Abstract
BackgroundFor 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.MethodsData 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.ResultsThe 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).ConclusionFor 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.
Highlights
For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect
Several meta-analyses have suggested that using statins in combination with thrombolysis had no significant effects on the prognosis of ischaemic stroke patients or that the combination increased the rate of haemorrhage [6,7,8]
In the univariate logistic regression analysis, we found that the use of statins (OR = 5.524, P < 0.001) and the Safety outcome When we evaluated haemorrhage events in the hospital, we found that the low-dose statin groups had a lower percentage of ICH events (p < 0.001) and gastrointestinal haemorrhage(p = 0.003) than the control group (Table 1)
Summary
For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. A study showed that high-dose statins could increase the risk of intracerebral haemorrhage in ischaemic stroke patients [9]. Other studies have suggested that highintensity statins after thrombolysis may increase the risk of bleeding in ischaemic stroke patients [10, 11]. These findings further raise doubts about the safety of intravenous thrombolysis combined with statins. It is speculated that reducing the dose of statins may improve the risk of bleeding in stroke patients undergoing thrombolysis
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