Drug-drug interactions between vitamin K antagonists and statins: a systematic review

source extracted confidence: high 2026-04-09
#anticoagulants #blood-coagulation #drug-interactions #humans #hydroxymethylglutaryl-coa-reductase-inhibitors

Drug-drug interactions between vitamin K antagonists and statins: a systematic review

Engell et al., 2021 | Eur J Clin Pharmacol | Systematic Review

Citation

Engell Anna E, Svendsen Andreas L O, ... Pottegård Anton. Drug-drug interactions between vitamin K antagonists and statins: a systematic review. Eur J Clin Pharmacol. 2021-Oct;77(10):1435-1441. doi:10.1007/s00228-020-03074-w

Abstract

PURPOSE: Concomitant use of vitamin K antagonists (VKA) and statins is frequent in cardiovascular patients. However, clinical guidelines on this drug combination are divergent. Therefore, we performed a systematic review to evaluate the effect of statin initiation on coagulation among VKA users. METHODS: Following the PRISMA guidelines, we applied two broad search strategies for the drug interaction between VKA and statins in both Embase and Pubmed; 8623 unique hits were obtained. In the final sample, eight studies were included. RESULTS: The most frequently used VKA in the studies was warfarin, while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean international normalized ratio (INR) ranged from 0.15-0.65. CONCLUSION: The anticoagulant effect of statin initiation in patients treated with VKA is likely to be of limited clinical relevance but should be evaluated individually.

Key Findings

The most frequently used VKA in the studies was warfarin, while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean international normalized ratio (INR) ranged from 0.15-0.65.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anticoagulants
  • Blood Coagulation
  • Drug Interactions
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • International Normalized Ratio
  • Vitamin K
  • Warfarin

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09