Atorvastatin (ATO) has the chemical formula of (C33H35FN2O5) and chemical structure displayed in Figure 1, belongs to the subgroup of statins. ATO is the most widely used statin drug that lowers plasma lipoprotein and cholesterol levels. Statins are cholesterol-lowering drugs due to 3-hydroxy-3-methylglutaryl-CoA reductase, which inhibits cholesterol biosynthesis in the liver . The ATO properties can be examined in terms of pharmacokinetic, in relation to solubility with lipophilic properties, in relation to the food effect with reduced bioavailability, 98% with protein binding (%), in relation to CYP450 metabolism, isoenzyme with 3A4 and renal excretion (%) was less than 5. ATO is responsible for the cholesterol synthesis and prevents the production of mevalonic acid .
ATO is one of the cholesterol-lowering drugs that can also reduce hematoma volume (HV) . It has been used to reduce cholesterol and other types of fats and also plays an effective and beneficial role in improving laboratory parameters in chronic patients [4-6]. If a suitable and practical drug is used to improve patients' laboratory parameters, on the one hand, it can help improve the patient's condition, and on the other hand, it can decline many complications of the disease and additional treatment costs [3,7].
One of the types of injuries is head trauma, which is one of the most common reasons for referrals to the emergency department. In many cases, the patient needs emergency care and diagnostic tests should be requested upon referral and immediately after the clinical examination in most cases [8,9]. The head traumas may lead to various complications, such as subdural hematoma and epidural hematoma, both of which have many destructive effects on the clinical condition of patients. Identification of hematoma type can be effective in the source of bleeding, associated lesions, type of treatment, clinical course, and prognosis [10-12].
Subdural hematoma is one of the most problems related to neurological diseases, especially head trauma, which increases with age. In fact, this type of hematoma is considered as the most treatable cause of death and disability in traumatic brain injury patients, which can lead to increase intracranial pressure, neurological disorders, and loss of consciousness [13-15]. Other symptoms of these patients include dizziness, loss of consciousness, headache, and seizures, each of which, if not prevented or treated, can lead to more serious and dangerous complications .
To treat this complication, various surgical and pharmacological methods have been suggested. The goal of surgical treatment is to remove pressure from the brain hemisphere and prevent the recurrence of chronic subdural hematomas (cSDH) . The surgical methods used to treat this disease may be invasive or less invasive, with less invasive methods having fewer complications. Among the surgical methods used to treat hematoma include skull perforation and hematoma drainage with or without catheter placement, closed perforation of the skull, drainage of the hematoma with an endoscope, and subdural-peritoneal (SP) shunting [18-20]. Pharmacological treatments include tranexamic acid [21,22], prednisolone , and atorvastatin [24,25].
Considering the importance of pharmacological treatments in improving the patient condition, the aim of the present study was to evaluate the ATO effect on CSDH status.
According to PARISMA checklist , in this systematic review (SR) study, all articles about the ATO effect on CSDH status were included in a study, without time constraints, by two authors who were professional in SR articles. Persian and English keywords were used to the search process in domestic databases and only English keywords in the case of foreign databases using Google Scholar browser.
Inclusion criteria consisted of the availability of all articles entitled the ATO effect on CSHD in patients and the availability of studies in the human population. Exclusion criteria also included case-report and retracted articles or ones which had incomplete data.
Articles were evaluated using a checklist including questions about demographic variables (author name, year of publication, length of study period, and study population), study method (sample size, drug type and dose, and follow-up time), and also the research findings (the ATO effect on HV). Data were reported qualitatively using Excel 2007 software.
In the initial search, 176 articles were found, of which 73 articles were deleted due to duplicate records, and after further review and removal of unrelated articles, this number reached 11 articles, and systematic review data was reported with 11 articles (Figure 2).
In all articles, radiological clinical findings were used to diagnose hematoma.
Chronic subdural hematoma
In most of the reviewed articles, atorvastatin was effective in reducing subdural hemorrhage, while in the study of Wei et al. , this drug had no effect on reducing HV of the patients (Table 1).
Demographic status of articles
The articles ranged from 2014 to 2021, the total sample size was 1278 patients and the follow-up period varied from 2 months to 4 years.
Interventions by the medical staff can improve the health of patients[43, 44]. Pharmacological and non-pharmacological interventions are effective in measures related to health promotion and can be a good guide for the treatment team [37,38]. The aim of the present study was to evaluate the effect of ATO on CSDH status. There have been many studies on the effect of drugs on CSDH status. In the present study, we initially compare the ATO effect on CSDH status in patients, and then discuss other HV-reducing drugs in CSDH patients.
According to the findings of most of the reviewed articles, ATO reduced HV levels in patients. Various review studies have been conducted in this field. In this regard, He et al. reviewed 6 articles on the ATO effect on CSDH status of 759 patients between 2016 and 2018. They found that ATO improves neurological function and reduces CSDH . Similarly, Wang et al. reviewed 12 articles on the effect of drugs (dexamethasone, atorvastatin, Goreisan, and prednisolone) on the CSDH status between 2014 and 2021. They found that ATO and tranexamic acid drugs reduced HV levels . In another SR study, Qiu et al. reviewed three articles on the ATO effect on CSDH status of 156 patients between 2014 and 2017. They reported that ATO can lead to a decrease in patients' HV level . Results of this SR study, in which reviewed 10 articles between 2014 and 2022, also revealed ATO reduced HV levels in most articles, which is consistent with the results of the studies mentioned above.
Holl et al. also reviewed seven articles on effect of corticosteroids on CSDH status of 1119 patients between 2007 and 2019. According to the findings, corticosteroid drugs reduced HV in CSDH patients . Other relevant studies include the study by Yao et al. that reviewed five articles on dexamethasone effect on CSDH status between 2001 and 2015. They found that dexamethasone reduced HV status in CSDH patients . The findings of the present study are consistent with other studies and show the effect of drug therapy on reducing HV status in CSDH patients.
Considering the ATO effect in reducing HV status in CSDH patients, it is recommended to prescribe this drug to improve HV levels.
The authors are grateful to Ilam University of Medical Sciences, Ilam, Iran.
Authors' Contribution: MH and KK contributed to all stages of the study, including conceptualization, data collection, data analysis, and manuscript writing.
Conflict of Interests: The authors declare no conflict of interest.
Ethical Approval: All participants signed informed consent.
Funding/Support: Ilam University of Medical Sciences, Ilam, Iran supported this study.
HV: hematoma volume
PARISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Masoud Hatefi: https://www.orcid.org/0000-0002-1529-2419
Khalil Komlakh: https://www.orcid.org/0000-0002-8291-5540
How to cite this article: Masoud Hatefi, Khalil Komlakh*. The effect of Atorvastatin on chronic subdural hematoma status: A systematic review of drug therapy. Eurasian Chemical Communications, 2022, 4(11), 1130-1137. Link: http://www.echemcom.com/article_153004.html
Copyright © 2022 by SPC (Sami Publishing Company) + is an open access article distributed under the Creative Commons Attribution License(CC BY) license (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.