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Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial.

Publication ,  Journal Article
Lynch, JR; Wang, H; McGirt, MJ; Floyd, J; Friedman, AH; Coon, AL; Blessing, R; Alexander, MJ; Graffagnino, C; Warner, DS; Laskowitz, DT
Published in: Stroke
September 2005

BACKGROUND AND PURPOSE: Cerebral vasospasm remains a major source of morbidity after aneurysmal subarachnoid hemorrhage (SAH). We demonstrate that simvastatin reduces serum markers of brain injury and attenuates vasospasm after SAH. METHODS: Patients with angiographically documented aneurysmal SAH were randomized within 48 hours of symptom onset to receive either simvastatin (80 mg daily; n=19) or placebo (n=20) for 14 days. Plasma alanine aminotransferase, aspartate aminotransferase, and creatine phosphokinase were recorded weekly to evaluate laboratory evidence of hepatitis or myositis. Serum markers of brain injury were recorded daily. The primary end point of vasospasm was defined as clinical impression (delayed ischemic deficit not associated with rebleed, infection, or hydrocephalus) in the presence of > or =1 confirmatory radiographic test (angiography or transcranial Doppler demonstrating mean V(MCA) >160 m/sec). RESULTS: There were no significant differences in laboratory-defined transaminitis or myositis between groups. No patients developed clinical symptoms of myopathy or hepatitis. Plasma von Willebrand factor and S100beta were decreased 3 to 10 days after SAH (P<0.05) in patients receiving simvastatin versus placebo. Highest mean middle cerebral artery transcranial Doppler velocities were significantly lower in the simvastatin-treated group (103+/-41 versus 149+/-47; P<0.01). In addition, vasospasm was significantly reduced (P<0.05) in the simvastatin-treated group (5 of 19) compared with those who received placebo (12 of 20). CONCLUSIONS: The use of simvastatin as prophylaxis against delayed cerebral ischemia after aneurysmal SAH is a safe and well-tolerated intervention. Its use attenuates serum markers associated with brain injury and decreases the incidence of radiographic vasospasm and delayed ischemic deficit.

Duke Scholars

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

September 2005

Volume

36

Issue

9

Start / End Page

2024 / 2026

Location

United States

Related Subject Headings

  • Vasospasm, Intracranial
  • Vascular Diseases
  • Treatment Outcome
  • Time Factors
  • Subarachnoid Hemorrhage
  • Simvastatin
  • Pilot Projects
  • Neurology & Neurosurgery
  • Models, Statistical
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Lynch, J. R., Wang, H., McGirt, M. J., Floyd, J., Friedman, A. H., Coon, A. L., … Laskowitz, D. T. (2005). Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke, 36(9), 2024–2026. https://doi.org/10.1161/01.STR.0000177879.11607.10
Lynch, John R., Haichen Wang, Matthew J. McGirt, James Floyd, Allan H. Friedman, Alexander L. Coon, Robert Blessing, et al. “Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial.Stroke 36, no. 9 (September 2005): 2024–26. https://doi.org/10.1161/01.STR.0000177879.11607.10.
Lynch JR, Wang H, McGirt MJ, Floyd J, Friedman AH, Coon AL, et al. Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke. 2005 Sep;36(9):2024–6.
Lynch, John R., et al. “Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial.Stroke, vol. 36, no. 9, Sept. 2005, pp. 2024–26. Pubmed, doi:10.1161/01.STR.0000177879.11607.10.
Lynch JR, Wang H, McGirt MJ, Floyd J, Friedman AH, Coon AL, Blessing R, Alexander MJ, Graffagnino C, Warner DS, Laskowitz DT. Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke. 2005 Sep;36(9):2024–2026.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

September 2005

Volume

36

Issue

9

Start / End Page

2024 / 2026

Location

United States

Related Subject Headings

  • Vasospasm, Intracranial
  • Vascular Diseases
  • Treatment Outcome
  • Time Factors
  • Subarachnoid Hemorrhage
  • Simvastatin
  • Pilot Projects
  • Neurology & Neurosurgery
  • Models, Statistical
  • Middle Aged