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Statin use after stroke not linked to bleeds

Risk of intracerebral haemorrhage no higher when taking statins after stroke

Louise Prime

Thursday, 15 September 2011

Using statins in aggressive lowering of cholesterol to reduce patients’ risk of recurrent ischaemic stroke or transient ischaemic attack (TIA) is not linked to an increased risk of intracerebral haemorrhage, shows research published Online First in Archives of Neurology.

Two earlier systematic reviews had suggested that although people treated aggressively with statins after ischaemic stroke or TIA appeared to have a reduced rate of recurrence, they were also at increased risk of subsequently suffering a haemorrhagic stroke.

Researchers in Ontario, Canada examined data on 17,872 people who had been admitted to hospital with an ischaemic stroke, who were at least 66 years old, and who had been followed up after discharge for a median of 4.2 years. They compared the risks of ischaemic and haemorrhagic stroke in patients who had received statins, with the risks in an equal number of patients who had not had statins (controls).

In fact, the rate of intracerebral haemorrhage was slightly, but not significantly, lower in patients allocated to statins than the rate in the control group – 2.94 vs. 3.71 episodes per 1000 patient-years. Subgroup analysis also failed to find a significant association of intracerebral haemorrhage with statin use.

The researchers said: “At present, more than 80% of patients discharged from the hospital with a diagnosis of ischaemic stroke are prescribed statin therapy … we found no evidence that such patients are at higher risk for cerebral bleeding than individuals who do not receive statins.”

They concluded: “Physicians should continue to adhere to current treatment guidelines recommending statin therapy for most patients with a history of ischaemic stroke.”

However, the author of an accompanying editorial still urges caution. “Until we have additional, high-level evidence to clarify the statin-ICH [intracerebral haemorrhage] risk relationship, I recommend careful control of modifiable risks for brain haemorrhage such as blood pressure in those who are treated with a statin.

“The clinical decision to administer a statin following ICH remains a challenging one with available evidence tilting in the direction of withholding such therapy, especially when there is a history of lobar brain haemorrhage.”

He adds that patients and their family should be clearly informed of the risks of treatment before they make a decision regarding statin use.

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