Department of Surgery, Section of Vascular Surgery, Conrad Jobst Vascular Research Laboratories, School of Medicine, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, USA.
J Thromb Thrombolysis. 2012 May;33(4):371-82. doi: 10.1007/s11239-012-0687-9.
Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism. The 2009 JUPITER trial showed a significant decrease in DVT in non-hyperlipidemic patients, with elevated C-reactive protein (CRP) levels, treated with rosuvastatin. The effects of statins on thrombosis are unclear, prompting this literature review. A literature search was performed (1950 to February 2011) with MEDLINE, EMBASE, and PUBMED databases including the following keywords: "statins", "hydroxymethylglutaryl-CoA reductase inhibitors", "VTE", "PE", "DVT", and either "anti-coagulation" or "inflammation". Editorials, reviews, case reports, meta-analysis and duplicates were excluded. Inflammatory biomarkers of DVT, include interleukin (IL)-6, CRP, IL-8, and monocyte chemotactic protein 1 (MCP-1). Statin therapy reduces IL-6 expression of CRP and MCP-1, usually elevated in VTE. Reduction of IL-6 induced MCP-1 has been linked to vein wall fibrosis, promoting post thrombotic syndrome (PTS) and recurrent DVT in patients. Also, our review suggests that the anti-thrombotic effects are likely exhibited through the anti-inflammatory properties of statins. This work supports that statin therapy has the ability to decrease the incidence and recurrence of VTE and the potential to decrease PTS. This is mainly due to the anti-inflammatory effects of statins and may explain why normolipidemic patients, with elevated CRP, appear to have the greatest reduction in VTE. Given their low risk of bleeding, statins have the potential to serve as a safe adjunctive pharmacological therapy to current treatments in select patients with VTE, however further investigations into this concept are needed and essential.
静脉血栓栓塞症（VTE）包括深静脉血栓形成（DVT）和肺栓塞。2009 年 JUPITER 试验表明，在非高脂血症患者中，C 反应蛋白（CRP）水平升高的患者使用瑞舒伐他汀治疗，DVT 的发生率显著降低。他汀类药物对血栓形成的影响尚不清楚，这促使我们进行了文献复习。对 MEDLINE、EMBASE 和 PUBMED 数据库进行了文献检索（1950 年至 2011 年 2 月），包括以下关键词：“他汀类药物”、“羟甲基戊二酰基辅酶 A 还原酶抑制剂”、“VTE”、“PE”、“DVT”，以及“抗凝”或“炎症”。排除社论、综述、病例报告、荟萃分析和重复文献。DVT 的炎症生物标志物包括白细胞介素（IL）-6、CRP、IL-8 和单核细胞趋化蛋白 1（MCP-1）。他汀类药物治疗可降低 CRP 和 MCP-1 的 IL-6 表达，VTE 患者通常会升高。IL-6 诱导的 MCP-1 减少与静脉壁纤维化有关，从而导致血栓后综合征（PTS）和患者的复发性 DVT。此外，我们的综述表明，他汀类药物的抗血栓作用可能是通过其抗炎特性发挥的。这一研究结果支持他汀类药物治疗能够降低 VTE 的发生率和复发率，并有可能降低 PTS。这主要是由于他汀类药物的抗炎作用，也可以解释为什么 CRP 升高的非高脂血症患者 VTE 发生率降低最大。鉴于他汀类药物出血风险低，它们有可能作为一种安全的辅助药物治疗，用于某些 VTE 患者，但需要进一步研究这一概念，这是必要的。
