Abstract 3726: Rate of Inappropriate Statin Use after Intracerebral Hemorrhage
Background: Statin use has been associated with an increased risk of intracerebral hemorrhage (ICH) and an increased risk of recurrent ICH. Statin use after ICH would be justified for indications where the benefits outweigh the risks of complications per randomized trial evidence. We evaluated the use of statins after ICH in both academic and community hospitals in a population-based study.
Methods: The Genetic and Environmental Risk Factors for Hemorrhagic Stroke Study (NS36695) prospectively identifies hemorrhagic strokes in the Greater Cincinnati/Northern Kentucky region. Chart abstraction was performed by nurses and case verification performed by physician review. Discharge medications were obtained and classified by type of medication including statin use. For this analysis, acceptable indications for statin use at discharge included history of coronary artery disease, myocardial infarction, angina, coronary artery bypass and prior ischemic stroke. Academic center was defined as having a neurosurgical or neurology residency program.
Results: During the period 7/08 to 12/09, 403 cases of ICH were enrolled of which 110 died during the hospitalization and 36 were discharged to hospice. Of the remaining 257 cases, 75 (29%) were on statins at the time of admission of which 12 had their statins stopped prior to discharge. Of the remaining 63 patients, 33 (52%) were discharged on statins without a proper indication. Of 182 ICH patients not on statins at the time of admission, 13 were discharged on statins, of whom 6 (46%) had no compelling indication for a statin. A total of 39 (15%) surviving ICH patients were discharged on statins without a clear indication. No difference in discharge on statins was observed for academic vs. community hospitals.
Conclusions: While statin use is appropriate after ischemic stroke, there is no evidence that use in ICH prevents recurrence or improves outcomes and evidence suggests that statin use increases the risk of ICH. We found that roughly 1 in 6 ICH patients were discharged on a statin without a justifiable indication given the associated risks. Education of medical providers regarding statins and hemorrhagic stroke may improve stroke care following ICH.
- © 2012 by American Heart Association, Inc.