Dose-dependent effects of rosuvastatin in deep vein thrombosis: a retrospective cohort study

Deep vein thrombosis (DVT) remains associated with substantial morbidity despite anticoagulation therapy, with 20-30% experiencing recurrence and up to 50% developing post-thrombotic syndrome (PTS). Statins possess anti-inflammatory properties that may benefit DVT outcomes, but evidence for adjunctive use remains limited.

We conducted a retrospective cohort study of 255 patients with first-episode proximal DVT diagnosed between January 1^st, 2020 and December 31^st, 2020, with follow-up through December 31^st, 2024. Using multinomial propensity scores, we matched patients 1:1:1 who were receiving rosuvastatin 20 mg (N.=85), rosuvastatin 10 mg (N.=85), or no statin (N.=85) for ≥3 months before DVT diagnosis. All patients received guideline-directed anticoagulation. Primary outcome was composite of DVT recurrence and/or PTS. We used Cox regression for time-to-event analyses and mixed-effects models for biomarker trajectories.

After median follow-up of 42 months (IQR 36-48), the primary outcome occurred in 31.8% of rosuvastatin 20-mg group, 38.8% of 10-mg group, and 47.1% of controls (HR=0.67, 95% CI 0.50-0.90, P=0.008 for 20 mg vs. control). Both rosuvastatin groups showed greater reductions in inflammatory markers compared to controls. Complete vein recanalization at 48 months was observed in 74.1%, 65.9%, and 58.8% respectively (overall P=0.045; pairwise 20 mg vs. control P=0.095, Table II). Safety profiles were similar across groups, with no excess bleeding or muscle-related events.

In this hypothesis-generating study, rosuvastatin use was associated with reduced DVT complications, with suggestions of dose-dependent effects. These associations require confirmation in prospective randomized trials before clinical recommendations can be made.