Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Cassius I. Ochoa Chaar

Abstract

Objectives: Statin therapy has been associated with a decreased incidence of venous thromboembolism (VTE) in clinical trials and enhanced thrombus resolution in animal models. The effect of statins on thrombus resolution has not been reported clinically. This study investigates the association of statins with thrombus resolution or improvement in patients with deep vein thrombosis (DVT).

Methods: A retrospective study of the electronic medical records of consecutive adult patients presenting with lower extremity DVT was performed. Patients were divided into two groups based on statin therapy (statin group) or lack thereof (non-statin group). The two groups were compared with respect to demographics, comorbidities, and risk factors for VTE. Initial as well as all subsequent ultrasound reports were reviewed for each patient to determine extent of DVT and subsequent change in thrombus characteristics. Long-term outcomes examined were thrombus improvement or resolution on follow up ultrasound, VTE recurrence, mortality. Multivariable analysis was used to determine independent predictors of thrombus resolution or improvement, VTE recurrence, and mortality.

Results: A total of 818 patients with DVT were identified [statin group: n = 279 (34%), non-statin group: n = 539 (66%)]. The patients in the statin group were significantly older (P < .001). Patients on statin were more likely to have risk factors for and manifestations of atherosclerosis and to be on antiplatelet therapy (P < .001) while those in the non-statin group were more likely to have a hypercoagulable disorder (P = .009) or prior DVT (P = .033). There was no significant difference in provoked DVT, extent of DVT, or association with PE (pulmonary embolus), but patients on statin were more likely to have high-risk PE (P = .046). There was no difference in patients receiving anticoagulation, type and duration of anticoagulation, inferior vena cava filter placement, or treatment with lytic therapy. There was no difference in thrombus resolution, mortality, or recurrence of DVT, PE, or VTE between the groups. On multivariable analysis, age, proximal DVT, CAD, and cancer were associated with higher mortality while anticoagulation with warfarin and DOACs and antiplatelet therapy were associated with lower mortality. Statin therapy, antiplatelet therapy and younger age were associated with thrombus resolution or improvement.

Conclusions: Statin therapy is associated with greater thrombus resolution or improvement in patients with DVT. However, statin therapy in this study was not associated with different clinical outcomes of VTE recurrence or mortality.

Comments

This is an Open Access Thesis.

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