Statins+Conventional Therapies Reduce VTE Risk

A team of researchers has found that statins, when used in conjunction with conventional blood clot prevention therapies, significantly reduced the risk for venous thromboembolic (VTE) events following total joint replacement (TJR) surgery. The research was led by Katharine T. Criner, M.D. while she was a resident at Temple University in Philadelphia. Dr. Criner is now a hand surgery fellow at NYU Hospital for Joint Diseases.

Current, standard VTE prevention techniques include the use of an elastic stocking and/or other external compression device upon admittance to the hospital, patient movement and rehabilitation beginning the first day after surgery and continuing for several months, and anticoagulant therapy (blood thinning medications) starting the night before surgery and continuing after the patient is discharged.

In this new study, researchers reviewed the outcomes of 546 total hip and knee replacement patients with a minimum of 11 months post-operative follow up. All patients received the standard VTE post-operative therapy, based on American Academy of Orthopaedic Surgeons (AAOS) guidelines. Patients who received a revision joint replacement surgery, a TJR following a fracture, patients with a history of blood clots, or patients taking hormone replacement therapy were excluded from the study. The average patient age was 65.5 years old, and 61% of patients were obese with a Body Mass Index (BMI) of 33 kg/m². Patients were divided into two groups: 196 patients who took statins before, during and after surgery (perioperatively); and 221 patients who did not take statins. The statin group had a significantly lower amount of VTE events (15 patients or 7.7%) compared to the non-statin group (32 patients or 14.5%).

“Our study found that statins, in addition to conventional venous thromboembolic pharmacologic therapy, significantly reduced the event of VTE in the post-operative period for patients undergoing elective total hip and knee replacements, ” said Dr. Criner in the March 11, 2014 news release. “The relative risk of VTE with use of statins was reduced by 48%. Statins not only have lipid-lowering effects, but anti-inflammatory effects that may account for their ability to decrease the development of VTE.”

Asked if there were any cautions when using these two together, Dr. Criner told OTW, “The most common adverse effect of statins is myalgias—which we didn’t detect in our retrospective study. However, since this is a retrospective study, patients could have experienced myalgias that weren’t reported in their medical records. We did not detect any significant adverse reactions when statins and anticoagulants were used simultaneously.”

“The study supports the ground work for a future prospective, randomized, placebo-controlled study to look at the effect of statins on VTEs following joint replacement surgery. This is necessary to see if there is a role for statins in the chemoprophylactic VTE guidelines. Also, if statins could be used in patients with contraindications to anticoagulants (hemorrhagic stroke patients) should be investigated.”