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静脉血栓栓塞抗凝治疗期间不同类型他汀类药物与全因死亡率:来自RIETE注册研究的验证性研究

Different Types of Statins and All-Cause Mortality during Anticoagulation for Venous Thromboembolism: Validation Study from RIETE Registry.

作者信息

Siniscalchi Carmine, Suriñach José M, Visonà Adriana, Fernández-Reyes José L, Gómez-Cuervo Covadonga, Verhamme Peter, Marchena Pablo J, Farge-Bancel Dominique, Moisés Jorge, Monreal Manuel

机构信息

Department of Internal and Emergency Medicine, Angiology Unit, Parma University Hospital, Parma, Italy.

Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain.

出版信息

TH Open. 2020 Sep 17;4(3):e236-e244. doi: 10.1055/s-0040-1716734. eCollection 2020 Jul.

Abstract

We previously reported that during the course of anticoagulation for venous thromboembolism (VTE) patients using statins were at a lower risk to die than nonusers.  We used the R egistro I nformatizado E nfermedad T rombo E mbólica (RIETE) registry to validate our previous findings in a subsequent cohort of patients and to compare the risk of death according to the use of different types of statins.  From January 2018 to December 2019, 19,557 patients with VTE were recruited in RIETE. Of them, 4,065 (21%) were using statins (simvastatin, 1,406; atorvastatin, 1,328; rosuvastatin, 246; and others, 1,085). During anticoagulation (192 vs.182 days, for statin and no statin users respectively), 500 patients developed a VTE recurrence, 519 suffered major bleeding, and 1,632 died (fatal pulmonary embolism [PE], 88 and fatal bleeding, 78). On multivariable analysis, statin users were at a lower risk to die (hazard ratio [HR] = 0.68; 95% confidence interval [CI]: 0.59-0.79) than nonusers. When separately analyzing the drugs, on multivariable analysis, patients using simvastatin (HR = 0.64; 95% CI: 0.52-0.80), atorvastatin (HR 0.72; 95% CI: 0.58-0.89), or other statins (HR = 0.67; 95% CI: 0.52-0.87) were at a lower risk to die than nonusers. For those using rosuvastatin, difference was not statistically significant (HR = 0.77; 95% CI: 0.50-1.19), maybe due to the sample size.  Our data validate previous findings and confirm that VTE patients using statins at baseline are at a lower risk to die than nonusers. No statistically differences were found according to type of statins.

摘要

我们之前报道过,在静脉血栓栓塞症(VTE)患者的抗凝治疗过程中,使用他汀类药物的患者死亡风险低于未使用者。

我们使用信息化静脉血栓栓塞症登记系统(RIETE)来验证我们之前在后续患者队列中的发现,并根据不同类型他汀类药物的使用情况比较死亡风险。

2018年1月至2019年12月,RIETE登记系统招募了19557例VTE患者。其中,4065例(21%)使用他汀类药物(辛伐他汀1406例;阿托伐他汀1328例;瑞舒伐他汀246例;其他1085例)。在抗凝治疗期间(他汀类药物使用者和未使用者分别为192天和182天),500例患者发生VTE复发,519例发生大出血,1632例死亡(致命性肺栓塞[PE]88例,致命性出血78例)。多变量分析显示,他汀类药物使用者的死亡风险低于未使用者(风险比[HR]=0.68;95%置信区间[CI]:0.59 - 0.79)。在分别分析药物时,多变量分析显示,使用辛伐他汀(HR=0.64;95%CI:0.52 - 0.80)、阿托伐他汀(HR 0.72;95%CI:0.58 - 0.89)或其他他汀类药物(HR=0.67;95%CI:0.52 - 0.87)的患者死亡风险低于未使用者。对于使用瑞舒伐他汀的患者,差异无统计学意义(HR=0.77;95%CI:0.50 - 1.19),可能是由于样本量的原因。

我们的数据验证了之前的发现,并证实基线时使用他汀类药物的VTE患者死亡风险低于未使用者。根据他汀类药物的类型未发现统计学差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/87af/7498305/4baf37b18b92/10-1055-s-0040-1716734-i200015-1.jpg

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