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HMG-CoA reductase inhibitors and the attenuation of risk for disseminated intravascular coagulation in patients with sepsis

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Abstract

Background

Disseminated Intravascular Coagulation (DIC) is a syndrome of dysregulated coagulation. Patients with sepsis are at increased risk for DIC. HMG-CoA Reductase Inhibitors (Statins) are primarily used as lipid-lowering agents; however, studies have suggested statins may possess anti-inflammatory, antithrombotic, anticoagulant, and endothelial stabilizing properties. These mechanisms may oppose those that underlie the pathogenesis of septic DIC.

Methods

To evaluate whether statins may be protective against the development of DIC, we conducted a multi-center, retrospective case-control study where 86,638 critically ill patients admitted to the ICU with sepsis, severe sepsis or septic shock were identified during a 3-year period. Patients who developed DIC during their hospitalization were identified and stratified by whether they received a statin or not during their hospitalization. Odds ratios for development of DIC was calculated by composite of any statin, as well as low, moderate, and high intensity statins.

Results

2236 patients would develop DIC compared to 84,402 who did not. The use of any statin was associated with a reduced likelihood for developing DIC (odds ratio [OR], 0.69; 95% CI, 0.61–0.78). This was observed with use of both moderate (OR, 0.64; 95% CI, 0.53–0.77) and high (OR, 0.72; 95% CI, 0.61–0.84) but not low intensity statins (OR, 0.84; 95% CI, 0.53–1.32).

Conclusions

The use of moderate and high intensity statins was associated with a significantly reduced odds of developing DIC in critically ill patients with sepsis. This present study may be the first to suggest that statin medications may independently reduce the frequency of DIC in critically ill patients with severe sepsis or septic shock. More research is needed to investigate the potential for this class of medication to be protective against DIC.

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Acknowledgements

We would like to thank Jacob Clute for his assistance with statistical analysis and Marley Morrell, BS, for assistance with graphic design.

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  1. Portsmouth Regional Hospital Internal Medicine Residency Program, HCA Healthcare/Tufts University School of Medicine, 333 Borthwick Ave. Portsmouth, New Hampshire, 03801, USA

    Nicholas B. Alana & William A. Ciurylo

  2. HCA Healthcare, 2000 Health Park Drive, Brentwood, TN, 37027, UK

    Natalie Hurlock

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Correspondence to Nicholas B. Alana.

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Alana, N.B., Ciurylo, W.A. & Hurlock, N. HMG-CoA reductase inhibitors and the attenuation of risk for disseminated intravascular coagulation in patients with sepsis. J Thromb Thrombolysis 57, 260–268 (2024). https://doi.org/10.1007/s11239-023-02910-x

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