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Bleeding Risk of Cerebral Cavernous Malformations in Patients on Statin and Antiplatelet Medication: A Cohort Study
Luca Lee Marques1, Christian Jaeggi2,3, Mattia Branca4
1Department of Neurosurgery, Kantonsspital St. Gallen, Sankt Gallen, Switzerland.
Insights
Antiplatelet medications, alone or with statins, reduce the risk of cerebral cavernous malformation (CCM) hemorrhage. Combined therapy showed a greater risk reduction than antiplatelet medication alone.
Area of Science:
- Neurology
- Vascular Medicine
- Pharmacology
Background:
- Cerebral cavernous malformations (CCMs) are vascular anomalies.
- Statin medication is a potential therapeutic target for CCM stabilization.
- Limited clinical data exist on statin use in CCM patients.
Purpose of the Study:
- To evaluate the risk of symptomatic CCM-related hemorrhage.
- To assess hemorrhage risk in patients using statin and/or antiplatelet medication.
- To analyze hemorrhage risk at diagnosis and during follow-up.
Main Methods:
- Retrospective analysis of a single-center CCM database over 41 years.
- Interrogation for symptomatic hemorrhage at diagnosis and follow-up.
- Assessment of statin and antiplatelet medication use.
Main Results:
- Antiplatelet medication (OR 0.26) and combined statin-antiplatelet therapy (OR 0.19) decreased hemorrhage risk at diagnosis.
- No follow-up hemorrhages occurred in patients on statin or combined therapy.
- Antiplatelet medication alone did not significantly reduce follow-up hemorrhage risk (HR 0.7).
Conclusions:
- Antiplatelet medication, alone or with statins, is associated with lower CCM hemorrhage risk at diagnosis.
- Combined statin-antiplatelet therapy demonstrated a potentially synergistic effect, exceeding the benefit of antiplatelet therapy alone.
- Antiplatelet medication alone was not linked to reduced follow-up hemorrhage risk.
Background:
Statin medication has been identified as a potential therapeutic target for stabilizing cerebral cavernous malformations (CCMs). Although increasing evidence suggests that antiplatelet medication decreases the risk of CCM hemorrhage, data on statin medication in clinical studies are scarce.
Objective:
To assess the risk of symptomatic CCM-related hemorrhage at presentation and during follow-up in patients on statin and antiplatelet medication.
Methods:
A single-center database containing patients harboring CCMs was retrospectively analyzed over 41 years and interrogated for symptomatic hemorrhage at diagnosis, during follow-up, and statin and antiplatelet medication.
Results:
In total, 212 of 933 CCMs (22.7%), harbored by 688 patients, presented with hemorrhage at diagnosis. Statin medication was not associated with a decreased risk of hemorrhage at diagnosis (odds ratio [OR] 0.63, CI 0.23-1.69, P = .355); antiplatelet medication (OR 0.26, CI 0.08-0.86, P = .028) and combined statin and antiplatelet medication (OR 0.19, CI 0.05-0.66; P = .009) showed a decreased risk. In the antiplatelet-only group, 2 (4.7%) of 43 CCMs developed follow-up hemorrhage during 137.1 lesion-years compared with 67 (9.5%) of 703 CCMs during 3228.1 lesion-years in the nonmedication group. No follow-up hemorrhages occurred in the statin and the combined statin and antiplatelet medication group. Antiplatelet medication was not associated with follow-up hemorrhage (hazard ratio [HR] 0.7, CI 0.16-3.05; P = .634).
Conclusion:
Antiplatelet medication alone and its combination with statins were associated with a lower risk of hemorrhage at CCM diagnosis. The risk reduction of combined statin and antiplatelet medication was greater than in patients receiving antiplatelet medication alone, indicating a possible synergistic effect. Antiplatelet medication alone was not associated with follow-up hemorrhage.
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