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

Anna E. Engell*, Andreas L.O. Svendsen, Bent S. Lind, Tore Bjerregaard Stage, Maja Hellfritzsch, Anton Pottegård

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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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.

Original languageEnglish
JournalEuropean Journal of Clinical Pharmacology
Issue number10
Pages (from-to)1435-1441
Publication statusPublished - Oct 2021


  • Anticoagulants
  • Drug interactions
  • Statins
  • Vitamin K antagonists
  • Warfarin


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