Statins after stroke not associated with intracerebral hemorrhage

Taking statins following an ischemic stroke was not associated with an increased risk of intracerebral hemorrhage, researchers found.

Canadian researchers conducted a retrospective, propensity-matched, cohort study among patients age 66 years and older who were admitted to any Ontario hospital with a primary diagnosis of acute ischemic stroke from July 1994 to March 2008. The primary study outcome was time to intracerebral hemorrhage, defined as a hospitalization or emergency department visit within 120 days of hospital discharge. A total of 17,872 patients (8,936 statin users and 8,936 matched controls) were followed for a median of 4.2 years. Results appeared in the Sept. 12 Archives of Neurology.

In the primary analysis comparing statin users with nonusers, there were 213 episodes of intracerebral hemorrhage, with a slightly lower rate in statin-treated patients than in matched controls (2.94 vs. 3.71 episodes per 1,000 patient-years, respectively). The hazard ratio (HR) for statin exposure was 0.87 (95% CI, 0.65 to 1.17) compared to nonuse. There was no effect found when considering the variables of age, sex, socioeconomic status, major comorbidities, or therapy with antiplatelets or anticoagulants. Patients were also examined by dosage, with doses defined as high when the prescription contained the maximum allowable dose in the product monograph and all other doses defined as low. Patients who took high or low doses of statins had intracerebral hemorrhage risks similar to those not taking statins (HR, 1.33; 95% CI, 0.30 to 5.96; and HR, 0.86; 95% CI, 0.64 to 1.16, respectively). There was no association between statins and fatal hemorrhagic stroke (HR, 0.96; 95% CI, 0.63 to 1.45).

The authors said the study supports current practice, whereby more than 80% of patients discharged from the hospital after ischemic stroke are prescribed statin therapy. An accompanying editorial stated, however, that until more evidence clarifies the association between statins and intracerebral hemorrhages, modifiable risks such as high blood pressure should be carefully controlled in patients taking statins. Other risks, such as history of intracerebral hemorrhage or use of antithrombotic therapy and cerebral microbleeds, should also be carefully considered when prescribing statins, it said.

“The clinical decision to administer a statin following intracerebral hemorrhage remains a challenging one with available evidence tilting in the direction of withholding such therapy, especially when there is a history of lobar brain hemorrhage,” the editorialist wrote. Input from patients and family members, once they have been told about possible bleeding risks with statins, is useful in making the decision, he added.