BMC Clinical Pharmacology | |
The association between statin therapy during intensive care unit stay and the incidence of venous thromboembolism: a propensity score-adjusted analysis | |
Yaseen M Arabi1  Asgar H Rishu2  Haytham M Tlayjeh2  Hasan M Al-Dorzi1  Mohammad Khedr1  Shmeylan A Al Harbi3  | |
[1] College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, MC 1425, PO Box 22490, Riyadh 1426, Saudi Arabia;King Abdulaziz Medical City, Riyadh, Saudi Arabia;College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia | |
关键词: Statins; Propensity scores; Hospital mortality; Intensive care; Outcome assessment; Venous thromboembolism; | |
Others : 860503 DOI : 10.1186/2050-6511-14-57 |
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received in 2013-02-18, accepted in 2013-11-06, 发布年份 2013 | |
【 摘 要 】
Background
Studies have shown that statins have pleiotropic effects on inflammation and coagulation; which may affect the risk of developing venous thromboembolism (VTE). The objective of this study was to evaluate the association between statin therapy during intensive care unit (ICU) stay and the incidence of VTE in critically ill patients.
Methods
This was a post-hoc analysis of a prospective observational cohort study of patients admitted to the intensive care unit between July 2006 and January 2008 at a tertiary care medical center. The primary endpoint was the incidence of VTE during ICU stay up to 30 days. Secondary endpoint was overall 30-day hospital mortality. Propensity score was used to adjust for clinically and statistically relevant variables.
Results
Of the 798 patients included in the original study, 123 patients (15.4%) received statins during their ICU stay. Survival analysis for VTE risk showed that statin therapy was not associated with a reduction of VTE incidence (crude hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.28-1.54, P = 0.33 and adjusted HR 0.63, 95% CI 0.25-1.57, P = 0.33). Furthermore, survival analysis for hospital mortality showed that statin therapy was not associated with a reduction in hospital mortality (crude HR 1.26, 95% CI 0.95-1.68, P = 0.10 and adjusted HR 0.98, 95% CI 0.72-1.36, P = 0.94).
Conclusion
Our study showed no statistically significant association between statin therapy and VTE risk in critically ill patients. This question needs to be further studied in randomized control trials.
【 授权许可】
2013 Al Harbi et al.; licensee BioMed Central Ltd.
【 预 览 】
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【 参考文献 】
- [1]Cook DJ, Crowther MA: Thromboprophylaxis in the intensive care unit: focus on medical-surgical patients. Crit Care Med 2010, 38(2 Suppl):S76-S82.
- [2]Cook D, Crowther M, Meade M, Rabbat C, Griffith L, Schiff D, Geerts W, Guyatt G: Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med 2005, 33(7):1565-1571.
- [3]Naess IA, Christiansen SC, Romundstad P, Cannegieter SC, Rosendaal FR, Hammerstrom J: Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007, 5(4):692-699.
- [4]Rosendaal FR, Vanhv A, Doggen CJ: Venous thrombosis in the elderly. J Thromb Haemost 2007, 5(Suppl 1):310-317.
- [5]Undas A, Brummel-Ziedins KE, Mann KG: Statins and blood coagulation. Arterioscler Thromb Vasc Biol 2005, 25(2):287-294.
- [6]Reich LM, Folsom AR, Key NS, Boland LL, Heckbert SR, Rosamond WD, Cushman M: Prospective study of subclinical atherosclerosis as a risk factor for venous thromboembolism. J Thromb Haemost 2006, 4(9):1909-1913.
- [7]Huerta C, Johansson S, Wallander MA, Rodriguez LA: Risk of myocardial infarction and overall mortality in survivors of venous thromboembolism. Thromb J 2008, 6:10. BioMed Central Full Text
- [8]Linnemann B, Schindewolf M, Zgouras D, Erbe M, Jarosch-Preusche M, Lindhoff-Last E: Are patients with thrombophilia and previous venous thromboembolism at higher risk to arterial thrombosis? Thromb Res 2008, 121(6):743-750.
- [9]Braekkan SK, Mathiesen EB, Njolstad I, Wilsgaard T, Stormer J, Hansen JB: Family history of myocardial infarction is an independent risk factor for venous thromboembolism: the Tromso study. J Thromb Haemost 2008, 6(11):1851-1857.
- [10]Tsai AW, Cushman M, Rosamond WD, Heckbert SR, Polak JF, Folsom AR: Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002, 162(10):1182-1189.
- [11]Prandoni P, Ghirarduzzi A, Prins MH, Pengo V, Davidson BL, Sorensen H, Pesavento R, Iotti M, Casiglia E, Iliceto S, et al.: Venous thromboembolism and the risk of subsequent symptomatic atherosclerosis. J Thromb Haemost 2006, 4(9):1891-1896.
- [12]Arslan F, Pasterkamp G, de Kleijn DP: Unraveling pleiotropic effects of statins: bit by bit, a slow case with perspective. Circ Res 2008, 103(4):334-336.
- [13]Perez A, Bartholomew JR: Interpreting the JUPITER trial: statins can prevent VTE, but more study is needed. Cleve Clin J Med 2010, 77(3):191-194.
