Suzanne Schol-Gelok1, Francesca Morelli1, Lidia R Arends2, Eric Boersma3, Marieke J H A Kruip4, Jorie Versmissen1, Teun van Gelder1. 1. Department of Hospital Pharmacy and Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 2. Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 3. Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 4. Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract
BACKGROUND: D-dimers are generated during endogenous fibrinolysis of a blood clot and have a central role in diagnostic algorithms to rule out venous thromboembolism. HMG-CoA reductase inhibitors, more commonly called statins, are known to have effects independent of LDL-cholesterol lowering, including antithrombotic properties. An effect of statins on D-dimer levels has been reported in a prior systematic review and meta-analysis, but methodological shortcomings might have led to an overestimated effect. To re-evaluate the association between statins and D-dimer levels, we systematically reviewed all published articles on the influence of statins on D-dimer levels and conducted a novel meta-analysis (PROSPERO registration number CRD42017058932). MATERIALS AND METHODS: We electronically searched EMBASE, Medline Epub, Cochrane, Web of Science and Google Scholar (100 top relevance) (date of last search: 5 October 2017). We included randomized controlled trials, cohort studies and cross-sectional studies. Two reviewers independently screened all articles retrieved and extracted data on study and patient characteristics, study quality and D-dimer levels. RESULTS: Study-level meta-analysis involving 18,052 study participants showed lower D-dimer levels in those receiving statin treatment than controls (SMD: -0.165, 95% CI -0.234; -0.096, P = <0.001). Sensitivity analyses and additional analyses on treatment duration (<12 weeks vs ≥12 weeks) and type of statin (lipophilic or hydrophilic) did not modify this overall result. CONCLUSION: This meta-analysis suggests an association between use of statins and reduction of D-dimer levels, independent of treatment duration and type of statin used. This effect is small but robust, and should be interpreted with caution.
BACKGROUND: D-dimers are generated during endogenous fibrinolysis of a blood clot and have a central role in diagnostic algorithms to rule out venous thromboembolism. HMG-CoA reductase inhibitors, more commonly called statins, are known to have effects independent of LDL-cholesterol lowering, including antithrombotic properties. An effect of statins on D-dimer levels has been reported in a prior systematic review and meta-analysis, but methodological shortcomings might have led to an overestimated effect. To re-evaluate the association between statins and D-dimer levels, we systematically reviewed all published articles on the influence of statins on D-dimer levels and conducted a novel meta-analysis (PROSPERO registration number CRD42017058932). MATERIALS AND METHODS: We electronically searched EMBASE, Medline Epub, Cochrane, Web of Science and Google Scholar (100 top relevance) (date of last search: 5 October 2017). We included randomized controlled trials, cohort studies and cross-sectional studies. Two reviewers independently screened all articles retrieved and extracted data on study and patient characteristics, study quality and D-dimer levels. RESULTS: Study-level meta-analysis involving 18,052 study participants showed lower D-dimer levels in those receiving statin treatment than controls (SMD: -0.165, 95% CI -0.234; -0.096, P = <0.001). Sensitivity analyses and additional analyses on treatment duration (<12 weeks vs ≥12 weeks) and type of statin (lipophilic or hydrophilic) did not modify this overall result. CONCLUSION: This meta-analysis suggests an association between use of statins and reduction of D-dimer levels, independent of treatment duration and type of statin used. This effect is small but robust, and should be interpreted with caution.
Authors: Anton De Spiegeleer; Antoon Bronselaer; James T Teo; Geert Byttebier; Guy De Tré; Luc Belmans; Richard Dobson; Evelien Wynendaele; Christophe Van De Wiele; Filip Vandaele; Diemer Van Dijck; Dan Bean; David Fedson; Bart De Spiegeleer Journal: J Am Med Dir Assoc Date: 2020-06-15 Impact factor: 4.669
Authors: Suzanne Schol-Gelok; Moniek P M de Maat; Joseph S Biedermann; Teun van Gelder; Frank W G Leebeek; Willem M Lijfering; Felix J M van der Meer; Dingeman C Rijken; Jorie Versmissen; Marieke J H A Kruip Journal: Br J Haematol Date: 2020-04-16 Impact factor: 6.998