Outcomes from intracerebral hemorrhage among patients pre-treated with statins / Prognóstico da hemorragia intracerebral em pacientes previamente tratados com estatinas

ABSTRACT

OBJECTIVE: 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been associated with improved clinical outcomes after ischemic stroke and subarachnoid hemorrhage, but with an increased risk of incidental spontaneous intracerebral hemorrhage (ICH). We investigated whether the statin use before ICH, was associated with functional independence, 90 days after treatment. METHOD: We analyzed 124 consecutive ICH patients with 90-day outcome data who were enrolled in a prospective cohort study between 2006 and 2009. Eighty-three patients were included in this study. Among ICH survivors, univariate Cox regression models and Kaplan-Meier plots were used to determine subject characteristics that were associated with an increased risk of recurrence. Statin usage was determined through interviewing the patient at the time of ICH and confirmed by reviewing their medical records. Independent status was defined as Glasgow Outcome Scale grades 4 or 5. RESULTS: Statins were used by 20 out of 83 patients (24 percent) before ICH onset. There was no effect from pre-ICH statin use on functional independence rates (28 percent versus 29 percent, P=0.84) or mortality (46 percent versus 45 percent, P=0.93). CONCLUSION: Pre-ICH statin use is not associated with changes to ICH functional outcome or mortality.

RESUMO

OBJETIVO: Inibidores da 3-hydroxy-3-methylglutaryl coenzima A (HMG-CoA) redutase, ou estatinas, têm sido associados com melhora do prognóstico após eventos encefálicos isquêmicos e hemorragia subaracnóidea, mas com um aumento do risco de evento encefálico hemorrágico (AVEh). Nós investigamos se o uso de estatinas prévio ao sangramento é associado com independência funcional em 90 dias. MÉTODO: Analisamos 124 pacientes consecutivos com AVEh com 90 dias de seguimento, selecionando 83 para um estudo coorte prospectivo entre 2006 e 2009. O uso de estatinas foi determinado pela entrevista ao paciente no momento da entrada ao hospital e complementado pela revisão do prontuário. Foi definido como independência funcional um GOS (Glasgow Outcome Scale) 4 ou 5. RESULTADOS: Estatinas eram usadas por 20/83 (24 por cento) antes do AVEh. Não houve efeito benéfico do uso prévio ao AVEh de estatinas nas taxas de independência funcional (28 por cento versus 29 por cento, P=0,84) ou mortalidade (46 por cento versus 45 por cento, P=0,93). CONCLUSÃO: O uso de estatina pré-AVEh não é associado com melhora do prognóstico funcional ou taxa de mortalidade.