- [14]Herrington DM, Vittinghoff E, Lin F, Fong J, Harris F, Hunninghake D, Bittner V, Schrott HG, Blumenthal RS, Levy R: Statin therapy, cardiovascular events, and total mortality in the Heart and Estrogen/Progestin Replacement Study (HERS). Circulation 2002, 105(25):2962-2967.
- [15]Doggen CJ, Lemaitre RN, Smith NL, Heckbert SR, Psaty BM: HMG CoA reductase inhibitors and the risk of venous thrombosis among postmenopausal women. J Thromb Haemost 2004, 2(5):700-701.
- [16]Ray JG, Mamdani M, Tsuyuki RT, Anderson DR, Yeo EL, Laupacis A: Use of statins and the subsequent development of deep vein thrombosis. Arch Intern Med 2001, 161(11):1405-1410.
- [17]Glynn RJ, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, et al.: A randomized trial of rosuvastatin in the prevention of venous thromboembolism. N Engl J Med 2009, 360(18):1851-1861.
- [18]Yang CC, Jick SS, Jick H: Statins and the risk of idiopathic venous thromboembolism. Br J Clin Pharmacol 2002, 53(1):101-105.
- [19]Smeeth L, Douglas I, Hall AJ, Hubbard R, Evans S: Effect of statins on a wide range of health outcomes: a cohort study validated by comparison with randomized trials. Br J Clin Pharmacol 2009, 67(1):99-109.
- [20]Arabi Y, Alshimemeri A, Taher S: Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage. Crit Care Med 2006, 34(3):605-611.
- [21]Arabi YM, Khedr M, Dara SI, Dhar GS, Bhat SA, Tamim HM, Afesh LY: Intermittent pneumatic compression and not graduated compression stockings Are associated with lower incident venous thromboembolism in critically Ill patients: a multiple propensity scores adjusted analysis. Chest 2013, 144(1):152-159.
- [22]Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13(10):818-829.
- [23]Austin PC, Grootendorst P, Anderson GM: A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med 2007, 26(4):734-753.
- [24]Brookhart MA, Schneeweiss S, Rothman KJ, Glynn RJ, Avorn J, Sturmer T: Variable selection for propensity score models. Am J Epidemiol 2006, 163(12):1149-1156.
- [25]Lacut K, Oger E, Le Gal G, Couturaud F, Louis S, Leroyer C, Mottier D: Statins but not fibrates are associated with a reduced risk of venous thromboembolism: a hospital-based case–control study. Fundam Clin Pharmacol 2004, 18(4):477-482.
- [26]Sorensen HT, Horvath-Puho E, Sogaard KK, Christensen S, Johnsen SP, Thomsen RW, Prandoni P, Baron JA: Arterial cardiovascular events, statins, low-dose aspirin and subsequent risk of venous thromboembolism: a population-based case–control study. J Thromb Haemost 2009, 7(4):521-528.
- [27]Ramcharan AS, Van Stralen KJ, Snoep JD, Mantel-Teeuwisse AK, Rosendaal FR, Doggen CJ: HMG-CoA reductase inhibitors, other lipid-lowering medication, antiplatelet therapy, and the risk of venous thrombosis. J Thromb Haemost 2009, 7(4):514-520.
- [28]Agarwal V, Phung OJ, Tongbram V, Bhardwaj A, Coleman CI: Statin use and the prevention of venous thromboembolism: a meta-analysis. Int J Clin Pract 2010, 64(10):1375-1383.
- [29]Squizzato A, Galli M, Romualdi E, Dentali F, Kamphuisen PW, Guasti L, Venco A, Ageno W: Statins, fibrates, and venous thromboembolism: a meta-analysis. Eur Heart J 2010, 31(10):1248-1256.
- [30]Pai M, Evans NS, Shah SJ, Green D, Cook D, Crowther MA: Statins in the prevention of venous thromboembolism: a meta-analysis of observational studies. Thromb Res 2011, 128(5):422-430.
- [31]Zarchanski R, Lim W, Rocha M, McIntyre L, Lamontagne F, Dodek P, Pai M, Cooper D, Alhashemi J, Zytaruk N: 112: DO Statins Influence Dvt Risk in the Critically Ill Patients? Crit Care Med 2011, 39(12):22. doi:10.1097/1001.ccm.0000408627.0000424229.0000408688
- [32]Sud S, Mittmann N, Cook DJ, Geerts W, Chan B, Dodek P, Gould MK, Guyatt G, Arabi Y, Fowler RA: Screening and prevention of venous thromboembolism in critically ill patients: a decision analysis and economic evaluation. Am J Respir Crit Care Med 2011, 184(11):1289-1298.
- [33]Detecting the Impact of Statin Therapy on Lowering Risk of Venous Thrombo-Embolic Events (DISOLVE). NCT01524653. http://clinicaltrials.gov/ct2/show/NCT01524653 webcite. Accessed on January 12, 2013
- [34]Re-STOP DVT: Reload of high dose atorvastatin for preventing deep vein thrombosis in statin user. NCT01063426. http://clinicaltrials.gov/ct2/show/NCT01063426 webcite. Accessed January 12, 2013
- [35]Lowering the Risk of Operative Complications Using Atorvastatin Loading Dose (LOAD). NCT01543555. http://clinicaltrials.gov/ct2/show/NCT01543555 webcite. Accessed on January 12, 2013