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Published on: May 21, 2017
Preoperative atorvastatin reduces bleeding and blood transfusions in patients undergoing elective isolated aortic
Antonio Nenna1, Cristiano Spadaccio2, Mario Lusini1
1Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Insights
Preoperative atorvastatin significantly reduced bleeding and the need for blood transfusions in patients undergoing aortic valve replacement surgery. This may lead to faster recovery and lower hospitalization costs.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Minimizing blood loss and transfusion is critical in cardiac surgery.
- Statins, like atorvastatin, have pleiotropic effects beyond lipid reduction.
- Previous studies linked atorvastatin to reduced bleeding after coronary surgery, but not aortic valve surgery.
Purpose of the Study:
- To investigate the effect of preoperative atorvastatin on postoperative bleeding and blood product use in patients undergoing aortic valve replacement.
- To determine if atorvastatin's benefits extend to aortic valve surgery patients.
Main Methods:
- Retrospective cohort study of 1145 patients undergoing elective isolated aortic valve replacement (2009-2017).
- Comparison between patients receiving preoperative atorvastatin (n=547) and a control group (n=598).
- Monitoring of postoperative bleeding, blood product transfusion, and complications.
Main Results:
- Atorvastatin group showed significantly lower bleeding in the first 12 hours (372 vs 561 ml) and overall (678 vs 981 ml).
- Reduced packed red blood cell transfusion rates in the atorvastatin group (26.3% vs 32.3%).
- Shorter hospital stay by an average of 1 day in the atorvastatin group.
Conclusions:
- Preoperative atorvastatin may decrease postoperative bleeding and red blood cell transfusions in elective isolated aortic valve replacement.
- This could potentially lead to quicker patient recovery and reduced healthcare expenses.
- Higher doses of atorvastatin were associated with greater reductions in postoperative bleeding.
Objectives:
Minimization of bleeding to reduce the use of blood products is of utmost importance in cardiac surgery. Statins are known for their pleiotropic effects beyond lipid-lowering properties, and the use of atorvastatin preoperatively is associated with reduced risk of bleeding and blood product use after coronary surgery. However, no studies have investigated if this beneficial effect also extends to aortic valve surgery.
Methods:
In this retrospective cohort study, 1145 consecutive patients undergoing elective primary isolated aortic valve replacement meeting the inclusion and exclusion criteria were selected from January 2009 to December 2017 (547 in the atorvastatin group, 598 in the control group). Postoperative bleeding, blood product use, and complications were monitored during hospitalization.
Results:
Postoperative bleeding was significantly lower in the atorvastatin group compared with the controls in the first 12 h after surgery (372 ± 137 vs 561 ± 219 ml; P = 0.001) and considering overall bleeding (678 ± 387 vs 981 ± 345 ml, P = 0.001). A total of 32.3% of controls and 26.3% of atorvastatin users received packed red blood cells (P = 0.027), and major surgical complications were similar between the groups. Postoperative length of stay was shorter in the atorvastatin group with an average reduction of 1 day of hospitalization (6.0 ± 1.4 vs 6.9 ± 2.1 days; P = 0.001). Postoperative bleeding among the atorvastatin-treated patients was significantly greater in those taking lower doses compared to those taking higher doses of atorvastatin with a 20% between-group difference (P = 0.001).
Conclusions:
Preoperative treatment with atorvastatin might reduce postoperative bleeding and transfusion of packed red blood cells in patients undergoing elective isolated aortic valve replacement. This result might translate into faster recovery after surgery and reduced hospitalization costs.
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