Effects of Simvastatin in Prevention of Vasospasm and Delayed Cerebral Ischemia in Nontraumatic Subarachnoid Hemorrhage (Preliminary Data)

Abstract

Introduction: Vasospasm is the main cause of death and cognitive deficits in patients with subarachnoid hemorrhage after rupture of the aneurysm(aSAH). Some trials have shown that statins in the acute phase of aSAH reduces the incidence, morbidity and mortality of cerebral vasospasm. Hypothesis: The purpose of this study is evaluate the potential of sinvastatin(SVT)as prevention against vasospasm. Methods: Was realized a prospective study, randomized, non-blind, with the use of 80mg of SVT(at night) in the first 72h of the beginning of bleeding, and the control group that didn't use SVT, for 21 days,between January to December 2008. Informed consent for all patients. CT scans was performed as control and another CT scan in patients with altered neurological signals. In the presence of changes suggestive of vasospasm or correlation in clinical and CT scans the patients were taken to cerebral arteriography exam followed by angioplasty procedure if necessary. Liver and renal function, LDL cholesterol evaluated weekly, and CK Total evaluated every 3day. Exclusion criteria: liver and renal disease, pregnant elevation of serum transaminases (3 times the value of normality), creatinine ≥ 2,5, rabdomyolysis or CK Total ≥1000U/L. Results: Were excluded 2 patients with bleeding more than 72hs. There was no significant change in the levels of CK total, renal or liver function. We included 21 patients, 11 in the SVT group and 9 in the control group. The mortality was 8 patients(38%), 6 patients in the control group and 2 of the SVT group. Vasospasm was confirmed by cerebral arteriography exam in 4 patients in the control group and 1 patient in the SVT group. All the patients who died had scale Fisher IV. Conclusions: The SVT at a dose of 80mg was effective in reducing the mortality (18,1% against 66%)compared to the group that did not use SVT, and also decrease the incidence of cerebral vasospasm despite the APACHEII higher in the group that used SVT(14,3 vs 10,7). Less morbidity in the SVT group with an average of scale of Glasgow 3,25 vs 2,1.