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VANCOUVER, British Columbia -- Patients taking blood thinners who were also prescribed statins had a lower risk of gastrointestinal bleeding, no matter what type of blood thinner was used, a retrospective analysis suggested.

Of the over 17 million people on blood thinners in the Epic Cosmos database, 11.2% experienced gastrointestinal bleeding compared with 4.4% of the over 10.6 million people on a blood thinner and statin, reported Azfar Niazi, MD, a resident at the Greater Baltimore Medical Center in Towson, Maryland, during the American College of Gastroenterology annual meeting.

"Our study suggests a potential association between statin use and a reduced risk of gastrointestinal bleeding in patients receiving a blood thinner," Niazi told MedPage Today at his poster presentation. "These findings provide a basis for further investigation and may contribute to the development of strategies to optimize the management of patients requiring both blood thinners and statins."

He said the relationship appeared to be consistent across different types of blood thinners. "I wanted to see if this overall picture held true among the different categories of blood thinners, and I did find the same trend."

Of the patients using aspirin as a blood thinner, 11.5% had gastrointestinal bleeds as noted on their hospital codes, versus 4.6% of those who were taking statins with aspirin (P<0.0001). There were also significant differences for patients on warfarin (16.9% vs 7.8% with statins) and direct oral anticoagulants (15.5% vs 7.1% with statins; both P<0.0001).

Commenting on the study, Franklyn Wallace, MD, a resident in internal medicine at the Mayo Clinic in Rochester, Minnesota, told MedPage Today, "I would be interested in knowing whether these bleeds were in the upper or lower gastrointestinal tract. I also would be interested in knowing if the effect was just in upper gastrointestinal bleeding, which is most often seen with blood thinner use, or if there is also an effect on lower gastrointestinal bleeding."

"I am still trying to wrap my head around the biologic plausibility of how statins could reduce bleeding, but there might be others things going on, like use of other medications that could affect bleeding," he added.

Niazi said his group will try to determine whether there is an effect on bleeding in both the upper and lower gastrointestinal tract, and also whether there is a dose-dependent response -- whether high-intensity statins have a greater effect in reducing gastrointestinal bleeding.

"Because of the nature of this retrospective study, we cannot make any recommendations as to whether statins should be prescribed," Niazi said.

He and his colleagues are also trying to tease out why statins were associated with reduced bleeding. Statins are known to have many other properties aside from lowering cholesterol, Niazi said, and the role that statins have in reducing inflammation may be a good starting place.

For this study, Niazi and colleagues retrieved data from the database, which includes 190 million individuals, for the period from January 2016 through December 2022. The patient population was restricted to those using blood thinners. They were stratified by whether they were using blood thinners alone or with statins, and then further stratified by the general category of blood thinners.

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