1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Statin Withdrawal After Acute Stroke

Patients who discontinued statins for 3 days after stroke were at increased risk for death or dependency 3 months later.

When patients with stroke are admitted to the hospital, their previous medications may be withheld — often for good reasons, but sometimes for no particular reason. In this study, Spanish researchers sought to determine whether withholding previously prescribed statins can be harmful.

Of 215 patients admitted with acute hemispheric ischemic stroke, 89 had been taking statins before the stroke. These 89 patients were randomized to continue statin therapy (atorvastatin, 20 mg daily for 3 days) or to interrupt therapy. Patients who were unable to swallow received the drug through nasogastric tubes. After 3 days, all patients received atorvastatin.

At 3 months, death or dependency was significantly more likely among patients who were withdrawn from statins than among those who continued statins (60% vs. 39%; P=0.04). In addition, neurologic deterioration during the first 48 hours after admission was more likely in the statin-withdrawal group.

Comment: The results of this small, nonblinded study suggest that we should continue statins without interruption in patients with acute ischemic stroke who took statins before the stroke. The authors attribute their findings to acute reversal of beneficial non–lipid-lowering effects of statins (e.g., improved endothelial function and anti-inflammatory and antithrombotic effects), with adverse rebound effects. Whether statins should be initiated immediately when statin-naive patients present with ischemic stroke warrants further investigation.

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 11, 2007

Citation(s):

Blanco M et al. Statin treatment withdrawal in ischemic stroke: A controlled randomized study. Neurology 2007 Aug 28; 69:904-10.

• Original article (Subscription may be required)
• Medline abstract (Free)