A Randomized, Double-Blind, Placebo-Controlled Pilot Study of Simvastatin in Aneurysmal Subarachnoid Hemorrhage

• Published in: Stroke (1970) 2008-10, Vol.39 (10), p.2891-2893
• Main Authors: CHOU, Sherry H.-Y, SMITH, Eric E, BADJATIA, Neeraj, NOGUEIRA, Raul G, SIMS, John R, OGILVY, Christopher S, RORDORF, Guy A, AYATA, Cenk
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Double-Blind Method; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Medical sciences; Middle Aged; Muscle; Neurology; Pharmacology. Drug treatments; Pilot Projects; Simvastatin - therapeutic use; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - drug therapy; Vascular diseases and vascular malformations of the nervous system; Vasospasm, Intracranial - etiology; Vasospasm, Intracranial - prevention & control
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.107.505875

Studies suggest statins ameliorate aneurysmal subarachnoid hemorrhage (SAH)-induced cerebral vasospasm and ischemic complications. We tested safety and feasibility of simvastatin 80 mg/d for vasospasm prevention in SAH patients. Thirty-nine statin-naïve Fisher grade 3 SAH subjects were double-blind randomized to receive simvastatin 80 mg/d (n=19) or placebo (n=20), stratified by Hunt and Hess grade. Primary end points were death and drug morbidity. Mortality was 3/20 in the placebo and 0/19 in the simvastatin group. Study drug was withdrawn in 1 subject in each treatment group for reversible liver enzyme or creatine phosphokinase elevation. Angiographically-confirmed vasospasm occurred in 8/20 placebo and 5/19 simvastatin-treated subjects. Vasospasm-related ischemic infarcts developed in 5/20 placebo and 2/19 simvastatin-treated subjects. Simvastatin for the prevention of delayed cerebral ischemia is safe and feasible after SAH. A larger study is needed to test its efficacy.