Statins may improve odds of surviving a bleeding stroke

People in the throes of a stroke caused by bleeding in the brain appear to fare better if they are taking cholesterol-lowering drugs called statins. In a review of medical records, researchers found that those getting statins while being treated for a hemorrhagic stroke were twice as likely to be alive 30 days later as were those not getting the drugs during treatment. Researchers report the results September 22 in JAMA Neurology.

There are two main types of stroke. Most are caused by blood clots in the brain, but up to 20 percent result from bleeding. While research has shown that statins help prevent and possibly treat clot-based strokes, some studies have found no protection against bleeding strokes. One even suggested that statins increased the bleeding-stroke risk, a finding that sent a ripple of worry through hospitals.

“The idea that statins should be avoided wherever brain hemorrhage is involved has permeated stroke practice,” write Columbia University physicians Marco Gonzalez and Randolph Marshall in a commentary in JAMA Neurology.

This caution made sense, says Alexander Flint, a stroke neurologist at Kaiser Permanente in Redwood City, Calif. Just to be on the safe side, physicians confronted with evidence of harm often accept such data with less skepticism than they would apply to evidence showing a benefit,  he says. The priority is to do no harm. The data suggesting statins are harmful came from a trial in which people were getting very high doses of the drugs, he notes.

To check for a link between statins and bleeding strokes, Flint and his colleagues pored over the records of 3,481 patients admitted to Kaiser hospitals for hemorrhagic strokes over a 10-year period and examined their statin history. In all, 18.4 percent of those receiving statins while in the hospital died within 30 days of the stroke, whereas 38.7 percent of those not getting the drugs did. What’s more, when the researchers adjusted for differences between the statin users and nonusers, such as their history of medical problems and the size of their brain hemorrhage, they calculated that 30-day survival was four times greater in those receiving statins. The records show that about 90 percent of people in this analysis who were taking statins were getting low doses of the drugs.

But hemorrhagic stroke patients who were taking statins before entering the hospital — then were taken off the drugs during stroke treatment — had 30-day death rates of nearly 58 percent, compared with about 19 percent for those who were kept on the drugs during treatment.

Doctors treating a brain hemorrhage have a lot to worry about — especially controlling high blood pressure in the patient, which is most often the cause of such bleeds. Those concerns should no longer include statin treatment, says Jan Scheitz a physician at CharitéUniversity Medicine in Berlin. The new study “reassures the safety of statin use after an acute intracerebral hemorrhage,” he says. And this and other studies now indicate that stopping statins in such patients “should probably be avoided,” he says.