Regarding Article “Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association”

HomeStrokeVol. 42, No. 2Regarding Article "Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBRegarding Article "Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association" Santiago Palacio, MD and Robert G. Hart, MD Santiago PalacioSantiago Palacio Department of Neurology University of Texas Health Science Center San Antonio, TX (Palacio,Hart) and Robert G. HartRobert G. Hart Department of Neurology University of Texas Health Science Center San Antonio, TX (Palacio,Hart) Originally published30 Dec 2010https://doi.org/10.1161/STROKEAHA.110.602474Stroke. 2011;42:e23Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2010: Previous Version 1 To the Editor:The recent American Heart Association Stroke Council guideline statement on the management of intracerebral hemorrhage includes the statement that "The recent Stroke Prevention with Aggressive Reductions in Cholesterol Levels (SPARCL) study found increased risk of subsequent ICH (unadjusted hazard ratio, 1.68; 95% confidence interval, 1.09 to 2.59) among subjects with prior stroke randomized to high-dose atorvastatin. It remains unclear whether this effect outweighs the benefits of statin treatment in reducing ischemic cardiac and cerebral events in ICH survivors."1Arguably, a more relevant estimate can be derived from the 93 SPARCL participants whose qualifying stroke was, in fact, an intracerebral hemorrhage. Although the number of recurrent strokes observed in this subgroup was small, the relative risk of recurrent intracerebral hemorrhage was 4.1 (Table).2,3 Because of the increase in recurrent intracerebral hemorrhage, total strokes were significantly increased among those assigned to atorvastatin (Table).Table. SPARCL Trial Results for Participants With Intracerebral Hemorrhage as Their Qualifying Stroke2Atorvastatin (n=45)Placebo (n=48)Hazard Ratio (95% CI)Ischemic strokes321.6 (0.3–9.8)Intracerebral bleeds724.1 (0.8–20)All strokes1042.8 (0.9–9.0)**Another calculation of the hazard ratio has also been published by the investigators: 3.2 (1.0–10), P=0.05.3Although certainly not definitive, these best available data support that high-dose statin therapy should probably be avoided in survivors of intracerebral hemorrhage unless there is a very compelling anticipated benefit on coronary events for an individual patient.Santiago Palacio, MDRobert G. Hart, MD Department of Neurology University of Texas Health Science Center San Antonio, TXDisclosuresNone.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. Include a completed copyright transfer agreement form (available online at http://stroke.ahajournals.org and http://submit-stroke.ahajournals.org). References 1. Morgenstern LB, Hemphill JC, Anderson C, Becker K, Broderick JP, Connolly ES, Greenberg SM, Huang JN, Macdonald RL, Messé SR, Mitchell PH, Selim M, Tamargo RJon behalf of the American Heart Association Stroke Council and Council on Cardiovascular Nursing. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010; 41:2108–2129.LinkGoogle Scholar2. Goldstein LB, Amarenco P, Szarek M, Callahan A, Hennerici M, Sillesen H, Zivin JA, Welch KMAon behalf of the SPARCL Investigators. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology. 2008; 70:2364–2370.CrossrefMedlineGoogle Scholar3. Amarenco P, Benavente O, Goldstein LB, Callahan A, Sillesen H, Hennerici M, Gilbert S, Rudolph AE, Simunovic L, Zivin JA, Welch KMAon behalf of the SPARCL Investigators. Results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial by stroke subtypes. Stroke. 2009; 40:1405–1409.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Abderezaei J, Martinez J, Terem I, Fabris G, Pionteck A, Yang Y, Holdsworth S, Nael K and Kurt M Amplified Flow Imaging (aFlow): A Novel MRI-Based Tool to Unravel the Coupled Dynamics Between the Human Brain and Cerebrovasculature, IEEE Transactions on Medical Imaging, 10.1109/TMI.2020.3012932, 39:12, (4113-4123) Lan X, Han X, Li Q, Li Q, Gao Y, Cheng T, Wan J, Zhu W and Wang J (2017) Pinocembrin protects hemorrhagic brain primarily by inhibiting toll-like receptor 4 and reducing M1 phenotype microglia, Brain, Behavior, and Immunity, 10.1016/j.bbi.2016.12.012, 61, (326-339), Online publication date: 1-Mar-2017. HUANG D, ANGUO L, YUE W, YIN L, TSE H and SIU C (2014) Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA 2 DS 2 -VASc Score of 1 , Pacing and Clinical Electrophysiology, 10.1111/pace.12445, 37:11, (1442-1447), Online publication date: 1-Nov-2014. February 2011Vol 42, Issue 2 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.110.602474PMID: 21193753 Originally publishedDecember 30, 2010 PDF download Advertisement