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Background  For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding.    Methods  Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years.    Results  The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days ( p  < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS <  = 2) ( p  < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage ( p  < 0.001) and gastrointestinal haemorrhage ( p  = 0.003) in the hospital and a lower percentage of death events ( p  < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697,  p  < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372,  p  = 0.049) and gastrointestinal haemorrhage (OR = 0.023,  p  = 0.016), and a lower percentage of death events (OR = 0.072,  p  < 0.001).    Conclusion  For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12883-021-02259-9.

Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis