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Mabuchi H, Nishikawa R, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Ono K, Nakagawa Y, Kimura T. Statins use and recurrent venous thromboembolism in the direct oral anticoagulant era: insight from the COMMAND VTE Registry-2. J Thromb Thrombolysis 2024:10.1007/s11239-024-03002-0. [PMID: 38762713 DOI: 10.1007/s11239-024-03002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
Statins were reported to have a potential effect of primary prevention of venous thromboembolism (VTE), although that of secondary prevention remains uncertain. To investigate the association between statins use and recurrent VTE in the current era. The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive VTE patients among 31 centers in Japan between January 2015 and August 2020. We divided the entire cohort into 2 groups according to statins use at the time of discharge; the statins (N = 865) and no statins groups (N = 4332). The statins group was older (72.9 vs. 66.7 years, P < 0.001), and less often had active cancer (22.0% vs. 30.4%, P < 0.001). The cumulative incidence of discontinuation of anticoagulation was significantly lower in the statins group (60.3% vs. 52.6%, Log-rank P < 0.001). The cumulative 5-year incidence of recurrent VTE was significantly lower in the statins group (6.8% vs. 10.1%, Log-rank P = 0.01). Even after adjusting for the confounders, the lower risk of the statins group relative to the no statins group remained significant for recurrent VTE (HR 0.65, 95% CI 0.45-0.91, P = 0.01). The cumulative 5-year incidence of major bleeding was significantly lower in the statins group (12.2% vs. 14.1%, Log-rank P = 0.04), although, after adjusting for the confounders, the risk of the statins group relative to the no statins group turned to be insignificant (HR 0.77, 95% CI 0.59-1.00, P = 0.054). In this large real-world VTE registry, statins use was significantly associated with a lower risk for the recurrent VTE in the current era.
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Affiliation(s)
- Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryuki Chatani
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuhisa Kaneda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yohei Kobayashi
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Toru Takase
- Department of Cardiology, Kinki University Hospital, Osaka, Japan
| | - Shuhei Tsuji
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Maki Oi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunori Otsui
- Department of General Internal Medicine, Kobe University Hospital, Kobe, Japan
| | - Jiro Sakamoto
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Inoue
- Department of Cardiology, Shiga General Hospital, Moriyama, Japan
| | - Shunsuke Usami
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Po-Min Chen
- Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan
| | - Kiyonori Togi
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | - Norimichi Koitabashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kosuke Doi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yoshiaki Tsuyuki
- Division of Cardiology, Shimada General Medical Center, Shimada, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | | | - Hisato Nakai
- Department of Cardiovascular Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Wataru Shioyama
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Tomohiro Dohke
- Division of Cardiology, Kohka Public Hospital, Koka, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
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Nassour N, Akhbari B, Ranganathan N, Shin D, Ghaednia H, Ashkani-Esfahani S, DiGiovanni CW, Guss D. Using machine learning in the prediction of symptomatic venous thromboembolism following ankle fracture. Foot Ankle Surg 2024; 30:110-116. [PMID: 38193887 DOI: 10.1016/j.fas.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/31/2023] [Accepted: 10/13/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the trauma setting, and both prediction and prevention of VTE have long been a concern for healthcare providers in orthopedic surgery. The purpose of this study was to evaluate the use of novel statistical analysis and machine-learning in predicting the risk of VTE and the usefulness of prophylaxis following ankle fractures. METHODS The medical profiles of 16,421 patients with ankle fractures were screened retrospectively for symptomatic VTE. In total, 238 patients sustaining either surgical or nonsurgical treatment for ankle fracture with subsequently confirmed VTE within 180 days following the injury were placed in the case group. Alternatively, 937 patients who sustained ankle fractures managed similarly but had no documented evidence of VTE were randomly chosen as the control group. Individuals from both the case and control populations were also divided into those who had received VTE prophylaxis and those who had not. Over 110 variables were included. Conventional statistics and machine learning methods were used for data analysis. RESULTS Patients who had a motor vehicle accident, surgical treatment, increased hospital stay, and were on warfarin were shown to have a higher incidence of VTE, whereas patients who were on statins had a lower incidence of VTE. The highest Area Under the Receiver Operating Characteristic Curves (AUROC) showing the performance of our machine learning approach was 0.88 with 0.94 sensitivity and 0.36 specificity. The most balanced performance was seen in a model that was trained using selected variables with 0.86 AUROC, 0.75 sensitivity, and 0.85 specificity. CONCLUSION By using machine learning, this study successfully pinpointed several predictive factors linked to the occurrence or absence of VTE in patients who experienced an ankle fracture. Training these algorithms using larger, more granular, and multicentric data will further increase their validity and reliability and should be considered the standard for the development of such algorithms. LEVEL OF EVIDENCE Case-Control study - 3.
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Affiliation(s)
- Nour Nassour
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Bardiya Akhbari
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Noopur Ranganathan
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David Shin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Hamid Ghaednia
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Foot and Ankle Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, MA, USA
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Luo P, Yuan Q, Wan X, Yang M, Xu P. A two-sample Mendelian randomization study of circulating lipids and deep venous thrombosis. Sci Rep 2023; 13:7432. [PMID: 37156934 PMCID: PMC10167313 DOI: 10.1038/s41598-023-34726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/06/2023] [Indexed: 05/10/2023] Open
Abstract
In view of the current debate about the relationship between lipids and deep venous thrombosis (DVT) in clinical studies, a two-sample Mendelian randomization (MR) study was conducted to clarify the effects of five circulating lipids (apolipoprotein A1, apolipoprotein B, low-density lipoprotein, high-density lipoprotein and triglycerides) on DVT from the perspective of genetic inheritance. Five lipids (exposure) were analysed by MR with DVT (outcome) from two different data sources. For the analysis, we used inverse variance weighting and a weighted mode, weighted median, simple mode and MR-Egger regression to analyse the effect of circulating lipids on DVT. In addition, we used the MR-Egger intercept test, Cochran's Q test and "leave-one-out" sensitivity analysis to evaluate horizontal multiplicity, heterogeneity and stability, respectively, in the analysis. In the analysis, the two-sample Mendelian randomization analysis of five common circulating lipids and DVT showed that common circulating lipids had no causal effect on DVT, which is somewhat inconsistent with the findings of many published observational studies. Based on our results, our two-sample MR analysis failed to detect a statistically significant causal relationship between five common circulating lipids and DVT.
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Affiliation(s)
- Pan Luo
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Qiling Yuan
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Xianjie Wan
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Mingyi Yang
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Peng Xu
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
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Beauchamp-Chalifour P, Belzile ÉL, Michael R, Langevin V, Gaudreau N, Normandeau N, Bédard L, Pelet S. The risk of venous thromboembolism in surgically treated hip fracture: A retrospective cohort study of 5184 patients. Orthop Traumatol Surg Res 2022; 108:103142. [PMID: 34775033 DOI: 10.1016/j.otsr.2021.103142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Elderly patients undergoing surgery for a hip fracture are at risk of venous thromboembolism (VTE). The known risk of VTE is low due to thromboprophylaxis (1.8-2.5% at three months). Most previous studies have ignored the high mortality in that population when calculating the risk of VTE. Hip fracture treatment has also evolved over the last decade. The real risk of VTE today is unknown. We asked what was the risk of symptomatic VTE following surgery for a hip fracture in an elderly population. We also asked what kind of bleeding events were associated with thromboprophylaxis. HYPOTHESIS The risk of VTE will be lower than previously described due to modern postoperative care. PATIENTS AND METHODS Retrospective cohort study of all patients≥65-years-old undergoing surgery for a hip fracture in two Canadian academic centers, between January 1, 2008, and January 1, 2019. Symptomatic VTE (pulmonary embolism or deep venous thrombosis) confirmed by imagery were assessed. The follow-up was fixed at 3 months. The cumulated risks of VTE and bleeding events were calculated using the Kaplan-Meier estimator and a logistic regression model was used to determine risk factors. RESULTS The cohort included 5184 patients. The mean age was 83±8 years old and 76% of patients were female. In total, 98.8% of this cohort received postoperative thromboprophylaxis. Low-molecular-weight heparin was given for 35 days in 87% of this cohort. The risk of venous thromboembolism was 4.7±0.5% at 3 months (n=144). Chronic obstructive pulmonary disease (odds ratio 1.6 [1.0-2.4]) and the use of warfarin as extended thromboprophylaxis (odds ratio 2.1 [1.3-3.6]) were associated with venous thromboembolism. The risk of bleeding was 5.9% (n=179) at 3 months. In total, 78% (n=141) of bleeding events were hematomas, of which only 12% (n=16) needed reoperation. The use of direct oral anticoagulant was associated with an increased risk of bleeding events (odds ratio, 2.8 [1.5-5.0]). Mortality at 3 months was 8.4%. DISCUSSION The risk of venous thromboembolism is higher than expected in a population treated for this condition (4.7% vs. 1.8-2.5% at 3 months as previously described). Bleeding events were mostly hematomas and few needed reoperations for wound complication. Future research should focus on the management of thromboprophylaxis in that population. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Philippe Beauchamp-Chalifour
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada
| | - Étienne L Belzile
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Department of Orthopedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada; Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada
| | - Reinemary Michael
- Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada
| | - Valérie Langevin
- Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada
| | - Noémie Gaudreau
- Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada
| | - Nicolas Normandeau
- Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada
| | - Luc Bédard
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Department of Orthopedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada; Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada
| | - Stéphane Pelet
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Department of Orthopedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada; Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada.
