Safety of fluvastatin in patients undergoing high-risk non-cardiac surgery.
BACKGROUND
In patients undergoing vascular surgery there is a high incidence of adverse cardiac events, due to sudden coronary plaque rupture. The non-lipid lowering or pleiotropic effects of statins can help reduce adverse cardiovascular events associated with vascular surgery.


METHODS
The evidence for perioperative use of fluvastatin, as well as other statins, in high-risk surgery patients is summarized in this review. Data on pharmacokinetics and metabolism is presented, together with considerations on possible drug interactions in the perioperative period.


RESULTS
The reader will gain a comprehensive understanding of the existing safety and efficacy data for fluvastatin and other statins in the perioperative period. The practical considerations of perioperative fluvastatin therapy will be presented, including potential side-effects and management of the early non-oral phase immediately post surgery. Finally, advice on when to initiate therapy and safety recommendations are offered.


CONCLUSIONS
In patients scheduled for high-risk vascular surgery, fluvastatin improves postoperative outcome, reducing the incidence of myocardial damage by approximately 50% in the first 30 days following vascular surgery. In comparison with placebo, fluvastatin was not associated with a rise in liver enzymes or creatine kinase levels. To bridge the non-oral phase, an extended-release formula is recommended.
Voûte
Michiel T
MT
Department of Vascular Surgery, Suite Z-838, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Winkel
Tamara A
TA
Poldermans
Don
D
D000284:Administration, Oral; D000777:Anesthetics / Q000493:pharmacokinetics; D001711:Biotransformation; D006348:Cardiac Surgical Procedures; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D003692:Delayed-Action Preparations; D004347:Drug Interactions; D005229:Fatty Acids, Monounsaturated / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D000077340:Fluvastatin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D007211:Indoles / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D009135:Muscular Diseases / Q000453:epidemiology / Q000209:etiology; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control*; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000188:drug therapy*; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D012422:Rupture, Spontaneous / Q000517:prevention & control; D013375:Substance Withdrawal Syndrome / Q000209:etiology
D000777:Anesthetics; D003692:Delayed-Action Preparations; D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D000077340:Fluvastatin; D003577:Cytochrome P-450 Enzyme System