A Randomized Trial of Rosuvastatin in the Prevention of Venous Thromboembolism

Glynn, Robert J.; Danielson, Eleanor; Fonseca, Francisco A.H.; Genest, Jacques; Gotto, Antonio M.; Kastelein, John J.P.; Köenig, Wolfgang; Libby, Peter; Lorenzatti, Alberto; MacFadyen, Jean; Nordestgaard, Børge G.; Shepherd, James; Willerson, James T.; Ridker, Paul M.

doi:10.1056/nejmoa0900241

Cited by 659 publications

(400 citation statements)

References 41 publications

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“…Interestingly, lipid-lowering drugs seem to play a certain role in the development of VTE events, as the JUPITER trial showed a significant reduction in the occurrence of symptomatic VTE by the use of rosuvastatin compared to placebo in apparently healthy people [17]. Whether this effect is due to changes in lipid metabolism or to other mechanisms of action in hemostasis induced by statins remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Changes in Lipid Metabolism and Extension of Venous Thromboembolism

Belaj

Hackl²,

Rief³

et al. 2014

Ann Nutr Metab

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Background/Aims: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common diseases with a vast number of acquired and congenital risk factors. Disorders of the lipid metabolism are not established risk factors for venous thromboembolism (VTE) so far. However, in recent literature, associations between VTE and the metabolic syndrome, especially with elevated lipid parameters, have been described. The aim of our study was to investigate the association between the extension of VTE and changes in the lipid profile. Methods: We included 178 VTE patients in our study; 59 patients had isolated PE, 39 patients had isolated DVT of the leg and 80 patients had both (DVT and PE). Concerning PE, we distinguished between massive and submassive PE. We evaluated plasma lipids and lipoproteins in PE and DVT patients as well as in massive and submassive PE patients. Results: PE patients had higher levels of plasma triglycerides [median (interquartile range): 162 (109-254) vs. 136.5 (96.5-162) mg/dl, p = 0.047] and lower levels of high-density lipoprotein cholesterol (HDL-C; 52.1 ± 17.2 vs. 63.9 ± 22.7 mg/dl, p = 0.004) than DVT patients. Furthermore, PE patients were significantly older than DVT patients (59.6 ± 16.9 vs. 52.2 ± 15.5 years, p = 0.02). We were not able to find differences in lipid parameters in patients with massive PE compared to those with submassive PE. However, patients with massive PE were more obese than patients with submassive PE (body mass index 29.1 ± 4.6 vs. 26.9 ± 4.9, p = 0.012). Conclusions: Lipid parameters and lipoproteins differ between DVT and PE patients. PE patients had higher triglyceride and lower HDL-C levels compared with DVT patients.

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Section: Discussionmentioning

confidence: 99%

Changes in Lipid Metabolism and Extension of Venous Thromboembolism

Belaj

Hackl²,

Rief³

et al. 2014

Ann Nutr Metab

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“…1). Moreover, subclinical carotid atherosclerosis may also suggest a coexisting venous disorder among thalassemic patients because disease of either vascular bed is associated with contralateral cerebrovascular events and benefited by statin therapy [7,8,15,16]. …”

Section: Discussionmentioning

confidence: 99%

Premature Atherosclerosis in Non-Transfusion-Dependent β-Thalassemia Intermedia

Hahalis

Καλογερόπουλος

Terzis³

et al. 2011

Cardiology

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Objectives: β-Thalassemias are inherited hemolytic anemias with a broad phenotype and an increased rate of vascular complications despite a near absence of coronary artery disease. Methods: We investigated the presence of endothelial dysfunction and subclinical atherosclerosis in non-transfusion-dependent patients with β-thalassemia intermedia (β-TI) by means of flow-mediated (FMD) and flow-independent (FID) brachial artery dilatation and carotid artery intima-media thickness. Results: In 20 nondiabetic young adults with β-TI, FMD (6.6 ± 3.7 vs. 10.3 ± 3.1%; p = 0.002) and FID (14.0 ± 4.7 vs. 18.0 ± 5.6%; p = 0.02) were both lower relative to the values in 20 matched control subjects, whereas the intima-media thickness was increased (0.51 ± 0.09 vs. 0.46 ± 0.07 mm; p = 0.049). Fibrin generation, soluble endothelial activation markers, and proinflammatory proteins were higher in the patient group, while the plasma cholesterol level was lower. Conclusions: These findings indicate premature atherosclerosis among patients with β-TI; this is in accord with the high incidence of noncoronary vascular episodes in β-TI.