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Matei SC, Matei M, Anghel FM, Derban MD, Olariu A, Olariu S. Impact of statin treatment on patients diagnosed with chronic venous disease. Morphological analysis of the venous wall and clinical implications. Phlebology 2021; 37:188-195. [PMID: 34877912 DOI: 10.1177/02683555211053566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The study evaluates the potential morphological changes that may occur in the venous wall in the case of the patients with chronic venous disease which associates treatment with statins for at least 2 years. METHODS Operated patients with chronic venous disease in the CEAP C2-C3 stage were included in the study. 215 venous fragments, collected from 50 patients within the study group and 179 venous fragments collected from 52 patients within the control group were microscopically analysed, evaluating a series of morpho-anatomical parameters. RESULTS In the study group, it was found that, venous reflux predominantly affects small veins, and also, a significant increase in collagen deposits in the adventitia and media tunics, proportional to the thickening of the venous wall. CONCLUSION Our results indicate possible effects of statins upon the venous morphology. Further studies are needed to determine the impact of these results on daily practice.
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Affiliation(s)
- Sergiu-Ciprian Matei
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO.,I'st Surgical Clinic, "Pius Brînzeu" University Clinical Hospital Timișoara, Liviu Rebreanu Boulevard, Timișoara, RO
| | - Mervat Matei
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO
| | | | - Mihnea Dragoș Derban
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO
| | - Andra Olariu
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO
| | - Sorin Olariu
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO.,I'st Surgical Clinic, "Pius Brînzeu" University Clinical Hospital Timișoara, Liviu Rebreanu Boulevard, Timișoara, RO
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Wang L, Shu T, Wang W, Chen H, Feng P, Xiang R, Huang W. Association of statin use and the risk of recurrent pulmonary embolism in real-world Chinese population. Pulm Circ 2021; 11:20458940211035006. [PMID: 34377437 PMCID: PMC8327238 DOI: 10.1177/20458940211035006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background Previous studies have suggested that statins exert protective effects against venous thromboembolism. However, few randomized studies have explicitly concentrated on patients with pulmonary embolism. Thus far, evidence of the effect of statins on the pulmonary embolism recurrence in China remains lacking. Methods A retrospective analysis was conducted utilizing our University database. Patients with an International Coding of Diseases-defined diagnosis of pulmonary embolism from 1 January 2017 to 31 December 2019 were included. The patients were divided into two groups, namely, with statin or without statin treatment. Propensity score matching was applied to balance the covariates between the comparison groups. Univariate analysis and multivariable logistic regression were performed to analyze the association between statin use and pulmonary embolism recurrence. Results A total of 365 patients diagnosed with pulmonary embolism were included in the research. Pulmonary embolism recurrence accounted for 15.1% of the patients and was observed during the entire study period. In the initial population, no significant difference in recurrence was observed between the groups with and without statins treatment (statin 15.6% vs. non-statin 14.9%, p = 0.860). After propensity score matching, multivariate logistic regression analysis revealed that the odds ratio of pulmonary embolism recurrence in the statin users was 0.489 (95% confidence interval 0.190–1.258, p = 0.138). Conclusions Our study provides no support for the use of statins as an adjunctive therapy in patients with pulmonary embolism at the initiated time of diagnosis or as a prophylactical plan when anticoagulation is discontinued attempting to reduce the risk of recurrence.
