Associations Between Statin And Symptomatic Intracranial Haemorrhage In Thrombolysis For Ischemic Stroke:A Meta-analysis

Background Stroke is a disease with high morbidity, mortality,80%-90% of the acute cerebral infarction for thrombus blockage caused by cerebral arteries, in the acute stage, the patient can recanalization occluded blood vessels as soon as possible, restore blood supply and its prognosis is closely related to the timely.Thrombolytic therapy for ischemic stroke is an effective treatment program, however, It will bring some complications such as intracranial hemorrhage, reperfusion injury, vascular occlusion again and so on, among them, the intracerebral haemorrhage after thrombolysis is the most dangerous. Statins have been widely applied in the primary and secondary prevention of ischemic stroke, it can reduce low-density lipoprotein (LDL) and cholesterol levels, improve endothelial function, oxidation resistance, inhibiting the inflammatory response and stable atheromatous plaque, affect blood clotting mechanism and other multiple functions. Previous published studies indicate that statin pretreatment can influence clinical outcomes for patients with ischemic stroke after thrombolytic therapy. However, the results are controversial.Objectives Through the meta-analysis evaluation of statins pretreatment and ischemic stroke patients after thrombolysis of symptomatic intracranial hemorrhage (SICH), the long-term outcome and the relationship with the mortality rate.Methods We systematically searched PUBMED and Embase before January 2015 for relevant studies, according to the inclusion and exclusion criteria, two researchers selected standard research literature independently. Preprocessing of statins in patients with and without pretreatment statins in patients, we focus on two results, the primary outcome of interest was SICH, and the secondary were favourable long-term outcome (mRS score<2) and mortality at 3 months for pretreatment statin users compared with non users. The Odds ratio (Odds Radio, OR) and 95% Confidence Interval (the Confidence Interval, CI) using a random effects model to calculate. Treatment for 3 months of brain function in patients with evaluation according to the modified Rankin scale (modified Rankin scale, mRS) score,0～2 is divided into brain function is good,3～6 points that brain function is poor.Results 4056 patients with ischemic stroke from 8 observational studies were included in our analysis. Pooled rate of SICH was significantly higher before discharge for pretreatment statin users than that of non users (odd ratios 1.78,95% CI 1.33-2.40; P< 0.001). At 3 months, favourable long-term outcome did not differ between the two groups (odd ratios 1.27,95% CI 0.84-1.93; p=0.256). Moreover, pretreatment statin users showed a relative higher mortality rate at 3 months than non users, but no significant difference was noted (odd ratios 1.32,95% CI 0.95-1.83;p=0.094).Conclusions Compared with non statin pretreatment, prior use of statins could be associated with higher SICH in thrombolysis for ischemic stroke. Due to the limited data, we could not draw conclusions about the exact impact of stains on favourable long-term outcome and mortality rate at 3 months. Further investigation is warrant.