Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Thromb Res. 2011 Nov;128(5):422-30. doi: 10.1016/j.thromres.2011.05.012.
Studies have established a relationship between inflammation and venous thromboembolism (VTE). Though statins modulate inflammation, it is uncertain if they prevent VTE in heterogeneous populations. A recent randomized trial demonstrated that statins prevent VTE in healthy older adults, yet this has not been well established in other groups, including younger individuals and individuals with comorbidities. The objective of this meta-analysis was to estimate the effect of statins on VTE in a heterogeneous group of adults.
We systematically reviewed the effect of statins in preventing VTE in adult inpatients and outpatients. We systematically searched MEDLINE (1966-Jan 2010), EMBASE (1980-Jan 2010), Google Scholar, Cochrane Library, PapersFirst, ProceedingsFirst, and ISI Web of Science, manually reviewed references, and contacted experts. Observational studies that compared any dose of statin to no statin or placebo, examined inpatients or outpatients, and assessed VTE, pulmonary embolism, and/or deep vein thrombosis were included. Study selection, data abstraction and study quality evaluation (using the Newcastle-Ottawa Scale) were independently conducted in duplicate.
Four cohort studies and four case-control studies met criteria. Comparing statins to control, the odds ratio for VTE was 0.67 (95% confidence interval 0.53, 0.84), and for deep vein thrombosis was 0.53 (95% confidence interval 0.22, 1.29). The association was attenuated in lower-quality studies and studies enrolling older individuals.
Further well-designed trials are needed to evaluate the risks and benefits of statins in preventing VTE in heterogenous populations of adults, identify high-risk subgroups, and analyze cost-effectiveness of statin use for this indication.
研究已经证实炎症与静脉血栓栓塞症（VTE）之间存在关联。虽然他汀类药物可调节炎症，但尚不确定它们是否能预防异质人群中的 VTE。最近的一项随机试验表明，他汀类药物可预防健康老年人的 VTE，但这在其他人群中尚未得到很好的证实，包括较年轻的人群和合并症患者。本荟萃分析的目的是评估他汀类药物在异质成年人群中对 VTE 的影响。
我们系统地检索了关于他汀类药物预防成年住院患者和门诊患者 VTE 的效果的文献。我们系统地检索了 MEDLINE（1966 年 1 月至 2010 年 1 月）、EMBASE（1980 年 1 月至 2010 年 1 月）、Google Scholar、Cochrane 图书馆、 PapersFirst、ProceedingsFirst 和 ISI Web of Science，并手动检索了参考文献，并联系了专家。纳入了比较任何剂量的他汀类药物与无他汀类药物或安慰剂、检查住院患者或门诊患者以及评估 VTE、肺栓塞和/或深静脉血栓形成的观察性研究。研究选择、数据提取和研究质量评估（使用纽卡斯尔-渥太华量表）由两名独立人员进行。
有四项队列研究和四项病例对照研究符合标准。与对照组相比，他汀类药物治疗 VTE 的比值比为 0.67（95%置信区间 0.53，0.84），深静脉血栓形成的比值比为 0.53（95%置信区间 0.22，1.29）。在质量较低的研究和纳入较年长个体的研究中，这种关联减弱了。
需要进一步进行精心设计的试验，以评估他汀类药物在预防异质成年人群中 VTE 的风险和益处，确定高危亚组，并分析他汀类药物用于该适应证的成本效益。
