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Combination of Thrombolysis and Statins in Acute Stroke Is Safe: Results of the STARS Randomized Trial (Stroke Treatment With Acute Reperfusion and Simvastatin).
Montaner, Joan; Bustamante, Alejandro; García-Matas, Silvia; Martínez-Zabaleta, Maite; Jiménez, Carmen; de la Torre, Javier; Rubio, Francisco R; Segura, Tomás; Masjuán, Jaime; Cánovas, David; Freijo, Mar; Delgado-Mederos, Raquel; Tejada, Javier; Lago, Aida; Bravo, Yolanda; Corbeto, Natália; Giralt, Dolors; Vives-Pastor, Bárbara; de Arce, Anna; Moniche, Francisco; Delgado, Pilar; Ribó, Marc.
Afiliação
  • Montaner J; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Bustamante A; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • García-Matas S; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Martínez-Zabaleta M; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Jiménez C; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • de la Torre J; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Rubio FR; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Segura T; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Masjuán J; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Cánovas D; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Freijo M; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Delgado-Mederos R; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Tejada J; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Lago A; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Bravo Y; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Corbeto N; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Giralt D; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Vives-Pastor B; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • de Arce A; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Moniche F; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Delgado P; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
  • Ribó M; From the Stroke Unit, Department of Neurology (J.M., M.R.), Neurovascular Research Laboratory, Institut de Recerca-Universitat Autónoma de Barcelona (J.M., A.B., N.C., D.G., P.D.), and Vall d' Hebron Institut d'Oncologia (S.G.-M.), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Neurovascular
Stroke ; 47(11): 2870-2873, 2016 11.
Article em En | MEDLINE | ID: mdl-27758944
ABSTRACT
BACKGROUND AND

PURPOSE:

The STARS trial (Stroke Treatment With Acute Reperfusion and Simvastatin) was conducted to demonstrate the efficacy and safety of simvastatin treatment in acute stroke.

METHODS:

STARS07 was a multicentre, phase IV, prospective, randomized, double-blind, placebo-controlled trial. Patients with Acute ischemic stroke recruited within 12 hours from symptom onset were randomized to oral simvastatin 40 mg or placebo, once daily for 90 days. Primary outcome was proportion of independent patients (modified Rankin Scale score of ≤2) at 90 days. Safety end points were hemorrhagic transformation, hemorrhagic events, death, infections, and serious adverse events.

RESULTS:

From April 2009 to March 2014, 104 patients were included. Fifty-five patients received intravenous tissue-type plasminogen activator. No differences were found between treatment arms regarding the primary outcome (adjusted odds ratio, 0.99 [0.35-2.78]; P=0.98). Concerning safety, no significant differences were found in the rate of hemorrhagic transformation of any type, nor symptomatic hemorrhagic transformation. There were no differences in other predefined safety outcomes. In post hoc analyses, for patients receiving tissue-type plasminogen activator, a favorable effect for simvastatin treatment was noted with higher proportion of patients experiencing major neurological recovery (adjusted odds ratio, 4.14 [1.18-14.4]; P=0.02).

CONCLUSIONS:

Simvastatin plus tissue-type plasminogen activator combination seems safe in acute stroke, with low rates of bleeding complications. Because of the low recruitment, the STARS trial was underpowered to detect differences in simvastatin efficacy. CLINICAL TRIAL REGISTRATION URL http//www.clinicaltrials.gov. Unique identifier NCT01073007.
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Avaliação de Resultados em Cuidados de Saúde / Ativador de Plasminogênio Tecidual / Inibidores de Hidroximetilglutaril-CoA Redutases / Sinvastatina / Acidente Vascular Cerebral / Fibrinolíticos Tipo de estudo: Clinical_trials / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Ano de publicação: 2016 Tipo de documento: Article País de publicação: EEUU / ESTADOS UNIDOS / ESTADOS UNIDOS DA AMERICA / EUA / UNITED STATES / UNITED STATES OF AMERICA / US / USA
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Avaliação de Resultados em Cuidados de Saúde / Ativador de Plasminogênio Tecidual / Inibidores de Hidroximetilglutaril-CoA Redutases / Sinvastatina / Acidente Vascular Cerebral / Fibrinolíticos Tipo de estudo: Clinical_trials / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Ano de publicação: 2016 Tipo de documento: Article País de publicação: EEUU / ESTADOS UNIDOS / ESTADOS UNIDOS DA AMERICA / EUA / UNITED STATES / UNITED STATES OF AMERICA / US / USA