neurological functional outcome among different statin groups

Variable	Non-statin	Statin (20 mg)	Statin (40 mg)	Total	p-value
Variable	N = 48	N = 56	N = 15	N = 119	p-value
Hemorrhagic transformation
Any ICH, n (%)	12 (25.0 %)	10 (17.9 %)	2 (13.3 %)	24 (20.2 %)	0.589
ICH					0.556 Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: of Behavioral Deficits in Rodents Following Brain Injury Across Species, Gender, and Experimental Model Infarction After Aneurysmal Subarachnoid Hemorrhage Ganglia Damage in Experimental Subarachnoid Hemorrhage Pretreatment Fails to Provide Neuroprotection Following a Surgically Induced Brain Injury Rat Model IGF-1 Reduced Rat Pup Germinal Matrix Hemorrhage Injection of Noncellular Cerebrospinal Fluid from Subarachnoid Hemorrhage Patient into Rat Ventricles Leads to Ventricular Enlargement and Periventricular Injury Stay updated, free articles. Join our Telegram channel Tags: Brain Edema XVI Oct 22, 2016 \| Posted by admin in NEUROSURGERY \| Comments Off on Use of Statin in Patients Treated with Alteplase for Acute Ischemic Stroke Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access