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Statins are associated with lower risk of gastrointestinal bleeding in patients with unstable coronary syndromes: analysis of the Orbofiban in Patients with Unstable coronary Syndromes-Thrombolysis In Myocardial Infarction 16 (OPUS-TIMI 16) trial.
- Source :
-
American heart journal [Am Heart J] 2006 May; Vol. 151 (5), pp. 976.e1-6. - Publication Year :
- 2006
-
Abstract
- Background: It has recently been shown that statins increase the myocardial content of prostaglandin (PG) I2 (prostacyclin) and PGE2. A systemic increase of PG production may protect the gastric mucosa and prevent gastrointestinal (GI) bleeding. We hypothesized that statins would lower the risk of GI bleeding associated with antiplatelet therapy in patients with acute coronary syndromes (ACS).<br />Methods: We retrospectively analyzed data on 10288 patients with ACS included in the OPUS-TIMI 16 trial and received aspirin and either the oral IIb/IIIa inhibitor orbofiban or placebo.<br />Results: Inhospital GI bleeding rate was significantly lower in patients who were receiving lipid-lowering drugs before admission compared with those who were not (0.2% vs 0.6%, P = .031). Throughout 10 months of follow-up, GI bleeding occurred in 1.8% of non-statin users compared with 1.0% of statin users (P = .001). Statin use was associated with less overall bleeding in both the orbofiban (1.4% vs 2.4%, P = .006) and the placebo groups (0.2% vs 0.8%, P = .047). Severe and major bleeding occurred less frequently with statin use (0.8% vs 1.5%, P = .001) in both the orbofiban (1.1% vs 2.0%, P = .006) and the placebo groups (0.1% vs 0.5%, P = .119). Logistic regression analysis showed that age > 65 years, orbofiban treatment, Killip class > 1, history of cerebrovascular disease, and calcium-channel blocker use were associated with higher risk of GI bleeding, whereas statin therapy was associated with a lower risk (odds ratio 0.68, 95% CI 0.45-1.04, P = .079).<br />Conclusions: Statins may exert protective effect against GI bleeding in patients with ACS. Additional studies are warranted to explore this additional potential benefit of statins.
- Subjects :
- Acute Disease
Administration, Oral
Aged
Alanine administration & dosage
Alanine adverse effects
Alanine therapeutic use
Anticoagulants adverse effects
Anticoagulants therapeutic use
Aspirin adverse effects
Aspirin therapeutic use
Female
Gastrointestinal Hemorrhage epidemiology
Gastrointestinal Hemorrhage physiopathology
Hospitalization
Humans
Incidence
Male
Middle Aged
Patient Discharge
Pyrrolidines administration & dosage
Pyrrolidines therapeutic use
Retrospective Studies
Risk Assessment
Severity of Illness Index
Syndrome
Coronary Disease drug therapy
Gastrointestinal Hemorrhage chemically induced
Gastrointestinal Hemorrhage prevention & control
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors
Pyrrolidines adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6744
- Volume :
- 151
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 16644315
- Full Text :
- https://doi.org/10.1016/j.ahj.2006.02.013