Clinical effects of antiplatelet drugs and statins on D‐dimer levels

Abstract

BackgroundAcute pulmonary embolism may be ruled out by combining nonhigh clinical probability and a normal D‐dimer level. Both antiplatelet drugs and HMG‐CoA reductase inhibitors (statins) have been associated with effects on thrombus formation, potentially influencing D‐dimer levels in this setting, leading to a higher rate of false‐negative tests. Therefore, we determined whether D‐dimer levels in patients with suspected pulmonary embolism are affected by concomitant use of antiplatelet drugs and/or statins and evaluated whether the effect of antiplatelet drugs or statins might affect diagnostic accuracy.Materials and methodsWe performed a posthoc analysis in the YEARS diagnostic study, comparing age‐ and sex‐adjusted D‐dimer levels among users of antiplatelet drugs, statins and nonusers. We then reclassified patients within the YEARS algorithm by developing a model in which we adjusted D‐dimer cut‐offs for statin use and evaluated diagnostic accuracy.ResultsWe included 156 statins users, 147 antiplatelet drugs users and 726 nonusers of either drugs, all with suspected pulmonary embolism. Use of antiplatelet drugs did not have a significant effect, whereas statin use was associated with 15% decrease in D‐dimer levels (95% CI, −28% to −0.6%). An algorithm with lower D‐dimer thresholds in statin users yielded lower specificity (0.42 compared to 0.33) with no difference in false‐negative tests.ConclusionsWe conclude that use of statins but not of antiplatelet agents is associated with a modest decrease in D‐dimer levels. Adjusting D‐dimer cut‐offs for statin use did, however, not result in a safer diagnostic strategy in our cohort.

Statins as Adjuvant Therapy for COVID-19 to Calm the Stormy Immunothrombosis and Beyond

“…Then, understandably, the magnitude of an increased D-dimer level discloses the extent of thrombus formation and also predicts the clinical severity of any thrombotic complication associated with a disease, such as deep vein thrombosis ( Andreescu et al, 2002 ). In a study of patients with suspected pulmonary embolism (156 statin users and 147 antiplatelet drug users), statin use was associated with a modest 15% decrease in D-dimer levels (95% confidence interval [CI] −28 to −0.6%) whereas the use an antiplatelet drug (mainly acetylsalicylic acid and clopidogrel) had no significant effect ( Schol-Gelok et al, 2018 ). Similarly, in a cohort study including 6,814 male and female subjects without cardiovascular disease (aged 45 to 84 years), the D-dimer levels were found to be 9% lower in statin users than in non-users ( Adams et al, 2013 ).…”

A revised systematic review and meta‐analysis on the effect of statins on D‐dimer levels

“…In these algorithms, a normal Ddimer level in combination with a low clinical probability of thrombosis safely excludes VTE. 63 However, further validation in a larger prospective cohort is needed. 61,62 These cut-off levels have high sensitivity rates, and therefore, a false negative test in statin users is unlikely to occur.…”

“…In a recent retrospective post hoc analysis, adjusting D-dimer cut-offs for statin users did not result in a safer diagnostic strategy. 63 However, further validation in a larger prospective cohort is needed. It is important to note that there are main differences between our methodology and the systematic review and (2).…”

Familial hypercholesterolaemia and COVID-19: A two-hit scenario for endothelial dysfunction amenable to treatment

“…On the other hand, statins have been shown to decrease serum D-dimer levels. A study of patients with suspected pulmonary embolism showed that statin use associated with a modest 15% decrease in D-dimer levels, while the use of antiplatelet drugs had no significant effect [ 72 ]. In a large cohort study of patients without cardiovascular disease (N = 6814), the D-dimer levels were 9% lower in statin users than in statin non-users [ 73 ].…”