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Preoperative atorvastatin reduces bleeding and blood products use in patients undergoing on-pump coronary artery bypass grafting

Nenna, Antonioa; Lusini, Marioa; Spadaccio, Cristianob; Nappi, Francescoc; Prestipino, Filippoa; Barbato, Raffaelea; Casacalenda, Adelea; Pugliese, Giuseppea; Barberi, Filippoa; Giacinto, Omara; Petitti, Tommasangelod; Covino, Elvioa; Chello, Massimoa

Journal of Cardiovascular Medicine: December 2017 - Volume 18 - Issue 12 - p 976–982
doi: 10.2459/JCM.0000000000000550
Research articles: Cardiac surgery

Aims Statins are a widely recognized weapon in the primary and secondary prevention of coronary artery disease for their pleiotropic effects. However, recent reports from the cerebrovascular and pharmacological literature are insinuating concerns about a potential increase in the haemorrhagic risk among statin users.

The effect of statins in postoperative bleeding should be carefully investigated in major cardiac surgery that exposes per se to risk of bleeding.

Methods In this retrospective cohort study, we evaluated 441 patients who received atorvastatin until surgery and 213 patients who had never been treated with statins, undergoing elective primary isolated on-pump coronary artery bypass grafting. Postoperative bleedings, blood products use and complications were monitored during hospitalization.

Results Preoperative and intraoperative variables were similar between groups. Early and overall postoperative bleedings were reduced among statin users, who had lower C-reactive protein values in the first postoperative day. Atorvastatin carries a strong protective effect against major bleedings, with a propensity score-adjusted odds ratio of 0.28 (P < 0.01). Also, blood products use for statin-treated patients was lower compared with controls, with fewer transfused patients and fewer red-packed cells units per transfused patient.

Conclusion Preoperative atorvastatin use is associated with reduced risk of bleeding and blood products use after coronary artery bypass grafting, likely due to a reduction in the postoperative inflammatory response. Statin continuation at the highest tolerable dose should be encouraged before cardiac surgery. The preoperative use of statins in cardiac surgery as ‘bleeding-preventers’ might have profound clinical implications.

aDepartment of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy

bDepartment of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK

cDepartment of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France

dDepartment of Public Health and Statistics, Università Campus Bio-Medico di Roma, Rome, Italy

Correspondence to Antonio Nenna, Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy Tel: +39 06 22541 1000; fax: +39 06 22541 1960; e-mail:,

Received 8 April, 2017

Revised 26 June, 2017

Accepted 20 July, 2017

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© 2017 Italian Federation of Cardiology. All rights reserved.