Coagulation

Statin effects on thrombin generation show promise for VTE prophylaxis


Statins reduce thrombin generation in patients with venous thromboembolism (VTE) and may prevent recurrent VTE without increasing bleeding risk, a new study shows.

Investigating a mechanism to explain why statins have antithrombotic effects, Dutch researchers have shown that rosuvastatin use is associated with significant reductions in endogenous thrombin potential (ETP) and peak thrombin.

The findings come from the STAtins Reduce Thrombophilia (START) trial, which has previously shown that treatment with rosuvastatin improved the coagulation profile in VTE patients by reducing factor VIII and D-dimer levels.

In a new analysis, the study investigators loked at additional coagulation effects following a VTE in 126 patients who took rosuvastatin 20mg daily for four weeks and 119 patients who did not use a statin.

The mean difference in ETP change between the groups was -120.24nM*min, representing a 10.4% reduction by rosuvastatin. Thrombin peak in both groups, and the mean difference in peak change was -11.88nM, yielding a 5% peak reduction by rosuvastatin.

Writing in the Journal of Thrombosis and Hemostasis, the researchers said that the  findings suggested rosuvastatin had the potential to reduce the risk of recurrent VTE by 14-25%, based on previous studies of thrombin generation and VTE risk.

And since thrombin generation and D-dimer are markers of hypercoagubility, the results suggested that statins may be preventing a rebound phenomenon after withdrawal of anticoagulation.

This statins may be a more convenient alternative treatment for secondary prevention of VTE, particularly as they do not increase the risk of bleeding complications, they said.

The researchers also noted that the effects of statin on thrombin generation were more pronounced in patients who had an unprovoked VTE and with cardiovascular risk factors. Such patients would already be likely to benefit from statins for cardioprotective effects.

“Therefore, the possibility of using one single drug to prevent both cardiovascular diseases and VTE could diminish the medication burden associated with the use of several classes of drugs and decrease the risk of adverse effects, thus increasing the changes of treatment efficacy,” they wrote.

The findings provided strong support for conducting randomised clinical trials to assess the impact of statin therapy on the risk of recurrent VTE, they concluded.

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