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Physicians may do best not to advise statin use in patients with prior intracerebral hemorrhage
Westover M. Arch Neurol. 2011;doi:10.1001/archneurol.2010.356.
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A computer decision model has indicated that patients treated with stains who had a history of intracerebral hemorrhage, in particular lobar intracerebral hemorrhage, had a higher risk of recurrence.
The study, published online in the Archives of Neurology, utilized a Markov decision model to determine the risks and benefits of statins in patients with prior intracerebral hemorrhage (ICH). According to a press release, the simulated patients were assigned to states that correspond to disease risk and could then experience any combination of events that may lead to the increased risk for stroke or heart disease, change in quality of life or death.
In the case of lobar ICH in patients without previous CV events, the main outcome measure of quality-adjusted life-years was 2.2 years higher in those not taking statins vs. those who did. For patients with lobar ICH but without previous CV events, researchers reported that to favor statin therapy in MI, the annual recurrence risk would have to exceed 90%. Similarly, avoiding statin therapy in primary and secondary prevention settings for patients who had survived deep ICH was beneficial, although by a smaller margin.
“Mathematical decision analysis of the available data suggests that, because of the high risk of recurrent ICH in survivors of prior hemorrhagic stroke, even a small amplification of this risk by use of statins suffices to recommend that they should be avoided after ICH,” the researchers concluded. “In the absence of data from a randomized clinical trial (ideally comparing various agents and doses), the current model provides some guidance for clinicians facing this difficult decision.”
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