Statins Decrease the Occurrence of Venous Thromboembolism in Patients with Cancer

Khemasuwan, Danai; Divietro, Matthew; Tangdhanakanond, Kawin; Pomerantz, Sherry; Eiger, Glenn

doi:10.1016/j.amjmed.2009.05.025

Cited by 55 publications

(36 citation statements)

References 29 publications

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“…In this context, a retrospective, casecontrol study reviewing 740 consecutive patients with a diagnosis of solid organ tumor suggested for the first time that in cancer patients, the use of statins decreased the odds ratio (0.33) of developing venous thromboembolism (95% CI, 0.19 -0.57; p Յ 0.05) compared with nonstatin users (Khemasuwan et al, 2010). These preliminary data are encouraging but suffer from some limitations, so a prospective, randomized, placebo-controlled trial would provide further support and stronger evidence for this finding, making the statins a possible safe alternative anticoagulant medication to the commonly used warfarin for venous thromboembolism in cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological Actions of Statins: A Critical Appraisal in the Management of Cancer

Gazzerro

Proto²,

Gangemi³

et al. 2011

Pharmacol Rev

401

370

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Section: Discussionmentioning

confidence: 99%

Pharmacological Actions of Statins: A Critical Appraisal in the Management of Cancer

Gazzerro

Proto²,

Gangemi³

et al. 2011

Pharmacol Rev

401

370

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“…A comparison of simvastatin with atorvastatin showed that there were fewer occurrences of VTE with simvastatin compared with atorvastatin (7.7% in the simvastatin group and 8.5% in the atorvastatin group; P = 0.029). 30 Finally, a retrospective cohort study involving 289 patients with nephrotic syndrome also found that VTE was less common in statin (individual statin type not analyzed) users compared with patients not using statins (HR, 0.2; 95% CI, 0.1-0.7). 31 Collectively, observational studies suggest that statin use may be associated with VTE reduction, and that this effect may be similar for both provoked and unprovoked VTE, that benefits may be a class effect, and that higher doses may be more effective.…”

Section: Resultsmentioning

confidence: 99%

Statins for the Prevention of Venous Thromboembolism? A Narrative Review

2012

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Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a substantial public health problem. The majority of VTE events are associated with transient periods of heightened risk, such as prolonged hospitalization, undergoing major surgery, experiencing trauma or lower extremity immobility, use of oral contraceptives, or having active cancer. Although pharmacologic thromboprophylaxis agents (eg, unfractionated heparin, low-molecular-weight heparins, warfarin, and novel oral anticoagulants) are effective, they remain underused, with concerns about increased bleeding risk often cited as a reason. The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (ie, statins), although used primarily for lipid lowering and arterial thrombosis risk reduction, have pleiotrophic effects that affect coagulation and inflammation, and do not increase bleeding risk. There is emerging evidence to suggest that through these pleiotrophic effects, statins may be effective in reducing the incidence of VTE. This article summarizes the literature with regard to statins' effect on VTE and suggests that additional investigations are needed to assess a potential adjunctive role for primary VTE thromboprophylaxis.

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“…Another study used a case-control study design of 740 patients at a single medical center. Their results suggested a protective association with statin use, however, they were similarly limited in the number of events ( N = 16) in the statin user group as well as the general limitations of case-control studies [20]. …”

Section: Discussionmentioning

confidence: 99%

“…Tagalakis and colleagues evaluated statin use and recurrent VTE risk in a cohort ≥65 years of age with cancer and found a reduction in VTE risk associated with current statin use with further reduction with longer duration of treatment [27]. Similarly, a case-control study conducted in patients with cancer found the risk of cancer-associated VTE was 8% in those treated with statins compared to 21% in those without statin treatment [20]. …”

Section: Introductionmentioning

confidence: 99%

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

El-Refai

Black

Adams

et al. 2017

Thrombosis Research

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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.

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Statins Decrease the Occurrence of Venous Thromboembolism in Patients with Cancer

Cited by 55 publications

References 29 publications

Pharmacological Actions of Statins: A Critical Appraisal in the Management of Cancer

Pharmacological Actions of Statins: A Critical Appraisal in the Management of Cancer

Statins for the Prevention of Venous Thromboembolism? A Narrative Review

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

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