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document
Statin treatment withdrawal in ischemic stroke : a controlled randomized study . BACKGROUND Pretreatment with statins has been shown to reduce brain injury in cerebral ischemia . In this controlled randomized study , we investigated the influence of statin pretreatment and its withdrawal on the outcome of acute ischemic stroke patients . METHODS From 215 patients admitted within 24 hours of a hemispheric ischemic stroke , 89 patients on chronic statin treatment were randomly assigned either to statin withdrawal for the first 3 days after admission ( n = 46 ) or to immediately receive atorvastatin 20 mg/day ( n = 43 ) . The primary outcome event was death or dependency ( modified Rankin Scale [ mRS ] score > 2 ) at 3 months . Early neurologic deterioration ( END ) and infarct volume at days 4 to 7 were secondary outcome variables . In a secondary analysis , outcome variables were compared with the nonrandomized patients without previous statin therapy ( n = 126 ) . RESULTS Patients with statin withdrawal showed a higher frequency of mRS score > 2 at the end of follow-up ( 60.0 % vs 39.0 % ; p = 0.043 ) , END ( 65.2 % vs 20.9 % ; p < 0.0001 ) , and greater infarct volume ( 74 [ 45 , 126 ] vs 26 [ 12 , 70 ] mL ; p = 0.002 ) compared with the non-statin-withdrawal group . Statin withdrawal was associated with a 4.66 ( 1.46 to 14.91 ) -fold increase in the risk of death or dependency , a 8.67 ( 3.05 to 24.63 ) -fold increase in the risk of END , and an increase in mean infarct volume of 37.63 mL ( SE 10.01 ; p < 0.001 ) after adjusting for age and baseline stroke severity . Compared with patients without previous treatment with statins , statin withdrawal was associated with a 19.01 ( 1.96 to 184.09 ) -fold increase in the risk of END and an increase in mean infarct volume of 43.51 mL ( SE 21.91 ; p = 0.048 ) . CONCLUSION Statin withdrawal is associated with increased risk of death or dependency at 90 days . Hence , this treatment should be continued in the acute phase of ischemic stroke .
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Intervention_Pharmacological
Statin treatment
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Intervention_Pharmacological
statin pretreatment
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Intervention_Pharmacological
statin
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Intervention_Pharmacological
statin
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Intervention_Pharmacological
atorvastatin
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Intervention_Physical
Statin
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Outcome_Mortality
death
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Outcome_Physical
dependency
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Outcome_Physical
modified Rankin Scale [ mRS ]
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Outcome_Mental
Early neurologic deterioration ( END )
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Outcome_Physical
infarct volume
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Outcome_Physical
mRS score
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Outcome_Physical
infarct volume
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Outcome_Mortality
death
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Outcome_Physical
dependency
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Outcome_Mental
END
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Outcome_Physical
mean infarct volume
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Outcome_Mental
END
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Outcome_Physical
mean infarct volume