This Article Full Text Full Text (PDF) All Versions of this Article: 38/5/1545    most recent STROKEAHA.106.475905v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tseng, M.-Y. Articles by Kirkpatrick, P. J. Search for Related Content PubMed PubMed Citation Articles by Tseng, M.-Y. Articles by Kirkpatrick, P. J. Related Collections Neuroprotectors Endothelium/vascular type/nitric oxide Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage

(Stroke. 2007;38:1545.)
© 2007 American Heart Association, Inc.

Original Contributions

Effects of Acute Pravastatin Treatment on Intensity of Rescue Therapy, Length of Inpatient Stay, and 6-Month Outcome in Patients After Aneurysmal Subarachnoid Hemorrhage

Ming-Yuan Tseng, MD, Mphil, MSc; Peter J. Hutchinson, PhD, FRCS(SN); Marek Czosnyka, PhD; Hugh Richards, PhD; John D. Pickard, FRCS, MChir, FmedSci Peter J. Kirkpatrick, FRCS(SN)

From the Department of Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, Cambridgeshire, UK.

Correspondence to Peter J. Kirkpatrick, FRCS(SN), Box 167, Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK. E-mail pjk21{at}medschl.cam.ac.uk

Background and Purpose— We have previously demonstrated that acute pravastatin therapy after aneurysmal subarachnoid hemorrhage ameliorates vasospasm-related delayed ischemic deficits. This study assesses the effects of pravastatin on the frequency and intensity for rescue therapy, length of inpatient stay, and long-term outcome at 6 months.

Methods— Eighty aneurysmal subarachnoid hemorrhage patients (age 18 to 84 years, onset 1.8±1.3 days) were randomized to receive daily oral pravastatin (40 mg) or placebo for up to 14 days. Clinical events were recorded during the trial. Six-month outcome was assessed using the Short Form 36 and the modified Rankin Scale.

Results— Although no significant difference in the outcome at discharge was found between the trial groups, multivariate analysis showed pravastatin therapy reduced unfavorable outcome by 73% (P=0.041). The benefit persisted at 6 months (P=0.063) and was notable in the physical (P<0.001) and psychosocial (P<0.001) aspects measured using Short Form 36. Furthermore, the acute pravastatin therapy reduced the requirement for triple-H therapy (hypertensive, hypervolemic, hemodilution; P=0.045) and mortality related to vasospasm (P=0.02) and sepsis (P=0.001); no significant difference was found in the length of inpatient stay between the trial groups.

Conclusions— This trial demonstrates that acute statin treatment reduces traditional rescue therapy for vasospasm after aneurysmal subarachnoid hemorrhage. Improvement in early outcome has proved robust at 6 months, particularly in relation to physical and psychosocial (Short Form 36) outcome.

Key Words: catecholamine • psychosocial • SF-36 • statins • subarachnoid hemorrhage

This article has been cited by other articles:

				V. A.H. Sillberg, G. A. Wells, and J. J. Perry Do Statins Improve Outcomes and Reduce the Incidence of Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis Stroke, September 1, 2008; 39(9): 2622 - 2626. [Abstract] [Full Text] [PDF]

				E. FitzMaurice, L. Wendell, R. Snider, K. Schwab, R. Chanderraj, C. Kinnecom, K. Nandigam, N. S. Rost, A. Viswanathan, J. Rosand, et al. Effect of Statins on Intracerebral Hemorrhage Outcome and Recurrence Stroke, July 1, 2008; 39(7): 2151 - 2154. [Abstract] [Full Text] [PDF]

				J. L Trimble and D. R Kockler Statin Treatment of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage Ann. Pharmacother., December 1, 2007; 41(12): 2019 - 2023. [Abstract] [Full Text] [PDF]

				Other articles noted Evid. Based Med., October 1, 2007; 12(5): 159 - 160. [Full Text] [PDF]