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Affiliation(s)
- Lu Wang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Shu
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wuwan Wang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huaqiao Chen
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Panpan Feng
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Xiang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bordbar M, de Mutsert R, Cevval M, Rosendaal FR, Jukema JW, Lijfering WM. Differential effect of statin use on coagulation markers: an active comparative analysis in the NEO study. Thromb J 2021; 19:45. [PMID: 34176487 PMCID: PMC8237446 DOI: 10.1186/s12959-021-00299-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background Statins are a potential treatment for venous thromboembolism (VTE) prophylaxis complementary to conventional anticoagulants without associated bleeding complications. This study aimed to compare pro-thrombotic activities of different classes of lipid-lowering drugs in an active comparator design and determine whether there is a relation between statin versus fibrate/niacin use and pro-coagulant factor outcomes. Methods This is a cross-sectional analysis of participants from the Netherlands Epidemiology of Obesity study using any class of lipid-lowering drugs, including any types of statins, niacin, and fibrates. We performed linear regression analyses to determine fibrinogen, factor (F) VIII, FIX, and FXI activity in statins versus fibrate/niacin users and adjusted for age, sex, tobacco smoking, body mass index (BMI), hypertension, diabetes, and prevalent cardiovascular disease. Results Among 1043 participants, the mean age was 58.4 ± 5.2 years, 61% were men, and the mean BMI was 31.3 ± 4.5 kg/m2. Clinical characteristics were balanced between statin and fibrate/niacin users. Statin users had lower mean FXI (18.3 IU/dL, 95% confidence interval (CI) 9.4 to 27.3) levels compared to fibrate/niacin users. The level of FVIII (15.8 IU/dL, 95% CI − 0.003 to 31.6), and FIX (11.3 IU/dL, 95% CI − 0.4 to 23.2) were lower in statin users than fibrate/niacin users with marginal statistical significance. Conclusion Current statin use was associated with lower plasma levels of FXI than fibrate/niacin use. The effects on coagulation factors may, in part, explain the benefit of statin therapy rendered in primary and secondary prevention of VTE.
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Affiliation(s)
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Melike Cevval
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Willem M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
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Abstract
Venous thromboembolism (VTE) is an important vascular disease and public health problem. Prevention of VTE has focused mainly on using thromboprophylaxis to avoid provoked VTE or recurrent VTE, with little attention paid to the possibility of preventing the one third to one half of VTEs that are unprovoked. We review growing research suggesting that unhealthy lifestyle risk factors may cause a considerable proportion of unprovoked VTE. Using epidemiologic data to calculate population attributable risks, we estimate that in the United States obesity may contribute to 30% of VTEs, physical inactivity to 4%, current smoking to 3%, and Western dietary pattern to 11%. We also review possibilities for VTE primary prevention either through a high-risk individual approach or a population-wide approach. Interventions for outpatients at high VTE risk but without VTE provoking factors have not been fully tested; yet, improving patient awareness of risk and symptoms, lifestyle counseling, and possibly statins or direct oral anticoagulants may prove useful in primary prevention of unprovoked VTE. A population approach to prevention would bolster awareness of VTE and aim to shift lifestyle risk factors downward in the whole population using education, environmental changes, and policy. Assuming the epidemiological associations are accurate, causal, and independent of each other, a reduction of obesity, physical inactivity, current smoking, and Western diet by 25% in the general population might reduce the incidence of unprovoked VTE by 12%. We urge further research and consideration that primary prevention of unprovoked VTE may be a worthwhile public health aim.
