A nonsurgical option for treating subdurals

There is yet another reason to add statins to the water, findings from a newly published study suggest

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Yet another reason to add statins to the water, findings from a newly published study suggest.

According to the double-blind trial, atorvastatin may be an effective nonsurgical alternative for treating patients chronic subdural haematoma. 

Almost 200 patients (median age 63.6 years) with a CT-diagnosed chronic subdural haematoma were randomised to either 20mg of atorvastatin daily or placebo, in the trial published in JAMA Neurology.

After eight weeks, the atorvastatin group had significant reduction in the volume of their haematomas, as well improved neurological function and quality of life compared with the placebo group. In fact, those patients taking atorvastatin were almost twice as likely to experience significant neurological improvement than those patients taking placebo. What’s more the benefit was still evident over a 16 week follow-up period.

In addition, atorvastatin appeared to protect against the need for surgery. While 11% of the atorvastatin patients needed surgery following a deterioration in their condition over the course of the study, this was less than half the percentage of patients taking placebo who needed surgery (23.5%).

On further analysis, the effectiveness of atorvastatin was found to be greater in patients 65 years and older and in patients with a haematoma of 30mL or more, but these findings needed to be validated in larger studies.

As for how it works, the study authors cite atorvastatin’s known ability to suppress local inflammation-induced vascular leakage thereby reducing the haematoma. It also promotes new blood vessel formation which would help improve neurological function.

With increasing life expectancy and the greater use of anticoagulation and antiplatelet medication, we can expect the incidence of chronic subdural haematomas to rise significantly worldwide, said the Chinese study authors.

“Surgery has long been the first choice for treating [chronic subdural haematomas], but it carries a considerable risk of complications and could be contradicted for patients who have mild symptoms, are at an advanced age, are taking long-term anticoagulation and/or antiplatelet medications, or are in poor physical health,” they said.

 Consequently, this study supporting the use of atorvastatin as a safe, effective, low-cost non-surgical option for treating this condition could have widespread clinical implications, but the findings needed to be validated in a phase III trial. 

The researchers also called further studies to determine the effectiveness of other statins in reducing chronic subdural haematomas and improving clinical outcomes.

JAMA Neurol. Published online July 30, 2018