Statins for Treatment of Primary Intracerebral Hemorrhage

This study is a multicenter, prospective, randomized, open-label, blinded end-point (PROBE) clinical trial aimed at evaluating the efficacy and safety of atorvastatin in patients with spontaneous intracerebral hemorrhage (ICH). Eligible participants include adults aged 18 to 80 years presenting with spontaneous ICH who are enrolled within 3 to 24 hours from symptom onset or the last known well time, provided they meet all inclusion criteria and no exclusion criteria. A total of 264 patients will be randomized in a 1:1 ratio into two treatment arms: the control group, receiving best medical treatment (BMT) in accordance with current ICH guidelines, and the experimental group, receiving BMT plus atorvastatin at a dosage of 20 mg once daily for 21 consecutive days. The primary objective is to determine whether atorvastatin improves clinical outcomes in patients with ICH. The primary efficacy endpoint is the proportion of patients with a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 4 to 6.

Inclusion criteria

• Patients with a diagnosis of spontaneous intracerebral hemorrhage (ICH) confirmed by computed tomography (CT);
• Age 18-80 years;
• Hematoma located in the supratentorial region;
• Time from symptom onset or last known well to baseline CT ranging from 3 to 24 hours;
• Atorvastatin treatment can be initiated within 48 hours of symptom onset or last known well;
• Glasgow Coma Scale (GCS) score ≥9;
• Baseline hematoma volume of 5-35 mL;
• Signed informed consent obtained.

Exclusion criteria

• ICH secondary to trauma, tumor, aneurysm, arteriovenous malformation (AVM), vascular anomaly, hemorrhagic transformation of infarction, cerebral venous thrombosis, or anticoagulant-related ICH;
• Patients who have undergone or are scheduled for immediate surgical intervention;
• Pregnancy or lactation;
• Use of oral anticoagulants within 1 month prior to symptom onset;
• Pre-stroke mRS >1;
• Known allergy to statins, active liver disease, liver dysfunction, or rhabdomyolysis;
• Known terminal illness with a pre-stroke life expectancy of less than three months, or patients with planned withdrawal of care.