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Affiliation(s)
- Aaron R. Folsom
- Division of Epidemiology & Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Mary Cushman
- Departments of Medicine and Pathology & Laboratory MedicineLarner College of Medicine at the University of VermontBurlingtonVT
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Stewart LK, Sarmiento EJ, Kline JA. Statin Use is Associated with Reduced Risk of Recurrence in Patients with Venous Thromboembolism. Am J Med 2020; 133:930-935.e8. [PMID: 32171773 DOI: 10.1016/j.amjmed.2019.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Statin therapy appears to reduce incidence of venous thromboembolism in secondary analyses of non-venous thromboembolism trials, but no evidence has shown effect of statins in large population samples. The objective of this study was to examine the magnitude of the effect of statin therapy on venous thromboembolism recurrence across a large statewide population. METHODS This was a retrospective analysis of the Indiana Network for Patient Care database. All patients with an International Classification of Diseases-defined diagnosis of either deep vein thrombosis or pulmonary embolism from 2004-2017 were included. We collected Generic Product Identifier codes to determine whether patients had been prescribed a statin medication and divided patients into 2 groups: + or - statin. We then performed a propensity-matching analysis to balance covariates and created a final logistic regression model with statin use as the predictor variable and venous thromboembolism recurrence as the dependent variable. RESULTS This study included a total of 192,908 patients with documented statin use in 13.5%. Venous thromboembolism recurrence occurred in 16% of all patients over the study period. After propensity matching, patients not on a statin were found to have significantly higher rates of venous thromboembolism recurrence (20% vs 16%, P < .0001). Logistic regression yielded an odds ratio of 0.75 (95% confidence interval, 0.72-0.79) for venous thromboembolism recurrence for those on statin therapy. CONCLUSIONS We found that a statin prescription reduced risk of venous thromboembolism recurrence by approximately 25% after adjusting for risk factors, supporting the adjunctive role of statins in the prevention of venous thromboembolism recurrence.
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Affiliation(s)
| | | | - Jeffrey A Kline
- Department of Emergency Medicine; Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis.
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10
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Khan NK, Oksala NK, Suominen V, Vakhitov D, Laurikka JO, Khan JA. Risk of symptomatic venous thromboembolism after abdominal aortic aneurysm repair in long-term follow-up of 1021 consecutive patients. J Vasc Surg Venous Lymphat Disord 2020; 9:54-61. [PMID: 32325149 DOI: 10.1016/j.jvsv.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism (PE), is an infrequent but consequential and potentially preventable complication after major surgical procedures. The aim of the study was to describe the long-term occurrence of symptomatic VTE in patients undergoing abdominal aortic aneurysm (AAA) repair and to ascertain patient-specific risk factors as well as to compare the rate with that of a reference population. METHODS The study included all patients who had undergone endovascular or open AAA repair, both elective and urgent/acute cases, at the Tampere University Hospital (Finland) between February 2001 and December 2016; 59% of patients had undergone endovascular and 41% open repair, and 23% of all cases had required urgent or emergency treatment. Information about later treatment episodes for symptomatic VTE and survival data were obtained from national registries. The reference population was obtained from national registries with a random sample of inhabitants matched for age, sex, and location of residence with a 4:1 ratio and was analyzed similarly. RESULTS Altogether, 1021 patients and 4065 controls were included (88% male; median age, 74 years in both groups). The high-risk period for VTE lasted for approximately 3 months, and during that time, its occurrence was highest in patients with coronary disease (2.5%), after open repair (2.4%), and in an urgent or emergency setting (2.6%), whereas the rate was low after endovascular aneurysm repair (1.0%). The cumulative incidence of VTE at 3 months, 1 year, 3 years, and 5 years was 1.1%, 1.6%, 2.7%, and 4.5% in patients and 0.1%, 0.3%, 1.0%, and 1.8% in the reference population, respectively (P < .001 each). Most VTE events were PE in the patient group. The 5-year mortality rates were 37.9% in patients and 23.8% in controls (P < .001). CONCLUSIONS The incidence of symptomatic VTE, particularly PE, after AAA repair is significant, in both short-term and long-term follow-up. Open surgery, acute setting, and concomitant coronary disease appear to increase the risk.
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Affiliation(s)
- Niina K Khan
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Niku K Oksala
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Cardiovascular Research Centre Tampere, Tampere University, Tampere, Finland
| | - Velipekka Suominen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Damir Vakhitov
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jari O Laurikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Cardiovascular Research Centre Tampere, Tampere University, Tampere, Finland; Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jahangir A Khan
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.
