Rosuvastatin use improvesmeasures of coagulation in patients with venous thrombosis
Rosuvastatin use improvesmeasures of coagulation in patients with venous thrombosis
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DOI：
10.1093/eurheartj/ehy014
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发表时间：
2018-05-14
影响因子：
39.3
通讯作者：
Lijfering, Willem M.
中科院分区：
文献类型：
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作者：
Biedermann, Joseph S.;Kruip, Marieke J. H. A.;Lijfering, Willem M.
目的观察性研究表明，他汀类药物可降低静脉血栓复发的风险。然而，尚未进行试验，其机制尚不清楚。我们的目的是确定他汀类药物治疗是否能改善既往有血栓的患者的凝血功能。方法和结果随机临床试验（NCT01613794）。患者随机服用瑞舒伐他汀20mg /天，持续4周或不进行干预。在基线和研究结束时抽血。主要转归因子(F) VIII:C。共测定五种凝血因子：FVIII:C、血管性血友病因子：Ag、FVII:C、FXI:C和d -二聚体。在247名随机参与者中，平均年龄为58岁，62%为女性，49%为非诱发性室速。对于所有测试的凝血因子，瑞舒伐他汀使用者的平均水平在研究结束时明显下降，而非他汀使用者的平均水平几乎没有差异。结果最一致的是FVIII:C，瑞舒伐他汀使用者的平均FVIII:C水平降低了7.2 IU/dL [95% CI（置信区间）2.9-11.5]，而在非使用者中，FVIII:C没有变化（平均差异为-0.1；95% CI为-3.0至2.9）。瑞舒伐他汀服用者与非服用者经年龄和性别调整后的平均FVIII: C变化差异为-6.7 IU/dL （95% CI -12.0 ~ -1.4）。亚组分析显示，瑞舒伐他汀对非诱发性室性心动过速患者和有心血管危险因素患者凝血因子的降低更为明显。结论瑞舒伐他汀20mg /d可显著改善既往室性心动过速患者的凝血状况，提示他汀类药物治疗可能对复发性室性心动过速患者有益。
Aims Observational studies indicate that statins reduce the risk of recurrent venous thrombosis (VT). However, trials have not been performed and the mechanism is unknown. We aimed to determine whether statin therapy improves the coagulation profile in patients with prior VT.Methods and results Randomized clinical trial (NCT01613794). Patients were randomized to rosuvastatin 20 mg/day for 4 weeks or no intervention. Blood was drawn at baseline and at end of study. The primary outcome was factor (F) VIII:C. In total, five coagulation factors were measured: FVIII:C, von Willebrand factor: Ag, FVII:C, FXI:C, and D-dimer. Among 247 randomized participants, mean age was 58 years, 62% were women and 49% had unprovoked VT. For all tested coagulation factors, mean levels were clearly decreased at end of study in rosuvastatin users, whereas they hardly differed in non-statin users. Results were most consistent for FVIII:C where mean FVIII:C levels were 7.2 IU/dL [95% CI (confidence interval) 2.9-11.5] lower in rosuvastatin users, while among non-users, no change in FVIII: C was observed (mean difference -0.1; 95% CI -3.0 to 2.9). The mean age and sex adjusted difference in FVIII: C change was -6.7 IU/dL (95% CI -12.0 to -1.4) in rosuvastatin users vs. non-users. Subgroup analyses revealed that the decrease in coagulation factors by rosuvastatin was more pronounced in participants with unprovoked VT and in those with cardiovascular risk factors.Conclusion Rosuvastatin 20 mg/day substantially improved the coagulation profile among patients with prior VT. These results suggest that statin therapy might be beneficial in patients at risk of recurrent VT.