Statins and the risk of bleeding in patients taking dabigatran

Ho, Bo-Lin; Lin, Ya-Ju; Lin, Shing‐Jong; Chou, Ping-Song; Chen, Chuan-Mu; Lin, Ruey‐Tay; Hu, Han‐Hwa; Chao, A-Ching

doi:10.1111/ane.13077

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…Thereinafter, no such study was performed for sulphonylureas, glucagon-like peptide-1 agonists, DPP-4 inhibitors, sodium glucose co-transporter-2 inhibitors, and insulin. Additionally, very limited data on these possible interactions exist for drugs so frequently used for the treatment of T2D-related diseases and complications, such as angiotensin-converting enzyme inhibitors [59] and statins [60, 61]. Therefore, this is the first issue which remains open for future research.…”

Section: Unanswered Issues and Practical Considerations Regarding mentioning

confidence: 99%

Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation

Prídavková

Samoš

Bolek

et al. 2019

Journal of Diabetes Research

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Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.

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Section: Unanswered Issues and Practical Considerations Regarding mentioning

confidence: 99%

Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation

Prídavková

Samoš

Bolek

et al. 2019

Journal of Diabetes Research

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“…On the other hand, a nationwide study from Taiwan found reduced major bleeding events with concurrent use of atorvastatin and DOACs ( 16 ). Another prospective study also observed lower bleeding risk with dabigatran and statin use compared to dabigatran alone ( 28 ). Like the above two studies, our data further confirmed that decreased major bleeding risks were observed among DOAC users taking statins, regardless of the intensity.…”

Section: Discussionmentioning

confidence: 94%

Concurrent use of statins decreases major bleeding and intracerebral hemorrhage in non-valvular atrial fibrillation patients taking direct oral anticoagulants—A nationwide cohort study

Chang

Lee

et al. 2022

Front. Cardiovasc. Med.

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BackgroundStatins are frequently prescribed with direct oral anticoagulants (DOACs), and previous studies have raised concerns about the increased risk of intracerebral hemorrhage or other major bleeding in concurrent statins and DOACs use. The objective of this study is to evaluate the risk of major bleeding in non-valvular atrial fibrillation patients taking DOACs with or without statins.MethodsThis nationwide, retrospective cohort study used data from the Taiwan National Health Insurance Research Database, enrolled a total of 90,731 non-valvular atrial fibrillation patients receiving rivaroxaban, dabigatran, apixaban or edoxaban from January 1st, 2012 to December 31st, 2017. Major bleeding was defined as a hospitalization or emergency department visit with a primary diagnosis of intracerebral hemorrhage, gastrointestinal tract bleeding, urogenital tract bleeding, or other sites of bleeding. Adjusted incidence rate ratios (IRR) and differences of major bleeding between person-quarters of DOACs with or without statins were estimated using a Poisson regression and inverse probability of treatment weighting using the propensity score.Results50,854 (56.0%) of them were male with a mean age of 74.9 (SD, 10.4) years. Using DOACs without statins as a reference, the adjusted IRR for all major bleedings in concurrent use of DOACs and statins was 0.8 (95% CI 0.72–0.81). Lower major bleeding risk was seen in both low-to-moderate-intensity statins (IRR: 0.8, 95% CI 0.74–0.84) and high-intensity statins (IRR: 0.8, 95% CI 0.74–0.88). Concurrent use of DOACs and statins decreased the risk for intracerebral hemorrhage with an IRR of 0.8 (95% CI 0.66–0.93), and gastrointestinal tract bleeding with an IRR of 0.7 (95% CI 0.69–0.79). The protective effect of statins on intracerebral hemorrhage was observed only in female patients (IRR 0.67, 95% CI 0.51–0.89), but not in male patients (IRR 0.87, 95% CI 0.70–1.08).ConclusionsAmong non-valvular atrial fibrillation patients who were taking DOACs, concurrent use of statins decreased major bleeding risk, including intracerebral hemorrhage and gastrointestinal tract bleeding. Considering this and other cardioprotective effects, statins should be considered in all eligible patients prescribed with DOACs.

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“…Statin alone or in combination with other antiplatelets/anti-coagulants might increase the risk of bleeding including GI tract and ICH, as reported in some studies 24 – 27 . However, other studies reported the contradictory results 28 – 30 . In a recent review that investigated this issue in both randomized controlled trials and observational studies, no significant evidence to support the role of statin therapy in the increased risk of ICH was found 31 .…”

Section: Discussionmentioning

confidence: 95%

The risk of major bleeding event in patients with chronic kidney disease on pentoxifylline treatment

Fang

Chen

et al. 2021

Sci Rep

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Patients with chronic kidney diseases (CKD) are often treated with antiplatelets due to aberrant haemostasis. This study aimed to evaluate the bleeding risk with CKD patients undergoing pentoxifylline (PTX) treatment with/without aspirin. In this retrospective study, we used Taiwan’s National Health Insurance Research Database to identify PTX treated CKD patients. Patients undergoing PTX treatment after CKD diagnosis were PTX group. A 1:4 age, sex and aspirin used condition matched CKD patients non-using PTX were identified as controls. The outcome was major bleeding event (MBE: intracranial haemorrhage (ICH) and gastrointestinal tract bleeding) during 2-year follow-up period. Risk factors were estimated using Cox regression for overall and stratified analysis. The PTX group had higher MBE risk than controls (hazard ratio (HR) 1.19; 95% confidence interval (CI) 0.94–1.50). In stratified analysis, hyperlipidaemia was a significant risk factor (HR: 1.42; 95% CI 1.01–2.01) of MBE. A daily PTX dose larger than 800 mg, females, non-regular aspirin usage, and ischaemic stroke were risk factors for MBE in PTX group. When prescribing PTX in CKD patients, bleeding should be closely monitored, especially in those with daily dose more than 800 mg, aspirin users, and with a history of ischaemic stroke.

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Statins and the risk of bleeding in patients taking dabigatran

Cited by 9 publications

References 34 publications

Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation

Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation

Concurrent use of statins decreases major bleeding and intracerebral hemorrhage in non-valvular atrial fibrillation patients taking direct oral anticoagulants—A nationwide cohort study

The risk of major bleeding event in patients with chronic kidney disease on pentoxifylline treatment

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