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Does statin therapy decrease the risk for bleeding in patients who are receiving warfarin?

James D Douketis1, Magda Melo, Chaim M Bell

  • 1Department of Medicine, McMaster University and St. Joseph's Healthcare, Hamilton, Ontario, Canada. jdouket@mcmaster.ca

The American Journal of Medicine
|April 3, 2007
PubMed

Insights

Long-term use of statins may reduce bleeding risk in atrial fibrillation patients on warfarin. Recent statin use showed no association, suggesting further research is needed to confirm this protective effect.

Area of Science:

  • Cardiology
  • Pharmacology
  • Epidemiology

Background:

  • Atrial fibrillation (AF) patients on warfarin have an increased bleeding risk.
  • Concomitant use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been observed to potentially lower this bleeding risk.

Purpose of the Study:

  • To investigate the association between statin use and the risk of bleeding in patients with atrial fibrillation who are prescribed warfarin.
  • To determine if statin therapy modifies bleeding risk in this specific patient population.

Main Methods:

  • A population-based, nested case-control study was conducted using linked administrative databases in Ontario, Canada.
  • Eligible patients (≥66 years, AF, warfarin users) were followed for upper gastrointestinal or intracranial bleeding.
  • Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for bleeding risk associated with statin use.

Main Results:

  • Long-term statin use (≥1 year) was associated with a statistically significant decreased risk of bleeding (OR=0.80; 95% CI, 0.66-0.97).
  • No significant association was found between recent statin use (<6 months) or statin use of any duration and bleeding risk.
  • Potential confounding by a health-user effect was suggested for the observed associations.

Conclusions:

  • Long-term statin use may be linked to a reduced risk of bleeding in warfarin-treated atrial fibrillation patients.
  • Further research is warranted to confirm this potential association and elucidate underlying mechanisms.
Abstract

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