• Orthopaedic Procedures
• Orthopaedics Clinical Trials
• Hip & Knee Conditions
• Thrombotic Disorders

• Orthopaedics
• Orthopaedic Procedures
• Orthopaedics Clinical Trials
• Hip & Knee Conditions
• Thrombotic Disorders

Statins reduce postoperative venous thromboembolism (VTE) events in patients undergoing elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). Katherine Criner, MD, Temple University Hospital, Philadelphia, Pennsylvania, USA, presented data from a retrospective study that evaluated the effect of statin use on postoperative VTE in patients who had undergone total knee or hip replacement.

VTE encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) and is a frequent complication of orthopedic surgery. Without appropriate prophylaxis, DVT occurs in 50% and 84% of patients that have undergone THA or TKA, respectively, and PE occurs in 20% and 7%. In addition to their effect on cholesterol levels, statins have anti-inflammatory and antithrombotic effects [Paumelle R, Staels B. Cir Res 2007; Liao JK, Laufs U. Annu Rev Pharmacol Toxicol 2005]. The purpose of this study was to determine if the addition of statins to standard VTE prophylaxis would reduce VTE following THA or TKA.

The retrospective chart review included patients who had undergone THA or TKA and were administered postoperative VTE prophylaxis between 2005 and 2012. Patients who experienced coagulopathy, underwent revision arthroplasty, had taken hormone replacement therapy, or were diagnosed with a fracture were excluded from the review. The follow-up period was a minimum of 11 months and the primary outcome was symptomatic VTE confirmed by venous duplex ultrasonography and computed tomography (CT) angiogram of the thorax.

In the study, 417 patients were assigned to receive no statin or a statin based on their perioperative statin status—patients that were taking a statin prior to surgery maintained the same dose during and after the procedure, whereas patients not taking a statin received only standard VTE prophylaxis. All patients received standard VTE prophylaxis following THA or TKA surgery. The mean age was 65 to 66 years, about half of the study population was African American and one third was white. The mean body mass index was 33 kg/m², with 61% of the study population considered obese. In addition, about a third of participants had diabetes mellitus. A majority of the population underwent TKA (77% to 80%), and the mean tourniquet times were similar, with a range of 52 to 54 minutes.

There was a significant reduction in postoperative VTE events in patients who received statins in addition to standard VTE prophylaxis resulting in a relative risk of 0.529 (95% CI, 0.295 to 0.946; Chi-squared p<0.041). The absolute relative risk was 0.068 (95% CI, 0.007 to 0.129), and the number needed to treat was 14 (95% CI, 139 to 8). The overall rate of postoperative VTE was 11.3%, with 7.7% occurring in patients who received statins and 14.5% occurring in patients who did not receive statins (p=0.027; Table 1). When the data were stratified, there was a trend of decreased DVT and PE in the statin arm compared with the arm that did not receive statins (p=0.192 and p=0.324, respectively). There were no fatal PEs. The mean time to VTE event was 6.5 days in the patients who received statins and 36.1 days in patients who did not receive statins.

Dr. Criner pointed out that the addition of statins resulted in a reduction of VTE risk by 48%. She stated that, in her opinion, the data from this retrospective chart review suggest that the addition of statins to standard VTE prophylaxis appears to have a protective effect in patients undergoing TKA or THA.

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