Preinjury statin use and thromboembolic events in trauma: a 10-year retrospective evaluation

J Surg Res. 2018 Jun;226:100-111. doi: 10.1016/j.jss.2017.12.018. Epub 2018 Feb 22.

Abstract

Background: Traumatic injury is well known to increase the risk of venous thromboembolic events (VTEs), occurring in up to 58% of trauma patients. Statin medications have significant anti-inflammatory properties and have been shown to reduce the risk of VTE. We hypothesized that trauma patients who received statin medication before injury would have a lower incidence of VTE after injury.

Methods: A 10-y retrospective review identified all patients admitted to our trauma service with an injury severity score >9 and an intensive care unit stay of >3 d. This population was categorized as either "statin recipient" (SR) or "statin naïve," with subsequent categorical division by occurrence of VTE. Our primary outcome measure was the occurrence of documented VTE in both statin naïve and SR subjects.

Results: A total of 2519 trauma patients were included with 97 (3.8%) developing VTE. Pretrauma statin use in males remained as an independent predictor of VTE (odds ratio = 2.25, 95% confidence interval = 1.25-4.04, P < 0.01). The median time to VTE onset was 3 d longer in SRs (10.0 d; confidence interval = 7.3-12.7, P < 0.05).

Conclusions: Pretrauma statin use does not appear to have a protective benefit of VTE prevention in trauma patients, as we have shown pretrauma SR male trauma patients to have a twofold increased incidence of VTE. However, when considering the 3 d longer median time to VTE onset found in SRs, we consider the protective benefit of statin use reported in the current literature as likely attributable to this observed delayed onset.

Keywords: Chemical prophylaxis; Critical care; Deep venous thrombosis; Inferior vena cava filter; Pulmonary embolus; Statins; Trauma; Venous thromboembolic event.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Incidence
  • Injury Severity Score
  • Male
  • Middle Aged
  • Odds Ratio
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Venous Thromboembolism / epidemiology*
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control
  • Wounds and Injuries / complications*
  • Wounds and Injuries / diagnosis
  • Young Adult

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors