Objective The present study was performed to explore the therapeutic potential 
of simvastatin in subarachnoid hemorrhage (SAH) in the context of the 
Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) trial. Methods 
MEDLINE, EMBASE, and the Cochrane Library were searched for all randomized 
controlled trials (RCTs) investigating the therapeutic effect of simvastatin on 
aneurysmal SAH. We applied a random-effects model to calculate the data. Results 
Five RCTs involving 951 patients met the eligibility criteria. We found no 
statistically significant effects on vasospasm detected by transcranial cerebral 
Doppler (relative risk [RR], 0.91; 95% confidence interval [CI], 0.55-1.49), 
delayed cerebral ischemia (DCI) (RR, 0.85; 95% CI, 0.63-1.14), or all-cause 
mortality (RR, 1.02; 95% CI, 0.67-1.54). Subgroup analysis showed that these 
consolidated results were stable at different doses, different times to start of 
treatment, and different courses of treatment in all included RCTs. Sensitivity 
analysis showed that the STASH trial, which had a large population, did not 
influence the consolidated results of all three outcomes. Conclusions 
Simvastatin showed no benefits in decreasing the incidence of vasospasm, DCI, or 
all-cause mortality after aneurysmal SAH. We conclude that patients with SAH 
should not be treated routinely with simvastatin during the acute stage.