Pre-op atorvastatin may lower bleeding during aortic valve replacement

  • Nenna A & al.
  • Interact Cardiovasc Thorac Surg
  • 11 Feb 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Pre-operative atorvastatin use may lower post-operative bleeding, packed red blood cells (PRBC) transfusions and post-operative length of stay in patients undergoing elective isolated aortic valve replacement (AVR).

Why this matters

  • The idea of a beneficial effect of statins on postoperative bleeding has been recently pointed out in coronary surgery and the study findings seem to extend these advantages in the context of aortic valve surgery

Study design

  • Retrospective cohort study of 1145 patients who underwent elective isolated AVR from January 2009 to December 2017 and received pre-operative atorvastatin (n=547) and any statin (control group; n=598).
  • Primary endpoint: overall post-operative bleeding.
  • Secondary endpoint: blood product use (PRBC unit) and post-operative complications, major bleedings and length of stay.
  • Funding: None disclosed.

Key results

  • Atorvastatin vs control group had lower post-operative bleeding in the first 12 hours post-surgery and overall post-operative bleeding (P=.001 for both).
  • Compared with the control group, atorvastatin group showed significant reduction in:
    • incidence of major bleeding (P=.003),
    • transfused PRBC unit (P=.027).
  • Post-operative length of stay was shorter in the atorvastatin group with an average reduction of 1 day in hospitalisation vs the control group (P=.001), and no significant difference was observed in post-operative complication between 2 groups.
  • Post-operative bleeding was higher in patients who received lower atorvastatin doses (40 mg/day) compared with those receiving higher doses (80 mg/day), with a 20% between-group difference (P=.001).

Limitations

  • Retrospective design.

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