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Liu H, Xu X. Effect of simvastatin in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis. Am J Emerg Med 2017; 35:1940-1945. [PMID: 28966073 DOI: 10.1016/j.ajem.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Simvastatin might be beneficial to the patients with aneurysmal subarachnoid hemorrhage. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of simvastatin for aneurysmal subarachnoid hemorrhage. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of simvastatin versus placebo on aneurysmal subarachnoid hemorrhage were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were delayed ischaemic deficit and delayed cerebral infarction. Meta-analysis was performed using the random-effect model. RESULTS Six RCTs involving 1053 patients were included in the meta-analysis. Overall, compared with control intervention, simvastatin intervention had no influence on delayed ischaemic deficit (RR=0.99; 95% CI=0.78 to 1.27; P=0.96), delayed cerebral infarction (RR=1.17; 95% CI=0.60 to 2.29; P=0.65), mRS≤2 (RR=0.97; 95% CI=0.87 to 1.09; P=0.61), vasospasm (RR=0.79; 95% CI=0.49 to 1.29; P=0.35), ICU stay (Std. mean difference=0.04; 95% CI=-0.54 to 0.63; P=0.88), hospital stay (Std. mean difference=0.01; 95% CI=-0.13 to 0.14; P=0.90) and mortality (RR=0.71; 95% CI=0.25 to 2.05; P=0.53) after aneurysmal subarachnoid hemorrhage. CONCLUSIONS Compared to control intervention, simvastatin intervention was found to have no influence on delayed ischaemic deficit, delayed cerebral infarction, mRS≤2, vasospasm, ICU stay, hospital stay, and mortality in patients with acute aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Hongju Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiaoli Xu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China.
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Wong GKC, Chan DYC, Siu DYW, Zee BCY, Poon WS, Chan MTV, Gin T, Leung M. High-dose simvastatin for aneurysmal subarachnoid hemorrhage: multicenter randomized controlled double-blinded clinical trial. Stroke 2014; 46:382-8. [PMID: 25516195 DOI: 10.1161/strokeaha.114.007006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Experimental evidence has indicated the benefits of simvastatin for the treatment of subarachnoid hemorrhage. Two randomized placebo-controlled pilot trials that used the highest clinically approved dose of simvastatin (80 mg daily) gave positive results despite the fact that a lower dose of simvastatin (40 mg daily) did not improve clinical outcomes. We hypothesized that a high dose of 80 mg of simvastatin daily for 3 weeks would reduce the incidence of delayed ischemic deficits after subarachnoid hemorrhage compared with a lower dose (40 mg of simvastatin daily) and lead to improved clinical outcomes. METHODS The study design was a randomized controlled double-blinded clinical trial. Patients with aneurysmal subarachnoid hemorrhage (presenting within 96 hours of the ictus) from 6 neurosurgical centers were recruited for 3 years. The primary outcome measure was the presence of delayed ischemic deficits, and secondary outcome measures included a modified Rankin disability score at 3 months and an analysis of cost-effectiveness. RESULTS No difference was observed between the groups treated with the higher dose or the lower dose of simvastatin in the incidence of delayed ischemic deficits (27% versus 24%; odds ratio, 1.2; 95% confidence interval, 0.7-2.0; P=0.586) or in the rate of favorable outcomes (modified Rankin Scale score, 0-2) at 3 months (73% versus 72%; odds ratio, 1.1; 95% confidence interval, 0.6-1.9; P=0.770). CONCLUSIONS High-dose simvastatin treatment should not be prescribed routinely for aneurysmal subarachnoid hemorrhage. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01077206.
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Affiliation(s)
- George K C Wong
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.).
| | - David Y C Chan
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.)
| | - Deyond Y W Siu
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.)
| | - Benny C Y Zee
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.)
| | - Wai S Poon
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.)
| | - Matthew T V Chan
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.)
| | - Tony Gin
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.)
| | - Michael Leung
- From the Division of Neurosurgery (G.K.C.W., D.Y.C.C., W.S.P.), Department of Anaesthesia and Intensive Care (M.T.V.C., T.G.), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Department of Diagnostic Imaging, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.); and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (B.C.Y.Z., M.L.)
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