Background/Purpose: Patients undergoing hip and knee arthroplasty are at high risk of venous thromboembolism (VTE). HMG Co-A reductases (“statins”) can reduce the risk of post-operative cardiovascular complications in some populations undergoing cardiac or non-cardiac surgery, and may reduce the risk of venous thromboembolism (VTE) in healthy adults.  We used the Hospital for Special Surgery Legacy Registry (HSS Registry) to determine whether statins protect against VTE after arthroplasty. 

Methods: Of the 20,764 patients in the HSS Registry who underwent hip or knee arthroplasty between July 1, 2007 and December 31, 2011, 16183 returned 6-month questionnaires.  VTE was identified using hospital discharge ICD-9 codes and self report on 6-month questionnaires. Self-reports of VTE were validated through a structured telephone interview.  Among the patients who returned 6-month questionnaires, 230 patients (1.4%) experienced VTE postoperatively (76 pulmonary embolism (PE), 173 deep vein thrombosis (DVT), 19 both). We performed logistic regression to determine the risk of postoperative VTE in patients taking statins.  

Results: Forty percent of patients in the HSS Registry were on statins.  Compared to patients not on statins, patients on statins were older (68.9 vs 63 years), heavier (BMI 29.6 vs 28.3) and more commonly male (49.2% vs 38.5%).  More patients on statins underwent knee (as opposed to hip) arthroplasty (52.4% vs 42.9%) and fewer underwent bilateral arthroplasty (6.5% vs 9.4%). Patients on statins had a longer length of stay (5.0 vs 4.9 days) and were more commonly discharged to a rehabilitation center (46.9% vs 37.9%).  More patients on statins had coronary artery disease (22.5% vs 4.2%), congestive heart failure (1.5% vs 0.7%), and diabetes (15% vs 5.7%) while fewer had rheumatoid arthritis (2.75% vs 4.1%). More patients on statins received warfarin rather than aspirin as VTE prophylaxis (61.8% vs 50.6%).  These differences were all significant, p<0.001.  In logistic regression analysis statins were associated with a lower rate of PE (OR 0.6, 95% CI 0.4-0.98) but not DVT (OR 1.3, 95% CI 0.9-1.7) or total VTE (OR 0.97, 95% CI 0.7-1.3). 

Conclusion: In this observational cohort, statins protected against PE but not total VTE following hip or knee arthroplasty.  Given significant differences in the characteristics of patients on statins and those not on statins, a prospective randomized controlled trial is needed to determine whether statins protect these patients from VTE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-statin-therapy-on-venous-thromboembolism-after-hip-or-knee-arthroplasty/