Introduction/Purpose The safety and efficacy of statin therapy following intracranial hemorrhage (ICH) remain controversial, given inconsistent findings and variable clinical practices. This systematic review and meta‐analysis aimed to clarify the impact of statin initiation versus resumption after ICH on recurrent hemorrhage, mortality, and functional recovery, hypothesizing that initiation offers equal safety with potentially greater benefit than resumption. Materials/Methods Following PROSPERO registration, a structured search was conducted in MEDLINE, Cochrane Library, and EMBASE. Eligible studies examined statin resumption or initiation and associated outcomes post‐ICH. Seven reviewer teams screened 19,716 titles/abstracts and 63 full texts. Risk of bias was assessed using ROB2 for clinical trials and Newcastle‐Ottawa Scale for cohort studies. Certainty of evidence was evaluated using GRADE. Data pertaining to mortality, functional status, recurrent ICH, and stroke were extracted and meta‐analyzed. (Figure 1, Figure 2) Results From 23 studies, statin initiation following ICH yielded significant reductions in short‐term mortality (≤90 days) (OR: 0.15, CI: 0.11–0.20), and long‐term mortality (>90 days to 1 year) (OR: 0.45, CI: 0.33–0.61). Statin resumption demonstrated short‐term benefit (OR: 0.32, CI: 0.18–0.55) and long‐term benefit (OR: 0.65, CI: 0.46–0.92), though effects were less pronounced than with initiation. Functional independence at 90 days and recurrent ICH risk also favored statin therapy compared to control. GRADE assessments identified limitations due to study design heterogeneity and predominance of non‐randomized data. Conclusion Statin initiation and resumption after ICH may improve mortality and reduce recurrent hemorrhage, with statin initiation yielding greater effect size. While these data support cautious statin use in this patient population, further randomized trials are needed for confirmation and to define patient selection criteria. Graphics/Tables: Figure 1. Meta‐analysis summary: Statin resumption versus control for all‐cause mortality and functional independence. Figure 2. Meta‐analysis summary: Statin initiation versus control for all‐cause mortality, recurrent ICH, and functional outcomes. image image
Baskaran et al. (Sat,) studied this question.
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