Title:The Landscape of Randomized Clinical Trial Meta-analyses on Statins for
Aneurysmal Subarachnoid Hemorrhage: A Scoping Review
Volume: 23
Issue: 11
Author(s): Panagiotis Skouras, Theodosis Kalamatianos, Mariam Markouli, Angelos Karagiannis and Lampis C. Stavrinou*
Affiliation:
- 2nd Department of Neurosurgery,
Attikon Hospital, National and Kapodistrian University of Athens, Greece
Keywords:
Statins, aneurysmal subarachnoid hemorrhage, aSAH, cerebral vasospasm, delayed cerebral ischemia, delayed ischemic neurologic deficits.
Abstract:
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of non-traumatic
SAH that can have detrimental effects on the central nervous system, resulting in severe disability or
death.
Methods: Early nimodipine is currently the only strongly recommended pharmacological treatment
that has shown efficacy in improving neurological/functional outcomes in aSAH patients. Whether
statin treatment is of benefit to aSAH patients is an issue that has generated considerable interest and
debate. In the present scoping review, we mapped and analyzed the available literature on metaanalyses
of randomized clinical trials (RCTs) examining the effect of statins on aSAH. Seventeen
meta-analyses of RCTs, published between 2008 and 2023, were identified.
Results: Treatments in included meta-analyses were based on various regimens of simvastatin,
pravastatin, pitavastatin or atorvastatin for up to 21 days. Eleven of the included reports indicated
some beneficial effect of statin treatment, reducing rates of at least one of the following: cerebral
vasospasm, delayed cerebral ischemia/delayed ischemic neurologic deficit, mortality or functional/
neurological outcome. In contrast, six meta-analyses, showed no such effects.
Conclusion: The limitations reported by several meta-analyses, included low patient numbers or disproportionate
representation of patients from certain RCTs, differences in drug treatment, patient diagnostic
criteria and outcome evaluation between RCTs, as well as poor data quality or lack of RCTs
data. Knowledge of the reported limitations may aid the design of future clinical trials and/or their
meta-analyses.
