­­Statins in the perioperative period

Abstract

In this review, we discuss clinical evidence-based data regarding the potential benefit of statin therapy in the perioperative period of non-cardiac surgery. Results from meta-analyses of prospective observational studies have provided conflicting evidence. Moreover, comparison among studies is complicated by varying data sources, outcome definitions, types of surgery, and preoperative versus perioperative statin therapy. However, results of two recent large prospective cohort studies showed that statin use on the day of or the day after non-cardiac surgery (or both) is associated with lower 30-day all-cause mortality and reduction in a variety of postoperative complications, predominantly cardiac, compared with non-use during this period. There is a paucity of data from randomized controlled trials assessing the benefit of statin therapy in non-cardiac surgery. No randomized controlled trials have shown that initiating a statin in statin-naïve patients may reduce the risk of cardiovascular complications in non-cardiac surgeries. One randomized clinical trial demonstrated that the use of a preoperative statin in patients with stable coronary heart disease treated with long-term statin therapy had a significant reduction in the incidence of myocardial necrosis and major adverse cardiovascular events after non-cardiac surgery. In conclusion, it is important that all health-care professionals involved in the care of the surgical patient emphasize the need to resume statin therapy, particularly in patients with established atherosclerotic cardiovascular disease. However, initiating a statin in statin-naïve patients undergoing non-cardiac surgery needs more evidence-based data.

Shrinking Weibel‐Palade bodies prevents high platelet recruitment in assays using thrombotic thrombocytopenic purpura plasma

“…Among the potential advantages of this particular drug is that statins are considered safe and their effect on WPBs (at least in vitro) is fast (24 hours), compared to their effects in reducing cholesterol levels, which require significantly longer to stabilize 36 . Indeed, statins have been successfully exploited perioperatively 20,37,38 . These in vitro proof‐of‐principle studies using an experimental model provide a foundation from which the concept could be expanded to in vivo models and then to clinical trials.…”

Current Concepts in the Prevention of Perioperative Myocardial Injury

“…The randomized prospective LOAD (Lowering the risk of Operative complications using Atorvastatin loading Dose) trial also failed to show a reduction in major cardiovascular complications when a short-term course of atorvastatin was initiated in statin-naïve patients undergoing non-cardiac surgery [6]. Initiating statins in statin-naïve patients undergoing non-cardiac surgery needs to be evaluated with further trials [59]. This failure of atorvastatin to reduce cardiovascular events in the LOAD trial is not really surprising, given that most perioperative MI is precipitated by sympathetically mediated tachycardia from the stress response to surgery rather than by plaque instability [1].…”

Effect of lipid-lowering medications in patients with coronary artery bypass grafting surgery outcomes

“…Statin use has also been shown to reduce mortality and shorten the length of hospital stay (LOS) in the same patient population [ 14 – 16 ]. It has been suggested that surgical patients should resume statin therapy in the perioperative period, particularly patients with atherosclerotic cardiovascular disease [ 17 ]. The goal of this study was to evaluate the effects of perioperative lipid-lowering medications on the incidence of postoperative adverse events and improving both short- and long-term outcomes in patients undergoing CABG/CABG with other procedures.…”