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Statins may help prevent VTE
Statin treatment appeared beneficial for protecting against venous thromboembolism, according to a meta-analysis published in The Lancet Haematology.
“Although pharmacological thromboprophylaxis agents are effective, they remain underused, because they are associated with increased risk of bleeding. Statins are … known to have pleiotropic effects on coagulation and inflammation, and do not increase the risk of bleeding,” Setor K. Kunutsor, PhD, of the musculoskeletal research unit at the School of Clinical Sciences at University of Bristol in the UK, and colleagues wrote. “Emerging evidence suggests that statins might be effective in reducing the incidence of VTE through these pleiotropic effects. Existing evidence shows that uncertainty about the effect of statins on VTE outcomes remains.”
The researchers performed a systemic review and meta-analysis of 13 cohort studies (n = 3,148,259) and 23 randomized controlled studies of statins compared with placebos or no treatment (n = 118,464). Kunutsor and colleagues reported a pooled RR of 0.75 for thromboembolism with statin use compared with no statin use in the observational studies (95% CI, 0.65-0.87), and an RR of 0.85 in the randomized trials (95% CI, 0.73-0.99). Rosuvastatin carried the lowest risk for VTE compared with other statins (RR = 0.57; 95% CI, 0.42-0.75).
Statin use significantly reduced the risk for specific endpoint of deep vein thrombosis compared with no statin use (RR = 0.7; 95% CI, 0.69-0.86).
“From a practical point of view, based on the available data, statins cannot replace anticoagulants in high-risk clinical situations in which thromboprophylaxis is recommended,” Anetta Undas, of the Institute of Cardiology at Jagiellonian University Medical College in Poland, wrote in an accompanying editorial. “Heparins should be used in most patients who require prevention of VTE,” Undas wrote.
The findings warranted further investigation, Undas wrote.
Larger studies of populations with varying VTE risk are needed to determine whether statins safely prevent arterial and VTE events and mortality.
“Given the rising number of patients taking statins on a long-term basis worldwide, one might speculate that even a small statin-associated reduction in the risk of VTE, without an elevated bleeding risk, is of vital importance in public health especially in elderly people.” – by Andy Polhamus
Disclosure: Kunutsor reports no relevant financial disclosures. Please see the study for a full list of all other researchers’ relevant financial disclosures. Undas reports no relevant financial disclosures.
Perspective
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Abdulraheem Yacoub
Deep venous thrombosis and venous thromboembolic (VTE) events continue to result in significant morbidity, mortality and health care cost in the modern era. VTE prevalence is increasing given the advancing age of the population, as well as a more frequent utilization of endovascular interventions. Therapeutic intervention that can result in reduced risk in VTE, without bleeding complications, can be of great contribution to the health of individual patients and be of significant advantage in health care economics.
The impact on VTE risk amelioration through therapy with statins — a group of medications that impact the lipid profile favorably and reduce cardiovascular risk through inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A reductase — has undergone extensive investigation and evaluations. Previous work conflicts and has not demonstrated consistent efficacy in prevention of VTE in patients receiving statins for cardiovascular indications.
In this well-designed meta-analaysis, Kunutsor and colleagues present the largest effort, to-date, by compiling many of the largest Interventional clinical trials addressing this issue. The meta-analysis identified 13 cohort studies that reported over 3,000,000 patients and 23 randomized trials comprising over 100,000 patients. Powered by the large number of subjects, the analysis identified a statistically significant risk-reduction of VTE in association with statin therapy. The hazard ratios were modest — 0.75 for cohort studies and 0.85 for randomized trials. These results are very intriguing and may fit into the growing body of evidence suggesting the physiologically favorable activity of statins in reduction for VTE.
It is challenging to carry those results forward to our current practices, as this modest VTE risk reduction might not be factored in the usual decision-making when starting a statin for lipid lowering and atherosclerotic risk reduction. Future prospective well-designed clinical trials might be needed to establish the role of statins in this niche.