Statins and venous thromboembolism: a novel effect of statins?

Paraskevas, Kosmas I.; Bessias, Nikolaos; Perdikides, Theodossios; Mikhailidis, Dimitri P.

doi:10.1185/03007990903052591

Cited by 11 publications

(11 citation statements)

References 30 publications

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“…Statins are 3-hydroxy-3-methyl coenzyme-A reductase inhibitors, able to lower the risk of venous thrombosis in NS patients when compared with placebo. 82 The pleiotropic effects of statins could explain the underlying mechanism based on lipid lowering, anti-inflammatory effects, and coagulation cascade modulation. 83 As prevention of thromboembolic events, antiplatelet drugs are frequently administered in nephrotic patients, especially in those at a lower thrombotic risk.…”

Section: Management Of Thrombosismentioning

confidence: 99%

Thrombosis in Nephrotic Syndrome

Barbano

Gigante

Amoroso

et al. 2013

Semin Thromb Hemost

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Nephrotic syndrome (NS) is characterized by heavy proteinuria, edema, hypoalbuminemia, and hyperlipidemia and the most frequent causes are glomerular diseases. An uncommon presentation is iatrogenic NS, an adverse effect of some drugs administration. In the clinical course of NS, a typical feature is dysregulated coagulation state, promoted by the breakdown of permselectivity barrier of the glomerular capillary wall, resulting in the leakage of high-molecular-mass proteins, at least the size of albumin. This hypercoagulable condition is supported by several factors, such as abnormalities in platelet activation and an imbalance between anticoagulation/antithrombosis and procoagulant/prothrombotic mechanisms. Thus, NS and the risk of developing thromboses are strictly related. Thrombotic events affect the venous system rather than arterial vessels with different features and frequencies. Deep venous system of the lower extremities and renal veins are the most frequent source of pulmonary embolism, the most dangerous NS complication. Prophylactic anticoagulation and thrombosis treatment are not clearly established because large randomized trials and guidelines are lacking. The management of NS and the decision of when and how to anticoagulate the patient represent a teamwork challenge for physicians.

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Section: Management Of Thrombosismentioning

confidence: 99%

Thrombosis in Nephrotic Syndrome

Barbano

Gigante

Amoroso

et al. 2013

Semin Thromb Hemost

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“…Reviews of this trial and of recent case control studies [12,13] have renewed the debate on the efficacy of statins in the prevention of VTE and the call for analysis of prospective data. A meta-analysis suggested that statin treatment was likely to reduce the risk of VTE, however there was significant heterogeneity of study outcome [14], and as the majority of studies looked at middle-aged rather than elderly populations and there was no separate analysis by age, it was not certain that elderly people benefit.…”

Section: Introductionmentioning

confidence: 99%

Incident venous thromboembolic events in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER)

et al. 2011

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BackgroundVenous thromboembolic events (VTE), including deep venous thrombosis and pulmonary embolism, are common in older age. It has been suggested that statins might reduce the risk of VTE however positive results from studies of middle aged subjects may not be generalisable to elderly people. We aimed to determine the effect of pravastatin on incident VTE in older people; we also studied the impact of clinical and plasma risk variables.MethodsThis study was an analysis of incident VTE using data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER), a randomized, double-blind, placebo-controlled trial of pravastatin in men and women aged 70-82. Mean follow-up was 3.2 years. Risk for VTE was examined in non-warfarin treated pravastatin (n = 2834) and placebo (n = 2865) patients using a Cox's proportional hazard model, and the impact of other risk factors assessed in a multivariate forward stepwise regression analysis. Baseline clinical characteristics, blood biochemistry and hematology variables, plasma levels of lipids and lipoproteins, and plasma markers of inflammation and adiposity were compared. Plasma markers of thrombosis and hemostasis were assessed in a nested case (n = 48) control (n = 93) study where the cohort was those participants, not on warfarin, for whom data were available.ResultsThere were 28 definite cases (1.0%) of incident VTE in the pravastatin group recipients and 20 cases (0.70%) in placebo recipients. Pravastatin did not reduce VTE in PROSPER compared to placebo [unadjusted hazard ratio (95% confidence interval) 1.42 (0.80, 2.52) p = 0.23]. Higher body mass index (BMI) [1.09 (1.02, 1.15) p = 0.0075], country [Scotland vs Netherlands 4.26 (1.00, 18.21) p = 0.050 and Ireland vs Netherlands 6.16 (1.46, 26.00) p = 0.013], lower systolic blood pressure [1.35 (1.03, 1.75) p = 0.027] and lower baseline Mini Mental State Examination (MMSE) score [1.19 (1.01, 1.41) p = 0.034] were associated with an increased risk of VTE, however only BMI, country and systolic blood pressure remained significant on multivariate analysis. In a nested case control study of definite VTE, plasma Factor VIII levels were associated with VTE [1.52 (1.01, 2.28), p = 0.044]. However no other measure of thrombosis and haemostasis was associated with increased risk of VTE.ConclusionsPravastatin does not prevent VTE in elderly people at risk of vascular disease. Blood markers of haemostasis and inflammation are not strongly predictive of VTE in older age however BMI, country and lower systolic blood pressure are independently associated with VTE risk.Trial RegistrationNot applicable when study undertaken.

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“…[8][9][10][11][12][13] In the past few years, several studies 14 The protective effect of statins on CIN was later verified by the same group in a larger trial (n ¼ 29 409 patients). 15 Preprocedural statin treatment was associated with a lower incidence of CIN (4.37% vs 5.93%, P < .0001) and nephropathy requiring dialysis (0.32% vs 0.49%, P ¼ .03) compared with statin nonuse.…”

Section: Statins and Cinmentioning

confidence: 99%