By Matthew E. Fink, MD
Feil Professor & Chair of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College
Dr. Fink reports no financial relationships relevant to this field of study.
SOURCE: Jiang R, Zhao S, Wang R, et al. Safety and efficacy of atorvastatin for chronic subdural hematoma in Chinese patients: A randomized clinical trial. JAMA Neurol 2018; Jul 30. doi: 10.1001/jamaneurology.2018.2030.
Chronic subdural hematoma is a common trauma-associated condition that often occurs in elderly people. Surgical evacuation is the treatment of choice, but often this is associated with recurring hemorrhages and poor outcomes. Nonsurgical treatments have not been proven effective. Researchers in China evaluated the effects of atorvastatin treatment on chronic subdural hematoma. In animal models, atorvastatin has been shown to produce significant anti-inflammatory effects as well as the ability to mobilize endothelial progenitor cells for vascular repair. This was a double-blind, randomized, controlled trial performed in multiple centers in China. The authors enrolled 200 patients and randomly assigned them to receive either 20 mg of atorvastatin or placebo daily for eight weeks; patients were followed for 24 weeks. The primary outcome was changing hematoma volume by CT scan after eight weeks of treatment. Secondary outcomes were neurological function assessed at four weeks, eight weeks,12 weeks, and 24 weeks. After eight weeks of treatment, hematoma volume in the treated group decreased by more than 12.55 mL (mean) compared to those taking placebo (P = 0.003). Forty-six percent of patients who were taking atorvastatin demonstrated significant improvement in neurological function compared to only 28% who were taking placebo. Eleven percent of patients taking atorvastatin and 23% of patients taking placebo eventually underwent surgery during the trial because of enlarging hematoma or deteriorating clinical condition.
This study suggests that atorvastatin may be a safe and effective nonsurgical alternative for patients with chronic subdural hematoma. Other investigators should repeat this trial using an international population to determine if the results can be reproduced and if the therapy will be effective in a broad and multiethnic population.