Continued Statin Treatment After Acute Intracranial Hemorrhage

Statin therapy has clearly demonstrated a beneficial effect in reducing the risk of first ever and recurrent ischemic stroke in patients with coronary artery and cerebrovascular diseases. However, the overall benefit of statins in patients with previous stroke appears to be partially offset by an increased risk of intracranial hemorrhage (ICH). Post hoc analyses of 2 large randomized trials, Heart Protection Society and Stroke Prevention by Aggressive Reduction in Cholesterol Levels, suggest that patients with previous stroke may be at increased risk of hemorrhagic stroke independently of cholesterol levels.1 Like dynamite, statins help fighting fires (ischemic strokes), but with an added risk of potential collateral damages (ICH). Thus, avoidance of statin initiation or continuation after ICH has been recommended by several experts. In contrast, recent observational cohort studies and 1 meta-analysis found no evidence of increased risk of ICH in patients treated with statins after an ischemic stroke. Therefore, it is a matter of controversy whether continuation or initiation of statins in acute ICH patients with history of ischemic stroke is beneficial or harmful in terms of ICH growth, stroke (ischemic and hemorrhagic) recurrence and clinical outcome.Dr Goldstein, …