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Rosuvastatin use reduces thrombin generation potential in patients with venous thromboembolism: a randomized controlled trial
Author(s): ,
Fernanda A. Orsi
Affiliations:
Department of Clinical Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
,
Joseph S. Biedermann
Affiliations:
Star‐Medical Anticoagulation Clinic, Rotterdam, the Netherlands. Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
,
Marieke J.H.A. Kruip
Affiliations:
Star‐Medical Anticoagulation Clinic, Rotterdam, the Netherlands. Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
,
Felix J. Meer
Affiliations:
Department of Internal Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Frits R. Rosendaal
Affiliations:
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
,
Astrid Hylckama Vlieg
Affiliations:
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
,
Mettine H. A. Bos
Affiliations:
Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands
,
Frank W. G. Leebeek
Affiliations:
Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
,
Suzanne C. Cannegieter
Affiliations:
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands. Department of Internal Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Willem M. Lijfering
Affiliations:
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
Correspondence: Willem M. Lijfering, Department of Clinical Epidemiology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands|Tel.: +31 71 5264037|E‐mail: w.m.lijfering@lumc.nl
ISTH Academy. Lijfering W.
Feb 8, 2019; 273389
Willem Lijfering
Willem Lijfering
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Background
Statin therapy could form an alternative prophylactic treatment for venous thromboembolism (VTE) if statins are proven to downregulate hemostasis and prevent recurrent VTE, without increasing bleeding risk.
Objectives
The STAtins Reduce Thrombophilia (START) trial investigated whether statin affects coagulation in patients with prior VTE.
Patients/methods
After anticoagulation withdrawal, patients were randomized to rosuvastatin 20 mg day for 4 weeks or no intervention. Plasma samples taken at baseline and at the end of the study were analyzed employing thrombin generation assay.
Results and conclusions
The study comprised 126 rosuvastatin users and 119 non‐users. Mean age was 58 years, 61% were men, 49% had unprovoked VTE and 75% had cardiovascular (CV) risk factors. Endogenous thrombin potential (ETP) increased from baseline to end of study in non‐statin users (mean 97.22 nm*min; 95% CI, 40.92–153.53) and decreased in rosuvastatin users (mean −24.94 nm*min; 95% CI, −71.81 to 21.93). The mean difference in ETP change between treatments was −120.24 nm*min (95% CI, −192.97 to −47.51), yielding a 10.4% ETP reduction by rosuvastatin. The thrombin peak increased in both non‐statin (mean 20.69 nm; 95% CI, 9.80–31.58) and rosuvastatin users (mean 8.41 nm; 95% CI −0.86 to 17.69). The mean difference in peak change between treatments was −11.88 nm (95% CI, −26.11 to 2.35), yielding a 5% peak reduction by rosuvastatin. Other thrombin generation parameters did not change substantially. The reduction in ETP and peak by rosuvastatin was more pronounced in the subgroups of participants with CV risk factors and with unprovoked VTE. We conclude that rosuvastatin reduces thrombin generation potential in patients who had VTE.
Keyword(s)
hydroxymethylglutaryl‐CoA reductase inhibitors, randomized clinical trial, thrombin generation, thrombophilia, venous thrombosis
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