JAMA Netw Open

Low LDL-C levels tied to higher bleeding risk in VTE patients

May 19, 2025

Study details: This retrospective cohort study analyzed data from patients with venous thromboembolism (VTE) in the RIETE registry to assess whether low-density lipoprotein cholesterol (LDL-C) levels are associated with bleeding risk during anticoagulation. Patients were stratified by LDL-C levels (<70 mg/dL vs. ≥70 mg/dL), and bleeding outcomes were tracked during treatment.

Results: Among 19,237 VTE patients, 13% had LDL-C <70 mg/dL. These patients were older, more often male, and had higher rates of hypertension, diabetes, arterial disease, anemia, and cancer. During the first 90 days of anticoagulation, low LDL-C was associated with increased bleeding risk (adjusted hazard ratio [AHR] 1.40 overall; 1.49 for nonmajor bleeding), especially hematomas (AHR, 2.11). This risk was independent of statin use and was evident early in treatment.

Clinical impact: While LDL-C lowering is a cornerstone of CV prevention, the findings suggest that very low LDL-C levels may increase bleeding risk in anticoagulated VTE patients. Consider bleeding risk when managing lipid levels in this population, especially in those with additional hemorrhagic risk factors.

Source:

Siniscalchi C, et al; RIETE Investigators. (2025, May 1). JAMA Netw Open. Low-Density Lipoprotein Cholesterol Levels and Bleeding Risk in Venous Thromboembolism. https://pubmed.ncbi.nlm.nih.gov/40343701/