Statins May Reduce Need For Surgery in Chronic Subdural Hematoma

MedicalResearch.com Interview with:
Jianning Zhang MD, Ph.D Chairman, II, VII Chinese Medical Association of Neurosurgery President, Tianjin Medical University General Hospital, China  Jianning Zhang MD, Ph.D
Chairman, II, VII Chinese Medical Association of Neurosurgery
President, Tianjin Medical University General Hospital,
China  

MedicalResearch.com: What is the background for this study?

Response: The elderly population is growing dramatically world widely, especially in China. The incidence of chronic subdural hematoma has been rising over the past years. Although the surgery is not a difficult process, the risk of death and recurrence persist, and the affliction and economic expenditure of the patients are relatively higher in the elderly. For these reasons, it is urgent to develop novel pharmacological therapies with sufficient safety and efficacy. 

It has been known that the high expression of VEGF and inflammatory factors in chronic subdural hematoma can lead to abundant angiogenesis of immature vessels on the wall of hematoma. In our previous study, patients with chronic subdural hematoma have impaired ability to promote vascular maturation. For example, the number of endothelial progenitor cells in circulating blood is about 67% of the healthy individuals with similar age. 

Atorvastatin can mobilize endothelial progenitor cells to reduce inflammation. It increases the number of circulating endothelial cells that are inversely correlated with the volume of hematoma. We have demonstrated that atorvastatin can promote endothelial cell formation and reduce the leakage of endothelial cell barrier in vitro. Results from in vivo experiments in animal models of subdural hematoma suggest that atorvastatin can promote the maturation of blood vessels and reduce inflammation on the margin of hematoma, and thus improve the neurological outcome.

MedicalResearch.com: What are the main findings?

Response: We found that atorvastatin (20mg per day) can:

1) Promote the absorption of chronic subdural hematoma in Chinese patients;

2) Reduce the need for surgery that is caused by increased hematoma volume and/or neurological deterioration during pharmacological treatment;

3) This study has demonstrated the efficacy of atorvastatin as a pharmacological treatment for chronic subdural hematoma by randomized clinical trial (RCT). 

MedicalResearch.com: What should readers take away from your report?

  1. Daily atorvastatin (20mg) can promote the absorption of hematoma and improve neurological function.
  2. For patients with chronic subdural hematomas characterized by mild clinical symptoms, smaller hematoma and lower risk of cerebral hernia, daily treatment of 20 mg atorvastatin (standard treatment) is safe and effective.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

  1. To study the therapeutic efficacy of different doses and types of statins in chronic subdural hematoma, and further optimize the types and regime for statin treatment. 
  1. Statins may have limited efficacy to restrict inflammation. Therefore, combination of statins with other anti-inflammatory medications may be more effective.

MedicalResearch.com: Is there anything else you would like to add?

  1. Although there are no obvious adverse effects, a small number of patients have mild liver dysfunction.
  2. Due to the limitation of medical ethics, our regime is safe and effective for patients with MGS-GCS < 3.
  3. In some patients with smaller hematoma, spontaneous absorption of hematoma was observed without treatment. 

Citation:

Jiang R, Zhao S, Wang R, et al. Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese PatientsA Randomized ClinicalTrialJAMA Neurol. Published online July 30, 2018. doi:10.1001/jamaneurol.2018.2030 

Jul 30, 2018 @ 4:51 pm

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