ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2017
Association between statin use and ischemic stroke or major hemorrhage in patients taking dabigatran for atrial fibrillation.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- The Effect of Statin Treatment on Outcomes of Cardioembolic Stroke: A Systematic Review and Meta-Analysis of Real-World Studies.CNS drugs · 2021Pooled it
- Comparative Effectiveness and Safety of Direct Oral Anticoagulants: Overview of Systematic Reviews.Drug safety · 2019Pooled it
- Pooled it
- Pleiotropic Effects of Statins: Focus on Endothelial Function, Plaque Stability and Thrombosis (Part II).Current atherosclerosis reports · 2026Review
- The Effect of Statins on Bleeding in Isolated Coronary Artery Bypass Grafting Statins in CABG.Journal of clinical medicine · 2025Article
- Association Between Statins Use and Major Bleeding in Patients Using Direct Oral Anticoagulants for Atrial Fibrillation.Pharmacoepidemiology and drug safety · 2025Article
- Type 2 statin use increased perioperative blood loss in primary reverse total shoulder arthroplasty.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Statins during Anticoagulation for Emergency Life-Threatening Venous Thromboembolism: A Review.Medicina (Kaunas, Lithuania) · 2024Review
- Low-Density Lipoprotein Cholesterol-Lowering Drugs: A Narrative Review.Journal of clinical medicine · 2024Review
- Statins Effects on Blood Clotting: A Review.Cells · 2023Review
- Effects of Simvastatin on Pharmacokinetics and Anticoagulant Effects of Dabigatran in Healthy Subjects.Pharmaceuticals (Basel, Switzerland) · 2023Article
- DOAC drug interactions management resource.Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC · 2022Article
- Drug-Drug Interactions of Direct Oral Anticoagulants (DOACs): From Pharmacological to Clinical Practice.Pharmaceutics · 2022Review
- Concurrent use of statins decreases major bleeding and intracerebral hemorrhage in non-valvular atrial fibrillation patients taking direct oral anticoagulants-A nationwide cohort study.Frontiers in cardiovascular medicine · 2022Article
- Prescription patterns of direct oral anticoagulants and concomitant use of interacting medications in the Netherlands.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2021Article
- The risk of major bleeding event in patients with chronic kidney disease on pentoxifylline treatment.Scientific reports · 2021Article
- Drug interactions of direct oral anticoagulants in elderly patients with cardiometabolic diseases.Current research in pharmacology and drug discovery · 2021Review
- Edoxaban and the Issue of Drug-Drug Interactions: From Pharmacology to Clinical Practice.Drugs · 2020Review
- Risk of major bleeding among users of direct oral anticoagulants combined with interacting drugs: A population-based nested case-control study.British journal of clinical pharmacology · 2020Article
- Effect of Statin Therapy on Outcomes of Patients With Acute Ischemic Stroke and Atrial Fibrillation.Journal of the American Heart Association · 2019Article
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDabigatran etexilate is a prodrug whose absorption is opposed by intestinal P-glycoprotein and which is converted by carboxylesterase to its active form, dabigatran. Unlike other statins, simvastatin and lovastatin are potent inhibitors of P-glycoprotein and carboxylesterase, and might either increase the risk of hemorrhage with dabigatran etexilate or decrease its effectiveness.
methodsWe conducted 2 population-based, nested case-control studies involving Ontario residents 66 years of age and older who started dabigatran etexilate between May 1, 2012, and Mar. 31, 2014. In the first study, cases were patients with ischemic stroke; in the second, cases were patients with major hemorrhage. Each case was matched with up to 4 controls by age and sex. All cases and controls received a single statin in the 60 days preceding the index date. We determined the association between each outcome and the use of simvastatin or lovastatin, relative to other statins.
resultsAmong 45 991 patients taking dabigatran etexilate, we identified 397 cases with ischemic stroke and 1117 cases with major hemorrhage. After multivariable adjustment, use of simvastatin or lovastatin was not associated with an increased risk of stroke (adjusted odds ratio [OR] 1.33, 95% confidence interval [CI] 0.88 to 2.01). In contrast, use of simvastatin and lovastatin were associated with a higher risk of major hemorrhage (adjusted OR 1.46, 95% CI 1.17 to 1.82).
interpretationIn patients receiving dabigatran etexilate, simvastatin and lovastatin were associated with a higher risk of major hemorrhage relative to other statins. Preferential use of the other statins should be considered in these patients.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.