Statin therapy and gastrointestinal hemorrhage: a retrospective cohort study with propensity score-matching

Badillo, Ricardo; Schmidt, Robert A.; Mortensen, Eric M.; Frei, Christopher R.; Mansi, Ishak A.

doi:10.1002/pds.3817

Cited by 18 publications

(25 citation statements)

References 25 publications

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“…This is due to the high population of elderly patients because of their high usage of NSAIDS and lowdose aspirin for relief of intense musculoskeletal disorders and prevention of arteriosclerotic disease. This explains (1) the increased frequency of PUD after age 60, and (2) the unchanged hazards ratio in gastric ulcer after treatment with statin, since patients were older and more likely to have past usage of NSAIDs and aspirin [12,13,15,34,35]. It is thought that sufficient gastrointestinal mucosal blood flow is important for inhibiting the back-diffusion of gastric acid and maintaining gastrointestinal mucosal integrity [25].…”

Section: Discussionmentioning

confidence: 94%

“…Contrarily, much research on gastroprotective effects and the preservation of vascular integrity are on animal subjects, and it appears that statin use actually lowers the rate of peptic ulcer development when administering antithrombotic treatment and NSAID to a patient [15,26,27]. Consequently, it is unknown how relevant it is to human models.…”

Section: Introductionmentioning

confidence: 97%

“…European Journal of Internal Medicine xxx (2015) xxx-xxx Despite that, an increase in statin related side effects such as gastrointestinal (GI) symptoms and GI hemorrhage has been reported [15][16][17]. Contrarily, much research on gastroprotective effects and the preservation of vascular integrity are on animal subjects, and it appears that statin use actually lowers the rate of peptic ulcer development when administering antithrombotic treatment and NSAID to a patient [15,26,27].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of statins on the occurrence of peptic ulcer

Feng

Chuang

Wu³

et al. 2015

European Journal of Internal Medicine

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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The effect of statins on the occurrence of peptic ulcer

Feng

Chuang

Wu³

et al. 2015

European Journal of Internal Medicine

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“…Further, statins alone (including pravastatin[39]) have not been shown to, themselves, impact bleeding risk. [23,25,39,40]…”

Section: Methodsmentioning

confidence: 99%

“…Further, there is some suggestion that statins and fibrates themselves may have antiplatelet and anticoagulant properties. [20-22] Yet, statins alone have not been associated with GIB[23] or ICH. [24,25] Corresponding outcome data on fibrates alone are scant.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal bleeding and intracranial hemorrhage in concomitant users of warfarin and antihyperlipidemics

Leonard

Brensinger

Bilker

et al. 2017

International Journal of Cardiology

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Background Drug interactions, particularly those involving warfarin, are a major clinical and public health problem. Minimizing serious bleeding caused by anticoagulants is a recent major focus of the United States (US) Department of Health and Human Services. This study quantified the risk of gastrointestinal bleeding (GIB) and intracranial hemorrhage (ICH) among concomitant users of warfarin and individual antihyperlipidemics. Methods The authors conducted a high-dimensional propensity score-adjusted cohort study of new concomitant users of warfarin and an antihyperlipidemic, among US Medicaid beneficiaries from five states during 1999–2011. Exposure was defined by concomitant use of warfarin plus one of eight antihyperlipidemics. The primary outcome measure was a composite of GIB/ICH within the first 30 days of concomitant use. As a secondary outcome measure, GIB/ICH was examined within the first 180 days of concomitant use. Results Among 236,691 persons newly-exposed to warfarin and an antihyperlipidemic, the crude incidence of GIB/ICH was 13.2 (95% confidence interval 12.7 to 13.8) per 100 person-years. Users were predominantly older, female, and Caucasian. Adjusted hazard ratios (aHRs) for warfarin and individual statins were consistent with no association. Warfarin + gemfibrozil was associated with an 80% increased risk of GIB/ICH within the first month of concomitant use (aHR = 1.8, 1.4 to 2.4). Warfarin + fenofibrate was associated with a similar increased risk (aHR = 1.8, 1.2 to 2.7), yet with an onset during the second month of concomitant use. Conclusions Among warfarin-treated persons, the use of fibrates—but not statins—increases the risk of hospital presentation for GIB/ICH.

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Statins and Lower Gastrointestinal Conditions: A Retrospective Cohort Study

Pearlman

Covin

Schmidt

et al. 2017

The Journal of Clinical Pharma

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Several studies have reported constipation, abdominal pain, or diarrhea as common adverse events for statins. Statins are among the most commonly prescribed medications, and the impact on the prevalence of these conditions was rarely studied as main outcomes. The aim of this study is to determine if statin therapy is associated with constipation, abdominal pain, diarrhea, or colitis. This was a retrospective cohort study using a regional military health care data from October 1, 2003, to March 1, 2012. A propensity score-matched cohort of statin users and nonusers was created based on 82 variables. The primary analysis evaluated the odds ratios of the following diagnoses: constipation, ≥3 encounters for constipation; abdominal pain, ≥3 encounters for abdominal pain; diarrhea, ≥3 encounters for diarrhea; colitis, ≥3 encounters for colitis; and endoscopy of the lower gastrointestinal tract, ≥3 endoscopies of the lower gastrointestinal tract. After propensity score matching of 6342 statin users and 6342 nonusers, there was no statistically significant difference in constipation (OR, 0.96; 95%CI, 0.87-1.05; P = .33), abdominal pain (OR, 0.95; 95%CI, 0.88-1.02; P = .15), or colitis (OR, 1.02; 95%CI, 0.91-1.14; P = .73). However, there was an association between statin therapy and endoscopy of the lower gastrointestinal tract (OR, 1.14; 95%CI, 1.04-1.26; P = .002) and decreased odds of diarrhea (OR, 0.88; 95%CI, 0.80-0.97; P = .01). In this retrospective cohort study, an association between statin therapy and increased likelihood of being diagnosed with lower gastrointestinal conditions could not be demonstrated, contrary to some statins package inserts.

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Statin therapy and gastrointestinal hemorrhage: a retrospective cohort study with propensity score-matching

Abstract: Statin use was not significantly associated with either an increased or decreased risk of gastrointestinal hemorrhage. Choice of statin therapy should not be limited in those patients at risk of gastrointestinal hemorrhage.

Cited by 18 publications

References 25 publications

The effect of statins on the occurrence of peptic ulcer

The effect of statins on the occurrence of peptic ulcer

Gastrointestinal bleeding and intracranial hemorrhage in concomitant users of warfarin and antihyperlipidemics

Statins and Lower Gastrointestinal Conditions: A Retrospective Cohort Study

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