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11
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Yoshikawa Y, Yamashita Y, Morimoto T, Mabuchi H, Amano H, Takase T, Hiramori S, Kim K, Oi M, Akao M, Kobayashi Y, Toyofuku M, Izumi T, Tada T, Chen PM, Murata K, Tsuyuki Y, Saga S, Nishimoto Y, Sasa T, Sakamoto J, Kinoshita M, Togi K, Takabayashi K, Shiomi H, Kato T, Makiyama T, Ono K, Murakami T, Kimura T. Effect of Statins on Recurrent Venous Thromboembolism (from the COMMAND VTE Registry). Am J Cardiol 2020; 125:189-197. [PMID: 31744599 DOI: 10.1016/j.amjcard.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/16/2022]
Abstract
Statins, which are considered as essential for primary and secondary prevention of atherosclerotic diseases, were also reported to reduce first venous thromboembolism (VTE). However, the effect of statins on VTE recurrence remains conflicting. We aimed to examine the association between statin use and VTE recurrence in a large observational study in Japan. The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE in 29 centers in Japan between January 2010 and August 2014. In the current study, the entire cohort was divided into statin group (N = 437) and no-statin group (N = 2590) according to the status of statin use at baseline. The statin group as compared with the no-statin group was older (statin group 71.2 vs no-statin group 66.5 years, p <0.001), included more women (67% vs 60%, p = 0.008), and less frequently had active cancer (12% vs 25%, p <0.001). There was no significant difference in the clinical presentation of VTE (pulmonary embolism, 58% vs 56%, p = 0.44). The cumulative 3-year incidence of recurrent VTE was significantly lower in the statin group than the no-statin group (3.8% vs 8.8%, p <0.001). After adjusting for confounders including active cancer, statin use was associated with significantly lower risk for recurrent VTE (Hazard ratio 0.49, 95% confidence interval 0.29 to 0.78, p = 0.002). The results were consistent in a sensitivity sub-group analysis with and without active cancer. In conclusion, statin use was associated with significantly lower risk for the recurrent VTE in patients with VTE.
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Affiliation(s)
- Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hidewo Amano
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toru Takase
- Department of Cardiology, Kinki University Hospital, Osaka, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Maki Oi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yohei Kobayashi
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Toshiaki Izumi
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Po-Min Chen
- Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiaki Tsuyuki
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Syunsuke Saga
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Tomoki Sasa
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Jiro Sakamoto
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | | | - Kiyonori Togi
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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12
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Li LJ, Chen DF, Wu GF, Guan WJ, Zhu Z, Liu YQ, Gao GY, Qin YY, Zhong NS. Incidence and risk of thromboembolism associated with bevacizumab in patients with non-small cell lung carcinoma. J Thorac Dis 2018; 10:5010-5022. [PMID: 30233875 DOI: 10.21037/jtd.2018.07.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor (VEGF), is effective for the treatment of advanced non-small cell lung cancer (NSCLC). However, severe adverse events (AEs) have been reported in NSCLC patients treated with bevacizumab. Currently, the contribution of Bevacizumab to thromboembolism is still controversial. We conducted a study to determine the overall risk and incidence of thromboembolism with bevacizumab in NSCLC patients. Methods Electronic databases such as the PubMed, Web of Science and Cochrane Library were searched for related trials. Statistical analyses were conducted to calculate the overall incidence rates, odds ratios (ORs), and 95% confidence intervals (CIs) by using either random-effect or fixed-effect models depending on the heterogeneity. We also used trial sequence analysis (TSA) to verify the pooled result. Results A total of 3,555 subjects from nine studies were included. The overall incidence of thromboembolism events in NSCLC patients treated with bevacizumab was 4.8% (95% CI: 1.9-7.7%). Without bevacizumab, this incidence was 2.9% (95% CI: 0.6-5.1%). Bevacizumab use was associated with a significantly increased risk in thromboembolism events (OR =1.74; 95% CI: 1.15-2.62; P=0.008). Subgroup analysis based on the doses showed that bevacizumab administered at 15 mg/kg (OR =1.81; 95% CI: 1.14-2.86; P=0.012), but not 7.5 mg/kg (OR =1.32; 95% CI: 0.78-2.24; P=0.296), increased the risk of thromboembolism. Conclusions Bevacizumab is associated with a significantly increased risk of thromboembolism development in NSCLC patients. It may have dose-toxicity relationship and low dose of bevacizumab may be a better choice for NSCLC patients, with equal efficacy and low hazard of thromboembolism events.
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Affiliation(s)
- Li-Juan Li
- Nanshan School, Guangzhou Medical University, Guangzhou 511436, China
| | - Di-Fei Chen
- Nanshan School, Guangzhou Medical University, Guangzhou 511436, China
| | - Guo-Feng Wu
- The 3rd Affiliated Hospital of Guangzhou Medical University Li-Wan Hospital, Guangzhou 510170, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Zheng Zhu
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Yi-Qian Liu
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Guo-Ying Gao
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Yin-Yin Qin
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
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