Should statins be paused or discontinued after thrombolysis or acute intracerebral hemorrhage? No!

A 78-year-old male patient arrives at the emergency department 3 hours after sudden onset of aphasia and right-sided sensorimotor hemiparesis (National Institutes of Health Stroke Scale=8). There is a medical history of coronary artery disease, hypertension, and hyperlipidemia. Prior medication consists of 100 mg aspirin, 5 mg bisoprolol, and 40 mg simv-astatin. Initial blood glucose is 5.6 mmol/L and blood pressure is 150/90 mm Hg. Computed tomography does not reveal any pathology. Intravenous recombinant tissue-plasminogen acti-vator (rt-PA) is rapidly administered 225 minutes after symptom onset. There is uncertainty about how to proceed with preex-isting statin treatment in the acute setting of thrombolysis. Several studies linked statin treatment with an increased risk of intracerebral hemorrhage (ICH) after stroke, and additional studies recently indicated an increased risk for ICH after thrombolysis.