Statins and venous thromboembolism: do they represent a viable therapeutic agent?

INTRODUCTION: Venous thromboembolism (VTE) is an important cause of preventable morbidity and mortality. Though anticoagulants are effective in preventing VTE, they are associated with major bleeding risk. The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (known as statins), are well established for the primary and secondary prevention of cardiovascular disease via their lipid-lowering properties. Emerging evidence suggests that statins may play a role in the prevention of VTE, but the evidence has been uncertain. Areas covered: This review summarizes the available epidemiological and interventional evidence on the role of statins in VTE prevention; the postulated biologic mechanisms involved; outlines areas of outstanding uncertainty; and the implications for clinical practice. Expert commentary: The body of evidence indicates statins may also play a potential role in the primary and secondary prevention of VTE. Further evidence is however warranted. There is insufficient evidence to recommend the use of statins to replace anticoagulants in VTE prevention. However, guideline bodies should review the overall evidence and consider including statin therapy as an adjunct to anticoagulant therapy in VTE prevention in specific patient populations. Statin therapy instead of anticoagulants may be considered in patients who are not candidates for anticoagulant therapy and in some low VTE risk patients.