Abstract Background and aims The role of statin therapy following intracranial hemorrhage (ICH) remains controversial. Prior meta-analyses have yielded inconsistent findings, often failing to distinguish between statin initiation in statin-naïve patients versus resumption in prior users. We conducted a systematic review and meta-analysis to evaluate the effects of statin initiation and resumption separately on outcomes following ICH. Methods Following PRISMA guidelines (PROSPERO: CRD42023466282), we searched MEDLINE, EMBASE, and Cochrane Library through January 2025. Studies evaluating statin therapy in patients with ICH were included. Primary outcomes were all-cause mortality and functional outcomes (mRS 0-2). Secondary outcomes included recurrent ICH and ischemic stroke. Random-effects meta-analyses were performed with prespecified subgroup analyses by statin strategy and follow-up duration. Results Twenty-three studies (76,974 patients) were included. Any statin use was associated with reduced mortality (OR 0.48, 95% CI 0.35-0.66, p0.01). In separate analyses, statin initiation was associated with reduced mortality (OR 0.34, 95% CI 0.22-0.52, p0.01) and improved functional outcomes (OR 1.72, 95% CI 1.45-2.04, p0.01). Statin resumption was associated with reduced mortality (OR 0.83, 95% CI 0.73-0.94, p0.01) but not significantly associated with improved functional outcomes (OR 1.57, 95% CI 0.73-3.36, p=0.25). Statin initiation was also associated with reduced recurrent ICH risk (OR 0.78, 95% CI 0.65-0.93, p=0.005). Conclusions Statin therapy following ICH was associated with reduced mortality. Statin initiation was associated with both mortality reduction and improved functional outcomes, while statin resumption was associated with mortality reduction only. Randomized trials are needed to confirm these findings. Conflict of interest Archit Baskaran: nothing to disclose Sammy Allaw: nothing to disclose Rami Z Morsi: nothing to disclose Elena Goicoechea: nothing to disclose Osama Siddiqui: nothing to disclose Taraf Jaro: nothing to disclose Khalid Trad: nothing to disclose Shyam Patel: nothing to disclose Issam A. Awad: nothing to disclose Tareq Kass-Hout: nothing to disclose
Baskaran et al. (Fri,) studied this question.