Statin use and venous thromboembolism in cancer: A large, active comparator, propensity score matched cohort study

Abstract

Background Statins have been shown to have a protective effect for venous thromboembolism (VTE) in the general population. This study sought to assess the association between statins and the risk for cancer-associated deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods Patients with newly diagnosed cancer were followed for up to one year in a healthcare claims database (2010–2013). Three treatment groups included statin users, non-statin cholesterol lowering medication users, and an untreated group with pre-existing indications for statin therapy (hyperlipidemia, diabetes, or heart disease). Propensity score matched groups were compared using competing risks survival models for DVT and PE outcomes reporting the hazard ratios (HR) between the treatment groups. Sensitivity analyses assessed the influence of age and individual medications. Results The total cohort included 170,459 patients, which, after matching, were similar on baseline characteristics. The overall model showed a statistically significant protective effect for statins compared to no treatment attributed only to leukemia for DVT (HR = 0.77, 95% CI 0.61–0.99) and colorectal cancers for PE (HR = 0.80, 95% CI 0.64–0.99) in stratified analyses. There were generally no differences in outcomes between statins and non-statins and no individual statin use showed results different from the class effect. Conclusions In this propensity score matched sample of patients with cancer, statins were shown to have a small protective effect in some cancers for DVT or PE compared to no treatment and little difference compared to an active control group. The lack of effect was consistent across statins and was also not found for any of the sensitivity analyses included.

Effect of Statins on Survival Following Stroke in Patients With Cancer

“…Recently, the Heart and Estrogen/Progestin Replacement Study and a randomized rosuvastatin trial found that statins reduced the occurrence of venous thromboembolism in different populations ( 36 , 37 ). This finding was duplicated in studies with cancer patients, where statin use was associated with a lower prevalence of DVTs (3.5–8% in statin users versus 8–21% in non-users) ( 38 , 39 ) although neutral results also exist ( 40 ). To our knowledge, the effect of statin therapy on stroke outcome in cancer patients has not been studied and this study presents novel findings on this issue.…”

Dissolution of metastatic thymic carcinoma–associated right atrial thrombus with rivaroxaban

“…[26][27][28][29] Low-dose aspirin and statin can also be considered as they confer a marginally protective benefit in high-risk cancers presenting with VTE. [30][31][32] The patient was initiated upon rivaroxaban for a myriad of reasons, including local accessibility, track-record in the SELECT-D trial, and prior cardiovascular experience in left ventricular mural thrombus dissolution. 33 The recommended dosage was instituted in addition to low aspirin and statin therapy as the multidisciplinary team considered the patient to be an advanced oncologic patient, given the metastatic thymic carcinoma and Khorana score of 3 coupled with an intermediate risk of bleeding as per the HAS-BLED scoring system.…”

What Can We Learn About Drug Safety and Other Effects in the Era of Electronic Health Records and Big Data That We Would Not Be Able to Learn From Classic Epidemiology?

“…Large health care claims databases can be used to parse out drug effects and/or toxicities in specific patient populations due to the large numbers of people in the database. El-Refai et al 36 were able to show that statins protect against venous thromboembolism, not just in the general population but also in cancer patients.…”