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“…Since the number of variables included in such analyses should be limited, we did not include established risk factors such as cancer, COPD, congestive heart failure, troponin or BNP in our analysis, since much larger studies have clearly demonstrated their impact on poor VTE outcome. In contrast to this, we decided to include established cardiovascular risk factors such as hyperlipidemia or diabetes in our risk factor assessment, since recent studies have indicated their impact on VTE [22][23][24]. Furthermore, given the demographic characteristics of our patients we suspected that the cardiovascular risk factors could have an impact on all-cause mortality.…”

Section: Outcome Event Rates and Risk Factorsmentioning

confidence: 99%

Outpatient or inpatient treatment for acute pulmonary embolism: a retrospective cohort study of 439 consecutive patients

Werth

Kamvissi

Stange

et al. 2014

J Thromb Thrombolysis

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Current guidelines consider outpatient treatment as an option for low-risk pulmonary embolism (PE), and risk assessment tools such as the HESTIA criteria can be used to identify PE patients who could feasibly be treated in an outpatient setting. Little is known about what proportion of patients in daily care this would comprise, and, in these patients, outcome data outside of clinical trials are scarce. To assess the proportion of PE patients receiving outpatient early discharge or in-hospital therapy, evaluate differences in patient characteristics between these subgroups and to assess clinical outcomes at 6 months. Monocentric, retrospective cohort study in 439 consecutive patients undergoing outpatient, early-discharge or in-hospital treatment for PE. Outcome data on recurrent VTE, pulmonary hypertension or death were collected from routine follow-up visits 6 months after VTE diagnosis. PE patients were treated as outpatient (OP; n = 49; 11.2 %); early-discharge (ED; n = 62; 14.1 %) or in-hospital (IH; n = 328; 74.7 %). Median duration of hospital stay in the ED and IH groups were 1 (IQR: 1) day and 9 (IQR: 7) days, respectively. Outcome event rates at 6 months were 3.9 % for recurrent VTE (95 % CI 2.3-6.1, similar between groups), 5.2 % for pulmonary hypertension (95 % CI 3.3-7.8, similar between groups) and 10.7 % for mortality (95 % CI 8.0-14.0). Mortality was significantly higher in IH patients (14.0 %; 95 % CI 10.5-18.3) compared to OP (0 %; 95 % CI 0.0-7.3) or ED (1.6 %; 95 % CI 0.0-8.7) patients. Mortality risk factors were high-risk ESC category (OR: 5.7), paraneoplastic VTE (OR: 3.0), need for oxygen supplementation (OR: 5.2), diabetes (OR: 2.5), age (OR per additional year: 1.1) and elevated INR (OR per 0.1 point increase: 1.5). No difference in the treatment groups for pulmonary hypertension during follow-up was found. Independent risk factors were thrombophilia (OR: 8.43), signs of right ventricular strain in baseline ECG (OR: 6.64) or echocardiography (RVESP > 40 mmHg OR: 2.99). 32 % of the OP or ED patients had at least one criterion of the HESTIA score that would have excluded them from outpatient treatment. In daily care, treating PE in an almost exclusively outpatient setting seems feasible and safe for up to 25 % of all PE patients. The HESTIA criteria seem to exclude up to 30 % of patients for whom outpatient or early-discharge treatment seems feasible and safe.

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A Randomized Trial of Rosuvastatin in the Prevention of Venous Thromboembolism

Cited by 659 publications

References 41 publications

Changes in Lipid Metabolism and Extension of Venous Thromboembolism

Changes in Lipid Metabolism and Extension of Venous Thromboembolism

Premature Atherosclerosis in Non-Transfusion-Dependent β-Thalassemia Intermedia

Outpatient or inpatient treatment for acute pulmonary embolism: a retrospective cohort study of 439 consecutive patients

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