Key result
Statins show insufficient evidence to support routine use alongside anticoagulation for VTE prevention.
Why the study?
Data on the impact and usefulness of statins during anticoagulation for VTE remain conflicting and under debate.
Does the addition of statins to anticoagulation therapy reduce VTE recurrence and mortality in patients with venous thromboembolism?
Does the addition of statins to anticoagulation therapy reduce VTE recurrence and mortality in patients with venous thromboembolism?
Statins should not substitute or routinely augment guideline-recommended VTE prophylaxis or anticoagulation treatment at this time, despite their potential pleiotropic antithrombotic benefits.
Current data do not support adding statins to anticoagulation for VTE; leaves open whether RCTs can resolve conflicting signals.
Venous thromboembolism (VTE) is the leading cause of morbidity and death worldwide, after cancer and cardiovascular diseases. VTE is defined to include pulmonary embolism (PE) and/or deep vein thrombosis (DVT). Approximately 25% of PE patients experience sudden death as an initial symptom of VTE, and between 10% and 30% of patients die within the first month after diagnosis. Currently, the only drugs approved for the treatment of both acute and chronic VTE are vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). However, their effectiveness is limited due to their associated risk of bleeding. Ideally, therapy should be able to treat VTE and limit the risk of VTE recurrence without increasing the risk of bleeding. Several studies have shown that the use of statins during anticoagulation for VTE reduces the risk of death and VTE recurrence. However, to date, there are conflicting data on the impact of statins during anticoagulation for VTE. A biological protective function of statins during anticoagulation has also been reported. Statins affect D-dimer levels; tissue factor (TF) gene expression; and VIII, VII, and Von Willebrand clotting factors-the major clotting factors they are able to affect. However, the usefulness of statins for the treatment and prevention of VTE is currently under debate, and they should not be substituted for guideline-recommended VTE prophylaxis or anticoagulation treatment. In this review of the literature, we illustrate the advances on this topic, including data on the role of statins in primary VTE prevention and secondary VTE prevention, related biological mechanisms, the risk of bleeding during their use, and their ability to reduce the risk of death.
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Siniscalchi et al. (2024) conducted a review in Venous thromboembolism (VTE). Statins vs. Standard anticoagulation without statins was evaluated on VTE recurrence, mortality, and bleeding risk. While statins may possess antithrombotic properties that could lower VTE recurrence and mortality, current data are conflicting and insufficient to recommend their routine use alongside anticoagulation.
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