Abstract DP284: Impact of Statin Initiation and Resumption Following Intracranial Hemorrhage (ICH): A Systematic Review and Meta-Analysis

Background: The use of statins following intracranial hemorrhage (ICH) is controversial. Previous studies have reported inconsistent effects on recurrent ICH, mortality, and functional recovery due to variability among clinicians. We performed a systematic review and meta-analysis of evidence on the safety and efficacy of statins after ICH, including subgroup analysis of resumption versus initiation, as prior research often does not distinguish between the two. We hypothesize that statin initiation is equally safe but potentially more efficacious than resumption, due to statins’ pleiotropic benefits in this population. Methods: A protocol was registered with PROSPERO (CRD42023466282). Searches used free-text and MeSH terms in MEDLINE (1946-2024), Cochrane Library (1996-2024), and EMBASE (1980-2024). Studies examining safety and efficacy of statin resumption or initiation post-ICH were included. Seven reviewer teams screened 19,716 titles/abstracts and 63 full-texts. Risk of bias was assessed by ROB2 for clinical trials and Newcastle-Ottawa Scale for cohort studies. GRADE analysis secondarily assessed certainty of key outcomes. Results: Twenty-three articles were included. For short-term mortality (≤90 days), statin initiation was associated with significant benefit (OR: 0.15, CI: 0.11-0.20, p<0.00001, I 2 =0%), and statin resumption also demonstrated benefit but to a lesser comparative extent (OR: 0.32, CI: 0.18–0.55, p<0.0001). For long-term mortality (>90 days to 1 year), statin initiation showed a reduction in long-term mortality with an OR of 0.45 (CI: 0.33-0.61, p<0.00001, I 2 =86%) and statin resumption also demonstrated benefit but to a lesser comparative extent (OR 0.65, CI: 0.46-0.92, p=0.0145). Discussion: Statin initiation and resumption post-ICH reduce short- and long-term mortality, with initiation showing more pronounced effects. GRADE analysis revealed low certainty due to limitations including predominance of non-randomized studies and heterogeneity. Conclusion: This meta-analysis provides evidence that statin therapy following ICH may reduce mortality and recurrent ICH risk, with more pronounced effects observed for statin initiation compared to statin resumption. Further research in the form of randomized controlled trials, such as that of the ongoing SATURN Trial, is needed to confirm these findings and optimize statin use in patients with ICH.