Effect of statins on the risk of recurrent venous thromboembolism: A systematic review and meta-analysis

Ruihao Li; Manqiu Yuan; Shixiong Yu; Wenlong Fu; Wu Yu; Siying Ling; Jianming Sun; Yikuan Chen

doi:10.1016/j.phrs.2020.105413

Effect of statins on the risk of recurrent venous thromboembolism: A systematic review and meta-analysis

Pharmacol Res. 2021 Mar:165:105413. doi: 10.1016/j.phrs.2020.105413. Epub 2021 Jan 5.

Authors

Ruihao Li¹, Manqiu Yuan², Shixiong Yu¹, Wenlong Fu¹, Wu Yu¹, Siying Ling¹, Jianming Sun¹, Yikuan Chen³

Affiliations

¹ Department of Vascular Surgery, Second Affiliated Hospital of Chongqing Medical University, #74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
² Department of Laboratory Medicine, First Hospital of Lanzhou University, #1 Western Donggang Road, Chengguan District, Lanzhou, 730000, China.
³ Department of Vascular Surgery, Second Affiliated Hospital of Chongqing Medical University, #74 Linjiang Road, Yuzhong District, Chongqing, 400010, China. Electronic address: 1737962164@qq.com.

PMID: 33412275
DOI: 10.1016/j.phrs.2020.105413

Abstract

Background: Recent studies have suggested that statins may be associated with a lower risk of recurrent venous thromboembolism (VTE).

Methods: We systematically searched PubMed, Web of Science and Cochrane Library from inception until May 2020 to identify any eligible studies that reported the association between statin use and the risk of recurrent VTE, and conducted a comprehensive systematic review and meta-analysis (PROSPERO registration number: CRD42020190169) on this matter.

Results: A total of 14 observational studies were included for qualitative review and 12 of them qualified for meta-analyses. The main meta-analysis found that statin use was associated with a lower risk of disease recurrence among patients with VTE (pooled adjusted HR: 0.76, 95% CI: 0.69-0.83), which was robust in sensitivity analyses and free of significant publication bias. Additionally, such association was present when restricting to periods after anticoagulation withdrawal (pooled adjusted HR: 0.78, 95% CI: 0.70-0.88) and when separately analyzing recurrent deep vein thrombosis (pooled adjusted HR: 0.71, 95% CI: 0.62-0.81) and recurrent pulmonary embolism (pooled adjusted HR: 0.80, 95% CI: 0.66-0.97; P = 0.027). Furthermore, statin use in patients with VTE was also found to be associated with a lower risk of all-cause mortality (adjusted HR: 0.65, 95% CI: 0.56-0.77), and possibly an even lower risk of bleeding (adjusted HR: 0.88, 95% CI: 0.73-1.07), albeit not statistically significant.

Conclusion: Statins have the potential to reduce recurrent events among patient with VTE. Randomized clinical trials to better explore the effect of statins in secondary prevention of VTE are warranted.

Keywords: Atorvastatin (PubChem CID: 60823); Fluvastatin (PubChem CID: 446155); Hydroxymethylglutaryl-CoA reductase inhibitors; Mortality; Pravastatin (PubChem CID: 54687); Pulmonary embolism; Rosuvastatin (PubChem CID: 446157); Simvastatin (PubChem CID: 54454); Venous thromboembolism; Venous thrombosis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
Pulmonary Embolism / chemically induced
Recurrence
Risk Factors
Venous Thromboembolism / chemically induced*
Venous Thrombosis / chemically induced

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors