HMG-CoA Reductase Inhibitors and the Modification of Risk for Disseminated Intravascular Coagulation in Patients with Sepsis

Background: Disseminated intravascular coagulation (DIC) is a highly morbid syndrome characterized by uncontrolled activation of coagulation leading to the consumption of clotting factors and platelets and increasing risk for life-threatening hemorrhage. Sepsis is one of the underlying disorders that can provoke DIC. The mechanism of DIC is thought to involve tissue factor overexpression, defective anticoagulation pathways, endothelial and monocytic cytokines, oxidation, and calpains. HMG-CoA reductase inhibitors (statins) have demonstrated anti-inflammatory and mild anti-coagulant properties effecting the pathways proposed to mediate DIC. Objectives: The aim of this study is to evaluate whether septic patients who take statin medications are at reduced risk for the development of DIC. Methods: In a retrospective cohort study, 120,397 critically ill patients with sepsis with and without shock were identified within a three year period from 2019 to 2021. Patients were stratified by whether they were medicated with low, medium, high intensity statins or none. Odds ratios for the development of DIC were calculated. Results: Overall, 2795 patients would develop DIC. The odds ratio for the development of DIC were .700 (95% CI .617-.794), .615 (95% CI .529-.714), and .901 (95% CI .635-1.277) when comparing high, moderate, and low intensity statin therapy to no statin therapy. Conclusion: The use of moderate and high intensity statins correlated with a significantly reduced association between critically ill septic patients and the development of DIC. More research is needed to clarify the potential for this class of medication to be protective against DIC.

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

No relevant conflicts of interest to declare.