Statin use ‘no barrier to thrombolysis in acute stroke’
MedWire News: Statin use does not independently predict functional outcomes or bleeding risk in patients receiving thrombolytic therapy for ischemic stroke, research suggests.
Instead, the results indicate that statin use at the time of stroke is a marker for baseline characteristics that are associated with a less favourable outcome, say Stefan Engelter (University Hospital Basel, Switzerland) and fellow authors.
Their study, which appears in the journal Neurology, pooled data from 11 databases of stroke patients receiving intravenous thrombolysis. Of a total of 4012 patients, 918 (22.9%) were taking a statin, with simvastatin being the most frequently prescribed.
Statin users differed from nonusers in a number of ways, note Engelter. They were more often male, were 3 years older on average, had lower blood pressure, were more often taking antithrombotic agents, and had a higher prevalence of hypertension, hypercholesterolemia, diabetes, and coronary heart disease
At 3 months post-stroke, there was no difference between statin users and non-users in rates of mortality (15.1 vs 13.0%), a favourable outcome, as indicated by a modified Rankin Scale (mRS) score of 0-2 (53.9 vs 54.6), or intracranial hemorrhage (ICH; 20.1 vs 17.4%).
However, two secondary outcomes differed significantly between statin users and non-users: rates of an excellent outcome (mRS score 0-1; 35.5 vs 39.7%) and rates of symptomatic ICH defined using the criteria of the European and Australian Cooperative Stroke Study II (6.9 vs 5.1%).
In multivariate analyses that adjusted for predefined variables, statin use was not significantly associated with the likelihood of an excellent functional outcome (adjusted odds ratio [AOR]=0.89) or with risk for ICH (AORs=1.15-1.32, depending on definition).
Taken together, the results suggest that statin use is associated with worse stroke outcomes but that this association is explained by statin users having a less favourable baseline profile.
"Our observations suggest that prior statin use in stroke patients receiving intravenous thrombolysis may be considered as an indicator of demographic and vascular risk factors that are associated with a less favorable course," conclude Engelter et al.
"However, as statin use was not an independent predictor of bleeding complications or unfavorable outcomes, the use of statins should not be an argument to withhold intravenous thrombolysis in acute stroke patients."
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By Joanna Lyford