Statin Treatment in Patients With Intracerebral Hemorrhage
| Autor: | Matthias Endres, Jan F. Scheitz, Christian H. Nolte |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Statin medicine.drug_class medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine therapeutic use [Hydroxymethylglutaryl-CoA Reductase Inhibitors] medicine Humans cardiovascular diseases ddc:610 Intensive care medicine Stroke metabolism [Cerebral Hemorrhage] Cerebral Hemorrhage Advanced and Specialized Nursing Intracerebral hemorrhage Cholesterol business.industry chemically induced [Cerebral Hemorrhage] adverse effects [Hydroxymethylglutaryl-CoA Reductase Inhibitors] Thrombolysis medicine.disease Comorbidity prevention & control [Cerebral Hemorrhage] Discontinuation chemistry Observational study Female Neurology (clinical) Hydroxymethylglutaryl-CoA Reductase Inhibitors Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery physiopathology [Cerebral Hemorrhage] |
| Zdroj: | Stroke 49(1), 240-246 (2018). doi:10.1161/STROKEAHA.117.019322 |
| DOI: | 10.1161/STROKEAHA.117.019322 |
| Popis: | Ever since the publication of the SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) in 2006, neurologists became aware of the fact that statins may increase the risk for future intracerebral hemorrhage (ICH) in patients with previous ischemic stroke or ICH.1,2 At the same time, observational studies reported an increased risk for hemorrhagic transformation or even symptomatic bleeding in ischemic stroke patients undergoing thrombolysis who were pretreated with statins.3,4 As a consequence, many physicians were very careful to administer statins in patients with ICH and often stopped statin medication immediately after hospital admission in those who had been taking the medication before the event. In 2011, Westover et al5 provided a Markov decision model that came to the conclusion that statins should be avoided in patients with a history of ICH, particularly in those cases with a lobar location. In clinical practice, this often results in the somewhat counterintuitive situation that after an ICH, statins are often permanently discontinued, whereas platelet inhibitors or even oral anticoagulants are resumed depending on the underlying comorbidity.6 Statins exert many pleiotropic effects in addition to cholesterol lowering. These properties may contribute to both its protective effects and also some unwanted side effects, including an increased risk for bleeding.7,8 On the other hand, however, sudden discontinuation of statins may lead to rebound effects which may impair vascular function and induce adverse clinical effects in patients with acute vascular events.9–12 Some years ago, we formulated the recommendation that statins should not be paused and acutely discontinued in ischemic stroke patients undergoing thrombolysis and inferred—based on only sparse clinical data—that this probably also applies for patients after acute ICH.13 In the meantime, a relevant number of research articles including 2 … |
| Databáze: | OpenAIRE |
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