• Jatinder S Minhas, Xia Wang, Hisatomi Arima, Philip M Bath, Laurent Billot, Joseph P Broderick, Geoffrey A Donnan, Jong S Kim, Pablo M Lavados, Tsong-Hai Lee, Martins Sheila Cristina Ouriques SCO Neurologia Vascular, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Braz, Verónica V Olavarría, Jeyaraj D Pandian, Octávio Marques Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K Sharma, Nguyen H Thang, Ji-Guang Wang, Mark Woodward, John Chalmers, Craig S Anderson, Thompson G Robinson, and ENCHANTED Investigators.
• Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
• Cerebrovasc. Dis. 2018 Jan 1; 45 (5-6): 213-220.

BackgroundDebate exists as to whether statin pretreatment confers an increased risk of 90-day mortality and symptomatic intracranial haemorrhage (sICH) in acute ischaemic stroke (AIS) patients treated with intravenous thrombolysis. We assessed the effects of undifferentiated lipid-lowering pretreatment on outcomes and interaction with low-dose versus standard-dose alteplase in a post hoc subgroup -analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study.MethodsIn all, 3,284 thrombolysis-eligible AIS patients (mean age 66.6 years; 38% women), with information on lipid-lowering pretreatment, were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 h of symptom onset. Of the total number of patients, 615 (19%) received statin or other lipid-lowering pretreatment. The primary clinical outcome was combined endpoint of death or disability (modified Rankin Scale scores 2-6) at 90 days.ResultsCompared with patients with no lipid-lowering pretreatment, those with lipid-lowering pretreatment were significantly older, more likely to be non-Asian and more likely to have a medical history including vascular co-morbidity. After propensity analysis assessment and adjustment for important baseline variables at the time of randomisation, as well as imbalances in management during the first 7 days of hospital admission, there were no significant differences in mortality (OR 0.85; 95% CI 0.58-1.25, p = 0.42), or in overall -90-day death and disability (OR 0.85, 95% CI 0.67-1.09, p = 0.19), despite a significant decrease in sICH among those with -lipid-lowering pretreatment according to the European Co-operative Acute Stroke Study 2 definition (OR 0.49, 95% CI 0.28-0.83, p = 0.009). No differences in key efficacy or safety outcomes were seen in patients with and without lipid-lowering pretreatment between low- and standard-dose alteplase arms.ConclusionsLipid-lowering pretreatment is not associated with adverse outcome in AIS patients treated with intravenous alteplase, whether assessed by 90-day death and disability or death alone.© 2018 S. Karger AG, Basel.

45 keywords...

hide…