[Statins after intracerebral haemorrhage: is this safe?]

Epidemiological research suggests that there is an inverse relationship between serum cholesterol level and the occurrence of intracerebral haemorrhage (ICH). In the SPARCL (Stroke prevention by aggressive reduction in cholesterol levels) study in over 4000 patients who suffered stroke, ICH or TIA, the risk of ICH was found to be higher in the atorvastatin group than in the placebo group. In meta-analyses of large statin trials no increased risk of ICH was found, most likely as a consequence of a low absolute risk of ICH. Results of available studies indicate that the possibility that use of statins increases the risk of ICH cannot be excluded but that this is only of clinical relevance in patients with a history of ICH. Statins do not need to be terminated immediately in patients with ICH. At check-up following ICH, the decision to start or to continue statins should be made based on the risk to the patient of ischemic cardiovascular disease and the estimated risk of recurrent haemorrhage, depending on the type of haemorrhage.