Effects of acute pravastatin treatment on intensity of rescue therapy, length of inpatient stay, and 6-month outcome in patients after aneurysmal subarachnoid hemorrhage

Background and Purpose - We have previously demonstrated that acute pravastatin therapy after aneurysmal subarachnoid hemorrhage ameliorates vasospasm-related delayed ischemic deficits. This study assesses the effects of pravastatin on the frequency and intensity for rescue therapy, length of inpatient stay, and long-term outcome at 6 months. Methods - Eighty aneurysmal subarachnoid hemorrhage patients ( age 18 to 84 years, onset 1.8 +/- 1.3 days) were randomized to receive daily oral pravastatin ( 40 mg) or placebo for up to 14 days. Clinical events were recorded during the trial. Six-month outcome was assessed using the Short Form 36 and the modified Rankin Scale. Results - Although no significant difference in the outcome at discharge was found between the trial groups, multivariate analysis showed pravastatin therapy reduced unfavorable outcome by 73% ( P=0.041). The benefit persisted at 6 months ( P=0.063) and was notable in the physical ( P=0.001) and psychosocial ( P<0.001) aspects measured using Short Form 36. Furthermore, the acute pravastatin therapy reduced the requirement for triple-H therapy ( hypertensive, hypervolemic, hemodilution; P=0.045) and mortality related to vasospasm ( P=0.02) and sepsis ( P=0.001); no significant difference was found in the length of inpatient stay between the trial groups. Conclusions - This trial demonstrates that acute statin treatment reduces traditional rescue therapy for vasospasm after aneurysmal subarachnoid hemorrhage. Improvement in early outcome has proved robust at 6 months, particularly in relation to physical and psychosocial ( Short Form 36) outcome.