Statins, inflammation and deep vein thrombosis: a systematic review

Abstract

Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism. The 2009 JUPITER trial showed a significant decrease in DVT in non-hyperlipidemic patients, with elevated C-reactive protein (CRP) levels, treated with rosuvastatin. The effects of statins on thrombosis are unclear, prompting this literature review. A literature search was performed (1950 to February 2011) with MEDLINE, EMBASE, and PUBMED databases including the following keywords: “statins”, “hydroxymethylglutaryl-CoA reductase inhibitors”, “VTE”, “PE”, “DVT”, and either “anti-coagulation” or “inflammation”. Editorials, reviews, case reports, meta-analysis and duplicates were excluded. Inflammatory biomarkers of DVT, include interleukin (IL)-6, CRP, IL-8, and monocyte chemotactic protein 1 (MCP-1). Statin therapy reduces IL-6 expression of CRP and MCP-1, usually elevated in VTE. Reduction of IL-6 induced MCP-1 has been linked to vein wall fibrosis, promoting post thrombotic syndrome (PTS) and recurrent DVT in patients. Also, our review suggests that the anti-thrombotic effects are likely exhibited through the anti-inflammatory properties of statins. This work supports that statin therapy has the ability to decrease the incidence and recurrence of VTE and the potential to decrease PTS. This is mainly due to the anti-inflammatory effects of statins and may explain why normolipidemic patients, with elevated CRP, appear to have the greatest reduction in VTE. Given their low risk of bleeding, statins have the potential to serve as a safe adjunctive pharmacological therapy to current treatments in select patients with VTE, however further investigations into this concept are needed and essential.

Venous thromboembolism, interleukin-6 and survival outcomes in patients with advanced ovarian clear cell carcinoma

“…35 Statin therapy is also suggested to reduce IL-6 activity and VTE risk by inhibiting inflammatory cytokines, resulting in reduced cancer-related mortality. 36,37 Currently (as of April 8, 2015), no ongoing clinical trial of a treatment targeting IL-6 for OCCC has been registered at clinicaltrials.gov. Further preclinical and clinical studies are warranted.…”

TGF-β1 and Serpine 1 expression changes in traumatic deep vein thrombosis

“…Clinical research has shown that the incidence of DVT was 42-73% in elderly patients after hip replacement surgery, while it was 37-59% after knee replacement (Rodriguez et al, 2012). Thrombosis is prone to detachment, causing pulmonary embolism when it is in a state of flux, which endangers the life of the patient.…”

Critical Promoter Region for Statin-Induced Human Endothelial Nitric Oxide Synthase (eNOS) Transcription in EA.hy926 Cells

“…For each sample, real-time PCR amplificalevels 4) ; however, statins can also have pleiotropic beneficial cardiovascular effects that are not explained by the reduction of serum LDL-cholesterol 5) . For instance, anti-inflammatory and anticoagulant activities of statins have been demonstrated 6) . Statins may also directly improve endothelial function and increase the expression and activity of eNOS [7][8][9] .…”