Atorvastatin for Chronic Subdural Hematoma: Efficacy, Predictors of Treatment Failure, and Prognosis

Objective: The aim of this study was to investigate the efficacy of atorvastatin in treating chronic subdural hematoma (CSDH), identify risk factors for treatment failure, assess complications, and evaluate prognosis. In addition, the study examined whether it is necessary to wait for the complete absorption of CSDH before discontinuing the medication. Methods: This study included 80 patients with CSDH who received atorvastatin treatment in the authors' department. Independent predictors of treatment failure were identified through univariate analysis, followed by a multivariable logistic regression model. A receiver operating characteristic (ROC) curve was generated to assess the specificity and sensitivity of the independent risk factors. In addition, the prognosis and complications associated with atorvastatin treatment were analyzed. Results: The effective rate of atorvastatin in treating CSDH was 72.5%. Aspirin use (OR: 16.730; 95% CI: 2.006–139.517; P = 0.009), hematoma volume before treatment (per 10 mL increase; OR: 1.309; 95% CI: 1.102–1.555; P = 0.002), acute bleeding in the hematoma cavity (OR: 15.572; 95% CI: 1.107–219.016; P = 0.042), increase in hematoma volume during the treatment process (OR: 6.837; 95% CI: 1.044–44.776; P = 0.045), and hyperdense hematoma (OR: 33.162; 95% CI: 2.254–487.838; P = 0.011) were independent risk factors for treatment failure with atorvastatin in CSDH. The cutoff value for hematoma volume before treatment was >118.52 mL. No recurrences were observed in either group during the 6-month follow-up. Two patients in the valid group developed spontaneous occipital hemorrhage during the treatment period. Conclusions: Atorvastatin shows promise as an alternative treatment for CSDH. Aspirin use, hematoma volume before treatment, acute bleeding in the hematoma cavity, increase in hematoma volume during the treatment process, and hyperdense hematomas are associated with increased treatment failure rates. The decision to use atorvastatin should be individualized based on patient-specific factors, with careful monitoring for potential complications.