October 15, 2014
A new study showed administering statins to hospitalized stroke victims improved survival rates and increased the likelihood of safe post-care discharge, which suggests patients on statins at the time of admission should continue on the therapy instead having it discontinued over fears of recurrent intracerebral hemorrhage (ICH).
The researchers assessed the impact of statin use on 30-day mortality and rates of discharge to home or inpatient rehabilitation facilities among 3,481 patients admitted to hospitals in the Kaiser Permanente Northern California (KPNC) health system for primary treatment of ICH.
According to the study, 425 of 2,321 non-statin users received a statin during hospitalization, while 391 of 1,160 established statin users had the therapy discontinued upon admission. Overall, 1,194 hospitalized patients received lovastatin, simvastatin, atorvastatin, or pravastatin sodium at a median dose of 10 mg per day.
Patients treated with a statin while hospitalized were approximately twice as likely as non-statin users to survive 30 days. Additionally, half of patients treated with statins were discharged to home or a rehab facility compared with a little more than one-third of patients who did not receive statins.
Established statin users whose therapy was discontinued had an unadjusted mortality rate of 57.8% compared with 18.9% for patients who continued on statin therapy while hospitalized. The trends remained consistent even after the researchers adjusted for demographics, medical comorbidities, ICH severity, ICH complications, and do-not-resuscitate status within 24 hours of admission.
The association between stopping statin therapy and poor outcomes must be part of the risk-benefit analysis of continuing or discontinuing statins in patients hospitalized for ICH, according to the researchers. They suggested stoke victims should continue to receive statins even though commonly held concerns about the drugs increasing risk of recurrent ICH may lead caregivers to do otherwise.
“Some previous research has suggested that treating patients with statins after they suffer hemorrhagic stroke may increase their long-term risk of continued bleeding,” said study lead author Dr. Alexander Flint, of the department of neuroscience at Kaiser Permanente Northern California. “Yet the findings of our study suggest that stopping statin treatments for these patients may carry substantial risks.”
The researchers noted the study was subject to the common limitations of a retrospective analysis, but the findings were based on a large patient cohort representative of the overall population in northern California, which suggests they could be applied to general clinical settings.
The study was published online in JAMA Neurology.
1. Flint AC, Conell C, Rao VA, et al. Effect of statin use during hospitalization for intracerebral hemorrhage on mortality and discharge. JAMA Neurol. 2014 Sep 22. [Epub ahead of print]