Statins and the risk of bleeding in patients taking dabigatran

Bo Lin Ho, Ya Ju Lin, Sheng Feng Lin, Ping Song Chou, Chien Fu Chen, Ruey Tay Lin, Han Hwa Hu, A. Ching Chao

Research output: Contribution to journalArticle

Abstract

Objectives: Dabigatran etexilate is a direct thrombin inhibitor that clinicians increasingly prescribe to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Clinicians also commonly prescribe statins for primary and secondary prevention of cardiovascular diseases. Little is known about the bleeding risk in patients taking a statin and dabigatran together. The aim of this study was to evaluate the safety and persistence of dabigatran after co-medication with statins. Materials and Methods: We performed a prospective, multicenter registry study of stroke patients with NVAF who initiated dabigatran therapy within 3 months after a clinically evident ischemic cerebrovascular event between 2013 and 2017. The main outcome measure was symptomatic bleeding after 90, 180, and 360 days. Results: In total, 652 patients (336 statin users, 316 non-users) were followed for 1 year after dabigatran therapy. Cox multivariate analysis demonstrated that male sex, prior use of aspirin, and concurrent use of an antiarrhythmic drug were associated with a higher risk of bleeding at 360 days. After adjusting time-dependent covariates, statin users had a significantly lower bleeding risk (adjusted hazard ratio: 0.11, P < 0.001) than non-users. Kaplan-Meier analysis indicated that patients prescribed with statins had a higher rate of bleeding-free survival (P = 0.028). Conclusion: For secondary prevention of stroke in patients with NVAF who are taking dabigatran etexilate, co-prescription with a statin was associated with a lower risk of bleeding complications. Future research is needed to determine the pharmacological mechanism underlying this effect.

Original languageEnglish
Pages (from-to)455-461
Number of pages7
JournalActa Neurologica Scandinavica
Volume139
Issue number5
DOIs
Publication statusPublished - May 1 2019

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hemorrhage
Atrial Fibrillation
Stroke
Secondary Prevention
Antithrombins
Anti-Arrhythmia Agents
Kaplan-Meier Estimate
Primary Prevention
Dabigatran
Aspirin
Multicenter Studies
Prescriptions
Registries
Cardiovascular Diseases
Multivariate Analysis
Outcome Assessment (Health Care)
Pharmacology
Safety
Survival

Keywords

  • anticoagulant
  • atrial fibrillation
  • bleeding
  • co-medication
  • dabigatran
  • statin

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Ho, B. L., Lin, Y. J., Lin, S. F., Chou, P. S., Chen, C. F., Lin, R. T., ... Chao, A. C. (2019). Statins and the risk of bleeding in patients taking dabigatran. Acta Neurologica Scandinavica, 139(5), 455-461. https://doi.org/10.1111/ane.13077

Statins and the risk of bleeding in patients taking dabigatran. / Ho, Bo Lin; Lin, Ya Ju; Lin, Sheng Feng; Chou, Ping Song; Chen, Chien Fu; Lin, Ruey Tay; Hu, Han Hwa; Chao, A. Ching.

In: Acta Neurologica Scandinavica, Vol. 139, No. 5, 01.05.2019, p. 455-461.

Research output: Contribution to journalArticle

Ho, BL, Lin, YJ, Lin, SF, Chou, PS, Chen, CF, Lin, RT, Hu, HH & Chao, AC 2019, 'Statins and the risk of bleeding in patients taking dabigatran', Acta Neurologica Scandinavica, vol. 139, no. 5, pp. 455-461. https://doi.org/10.1111/ane.13077
Ho BL, Lin YJ, Lin SF, Chou PS, Chen CF, Lin RT et al. Statins and the risk of bleeding in patients taking dabigatran. Acta Neurologica Scandinavica. 2019 May 1;139(5):455-461. https://doi.org/10.1111/ane.13077
Ho, Bo Lin ; Lin, Ya Ju ; Lin, Sheng Feng ; Chou, Ping Song ; Chen, Chien Fu ; Lin, Ruey Tay ; Hu, Han Hwa ; Chao, A. Ching. / Statins and the risk of bleeding in patients taking dabigatran. In: Acta Neurologica Scandinavica. 2019 ; Vol. 139, No. 5. pp. 455-461.
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abstract = "Objectives: Dabigatran etexilate is a direct thrombin inhibitor that clinicians increasingly prescribe to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Clinicians also commonly prescribe statins for primary and secondary prevention of cardiovascular diseases. Little is known about the bleeding risk in patients taking a statin and dabigatran together. The aim of this study was to evaluate the safety and persistence of dabigatran after co-medication with statins. Materials and Methods: We performed a prospective, multicenter registry study of stroke patients with NVAF who initiated dabigatran therapy within 3 months after a clinically evident ischemic cerebrovascular event between 2013 and 2017. The main outcome measure was symptomatic bleeding after 90, 180, and 360 days. Results: In total, 652 patients (336 statin users, 316 non-users) were followed for 1 year after dabigatran therapy. Cox multivariate analysis demonstrated that male sex, prior use of aspirin, and concurrent use of an antiarrhythmic drug were associated with a higher risk of bleeding at 360 days. After adjusting time-dependent covariates, statin users had a significantly lower bleeding risk (adjusted hazard ratio: 0.11, P < 0.001) than non-users. Kaplan-Meier analysis indicated that patients prescribed with statins had a higher rate of bleeding-free survival (P = 0.028). Conclusion: For secondary prevention of stroke in patients with NVAF who are taking dabigatran etexilate, co-prescription with a statin was associated with a lower risk of bleeding complications. Future research is needed to determine the pharmacological mechanism underlying this effect.",
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