Article information
Abstract
Administration of statins has been shown to be effective in reducing cardiovascular mortality. Their benefit could expand towards other areas of intensive medicine, it being possible to decrease mortality of the critically ill patient. There are several studies, although without a high level of evidence, that have detected a possible benefit when they are administered as well as clinical deterioration when they are discontinued, compared to those patients who had previously taken them.
Even though most of the patients who had previously taken statins did so as primary or secondary prevention, thus having greater comorbidity, overall, a decrease is detected in the mortality of these subgroups. This benefit could be generalized to all the critical conditions, although studies with a higher level of evidence are needed for their adequate comparison.
Keywords:
Statins
Critically ill patient
Sepsis
Mortality
Resumen
La administración de estatinas se ha mostrado eficaz en reducir la mortalidad cardiovascular. Su beneficio podría expandirse hacia otras áreas de la medicina intensiva, pudiendo disminuir la mortalidad del paciente críticamente enfermo. Existen diversos estudios, aunque sin un alto nivel de evidencia, en el que parece detectarse un posible beneficio en su administración, y un empeoramiento clínico con la discontinuación de estos fármacos, sobre los pacientes que previamente las tomaban.
A pesar de que la mayoría de los pacientes que tomaban previamente estatinas lo hacían como prevención primaria o secundaria, teniendo por tanto una mayor comorbilidad, en global se detecta una disminución de la mortalidad en dichos subgrupos. Este beneficio podría ser generalizado ante toda la patología crítica, aunque se requieren estudios con un mayor nivel de evidencia, para su adecuada contrastación.
Palabras clave:
Estatinas
Paciente críticamente enfermo
Sepsis
Mortalidad
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References
[1.]
M. Ruiz Bailén, L. Rucabado Aguilar, A. López Martínez.
Aturdimiento miocárdico neurogénico.
Med Intensiva, 30 (2006), pp. 13-18
[2.]
W. Pan, T. Pintar, J. Anton, V.V. Lee, W.K. Vaughn, C.D. Collard.
Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery.
Circulation, 110 (2004), pp. II45-II49
[3.]
I.S. Ali, K.J. Buth.
Preoperative statin use and outcomes following cardiac surgery.
Int J Cardiol, 103 (2005), pp. 12-18
[4.]
C.D. Collard, S.C. Body, S.K. Shirnan, S. Wang, D.T. Mangano.
Preoperative statin therapy is associated with reduced cardiac mortality after coronary artery bypass graft surgery.
J Thorac Cardiovasc Surg, 132 (2006), pp. 392-400
[5.]
M. Chello, A. Anselmi, C. Spadaccio, G. Patti, C. Goffredo, G. Di Sciascio, et al.
Simvastatin increases neutrophil apoptosis and reduces inflammatory reaction after coronary surgery.
Ann Thorac Surg, 83 (2007), pp. 1374-1380
[6.]
O.J. Liakopoulos, Y.H. Choi, P.L. Haldenwang, J. Strauch, T. Wittwer, H. Dorge, et al.
Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30.000 patients.
Eur Heart J, 29 (2008), pp. 1548-1549
[7.]
A. Ouattara, H. Benhaoua, Y. Le Manach, N. Mabrouk-Zerguini, O. Itani, A. Osman, et al.
Perioperative statin therapy is associated with a significant and dose-dependent reduction of adverse cardiovascular outcomes after coronary artery bypass graft surgery.
J Cardiothorac Vasc Anesth, 23 (2009), pp. 633-638
[8.]
A.D. Ryding, S. Kumar, A.M. Worthington, D. Burgess.
Prognostic value of brain natriuretic peptide in noncardiac surgery: a meta-analysis.
Anesthesiology, 111 (2009), pp. 311-319
[9.]
D.T. Mangano.
Adverse outcomes after surgery in the year 2001−a continuing odyssey.
Anesthesiology, 88 (1998), pp. 561-564
[10.]
D. Poldermans, J.J. Bax, M.D. Kertai, B. Krenning, C.M. Westerhout, A.F. Schinkel, et al.
Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery.
Circulation, 107 (2003), pp. 1848-1851
[11.]
M.D. Kertai, E. Boersma, C.M. Westerhout, J. Klein, H. Van Urk, J.J. Bax, et al.
A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery.
Eur J Vasc Endovasc Surg, 28 (2004), pp. 343-352
[12.]
P.K. Lindenauer, P. Pekow, K. Wang, B. Gutierrez, E.M. Benjamin.
Lipidlowering therapy and in-hospital mortality following major noncardiac surgery.
JAMA, 291 (2004), pp. 2092-2099
[13.]
K. O’Neil-Callahan, G. Katsimaglis, M.R. Tepper, J. Ryan, C. Mosby, J.P.A. Ioannidis, et al.
Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the statins for risk reduction in surgery (StaRRS) study.
J Am Coll Cardiol, 45 (2005), pp. 336-342
[14.]
T.A. Winkel, O. Schouten, J.P. van Kuijk, H.J. Verhagen, J.J. Bax, D. Poldermans.
Perioperative asymptomatic cardiac damage after endovascular abdominal aneurysm repair is associated with poor long-term outcome.
J Vasc Surg, 50 (2009), pp. 749-754
[15.]
H.H. Feringa, J.J. Bax, S. Hoeks, V.H. van Waning, A. Elhendy, S. Karagiannis, et al.
A prognostic risk index for long-term mortality in patients with peripheral arterial disease.
Arch Intern Med, 167 (2007), pp. 2482-2489
[16.]
M.A. Corriere, M.S. Edwards, J.D. Pearce, J.S. Andrews, R.L. Geary, K.J. Hansen.
Restenosis after renal artery angioplasty and stenting: Incidence and risk factors.
Vasc Surg, 50 (2009), pp. 813-819
[17.]
A. Schanzer, N. Hevelone, C.D. Owens, J.A. Beckman, M. Belkin, M.S. Conte.
Statins are independently associated with reduced mortality in patients undergoing infrainguinal bypass graft surgery for critical limb ischemia.
Vasc Surg, 47 (2008), pp. 774-781
[18.]
A.E. Durazzo, F.S. Machado, D.T. Ikeoka, C. De Bernoche, M.C. Monachini, P. Puech-Leao, et al.
Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial.
J Vasc Surg, 39 (2004), pp. 967-975
[19.]
M. Dunkelgrun, E. Boersma, O. Schouten, A.W. Koopman-Van Gemert, F. Van Poorten, J.J. Bax, Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group, et al.
Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediaterisk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV).
Ann Surg, 249 (2009), pp. 921-926
[20.]
H. Wu, D. Lu, H. Jiang, Y. Xiong, C. Qu, B. Li, et al.
Increase in phosphorylation of Akt and its downstream signaling targets and suppression of apoptosis by simvastatin after traumatic brain injury.
J Neurosurg, 109 (2008), pp. 691-698
[21.]
R. Pannu, D.K. Christie, E. Barbosa, I. Singh, A.K. Singh.
Post-trauma Lipitor treatmentprevents endothelial dysfunction, facilitates neuroprotection, and promotes locomotor recovery following spinal cord injury.
J Neurochem, 101 (2007), pp. 182-200
[22.]
M.J. McGirt, J.R. Lynch, A. Parra, H. Sheng, R.D. Pearlstein, D.T. Laskowitz, et al.
Simvastatin increases endothelial nitric oxide synthase and ameliorates cerebral vasospasm resulting from subarachnoid hemorrhage.
Stroke, 33 (2002), pp. 2950-2956
[23.]
M.J. McGirt, G. Pradilla, F.G. Legnani, Q.A. Thai, P.F. Recinos, R.J. Tamargo, et al.
Systemic administration of simvastatin after the onset of experimental subarachnoid hemorrhage attenuates cerebral vasospasm.
Neurosurgery, 58 (2006), pp. 945-951
[24.]
M.J. McGirt, G.L. Garces Ambrossi, J. Huang, R.J. Tamargo.
Simvastatin for the prevention of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a single-institution prospective cohort study.
J Neurosurg, 110 (2009), pp. 968-974
[25.]
A. Parra, K.T. Kreiter, S. Williams, R. Sciacca, W.J. Mack, A.M. Naidech, et al.
Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurismal subarachnoid hemorrhage: a matched controlled cohort study.
Neurosurgery, 56 (2005), pp. 476-484
[26.]
J.R. Lynch, H. Wang, M.J. McGirt, J. Floyd, A.H. Friedman, A.L. Coon, et al.
Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial.
Stroke, 36 (2005), pp. 2024-2026
[27.]
S.H. Chou, E.E. Smith, N. Badjatia, R.G. Nogueira, J.R. Sims, C.S. Ogilvy, et al.
Randomized, double-blind, placebo-controlled pilot study of simvastatin in aneurismal subarachnoid hemorrhage.
Stroke, 39 (2008), pp. 2891-2893
[28.]
R. Risselada, H. Straatman, F. Van Kooten, D.W. Dippel, A. Van der Lugt, W.J. Niessen, et al.
Withdrawal of statins and risk of subarachnoid hemorrhage.
Stroke, 40 (2009), pp. 2887-2892
[29.]
A.B. Sihgahl, M.A. Topcuoglu, D.J. Dorer, C.S. Ogilvy, B.S. Carter, W.J. Koroshetz.
SSRI and statin use increases the risk for vasospasm after subarachnoid hemorrhage.
Neurology, 64 (2005), pp. 1008-1013
[30.]
G.G. Schwartz, A.G. Olsson, M.D. Ezekowitz, P. Ganz, M.F. Oliver, D. Waters, et al.
Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) StudyInvestigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial.
JAMA, 285 (2001), pp. 1711-1718
[31.]
P. Amarenco, J. Bogousslavsky, A. Callahan, L.B. Goldstein, M. Hennerici, A.E. Rudolph, et al.
Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. Highdose atorvastatin after stroke or transient ischemic attack.
N Engl J Med, 355 (2006), pp. 549-559
[32.]
S. Aslanyan, C.J. Weir, G.T. McInnes, J.L. Reid, M.R. Walters, K.R. Lees.
Statin administration prior to ischaemic stroke onset and survival: exploratory evidence from matched treatment-control study.
Eur J Neurol, 12 (2005), pp. 493-498
[33.]
P. Amarenco, O. Benavente, L.B. Goldstein, A. Callahan, H. Sillesen, M.G. Hennerici, et al.
Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators. Results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial by stroke subtypes.
Stroke, 40 (2009), pp. 1405-1409
[34.]
P.C. Lavallée, J. Labreuche, F. Gongora-Rivera, A. Jaramillo, D. Brenner, I.F. Klein, et al.
Lacunar-BICHAT Investigators. Placebo-controlled trial of high-dose atorvastatin in patients with severe cerebral small vessel disease.
Stroke, 40 (2009), pp. 1721-1728
[35.]
N. Meier, K. Nedeltchev, C. Brekenfeld, A. Galimanis, U. Fischer, O. Findling, et al.
Prior statin use, intracranial hemorrhage, and outcome after intra-arterial thrombolysis for acute ischemic stroke.
Stroke, 40 (2009), pp. 1729-1737
[36.]
S. Greisenegger, M. Mullner, S. Tentschert, W. Lang, W. Lalouschek.
Effect of preteatment with statins on the severity of acute ischemic cerebrovascular events.
J Neurol Sci, 221 (2004), pp. 1-2
[37.]
M.D. Vergouvwen, R.J. de Haan, M. Vermeulen, Y.B. Roos.
Statin treatment and the occurrence of hemorrhagic stroke in patients with a history of cerebrovascular disease.
Stroke, 39 (2008), pp. 497-502
[38.]
N.S. Naval, T.A. Abdelhak, N. Urrunaga, P. Zeballos, M.A. Mirski, J.R. Carhuapoma.
An association of prior statin use with decreased perihematomal edema.
Neurocrit Care, 8 (2008), pp. 13-18
[39.]
N.S. Naval, T.A. Abdelhak, P. Zeballos, N. Urrunaga, M.A. Mirski, J.R. Carhuapoma.
Prior statin use reduces mortality in intracerebral hemorrhage.
Neurocrit Care, 8 (2008), pp. 6-12
[40.]
R.R. Leker, S.T. Khoury, G. Rafaeli, R. Shwartz, R. Eichel, D. Tanne.
NASIS Investigators. Prior use of statins improves outcome in patients with intracerebral hemorrhage: prospective data from the National Acute Stroke Israeli Surveys (NASIS).
Stroke, 40 (2009), pp. 2581-2584
[41.]
H. Tapia-Perez, M. Sanchez-Aguilar, J.G. Torres-Corzo, I. Rodriguez-Leyva, D. Gonzalez-Aguirre, A. Gordillo-Moscoso, et al.
Use of statins for the treatment of spontaneous intracerebral hemorrhage: results of a pilot study.
Cen Eur Neurosurg, 70 (2009), pp. 15-20
[42.]
N.S. Naval, M.A. Mirski, J.R. Carhuapoma.
Impact of statins on validation of ICH mortality prediction models.
Neurol Res, 31 (2009), pp. 425-429
[43.]
P.J. Van der Most, A.M. Dolga, I.M. Nijholt, P.G. Luiten, U.L. Eisel.
Statins: mechanisms of neuroprotection.
Prog Neurobiol, 88 (2009), pp. 64-75
[44.]
A.I. Blamoun, G.N. Batty, V.A. DeBari, A.O. Rashid, M. Sheikh, M.A. Khan.
Statins may reduce episodes of exacerbation and the requirement for intubation in patients with COPD: evidence from a retrospective cohort study.
Int J Clin Pract, 62 (2008), pp. 1373-1378
[45.]
P. De Lucas-Ramos, J.L. Izquierdo-Alonso, J.M. Rodríguez-González Moro, J.M. Bellón-Cano, J. Ancochea-Bermúdez, M. Calle-Rubio, et al.
Factores de riesgo cardiovascular en la enfermedad pulmonar obstructiva crónica. El estudio ARCE.
Arch Bronconeumol, 44 (2008), pp. 233-238
[46.]
F.J. Frost, H. Petersen, K. Tollestrup, B. Skipper.
Influenza and COPD mortality protection as pleiotropic, dose-dependent effects of statins.
Chest, 131 (2007), pp. 1006-1012
[47.]
Y.R. Van Gestel, S.E. Hoeks, D.D. Sin, C. Simsek, G.M. Welten, O. Schouten, et al.
Effect of statin therapy on mortality in patients with peripheral arterial disease and comparison of those with versus without associated chronic obstructive pulmonary disease.
Am J Cardiol, 102 (2008), pp. 192-196
[48.]
M. Imamura, K. Okunishi, H. Ohtsu, K. Nakagome, H. Harada, R. Tanaka, et al.
Pravastatin attenuates allergic airway inflammation by suppressing antigen sensitisation, interleukin 17 production and antigen presentation in the lung.
Thorax, 64 (2009), pp. 44-49
[49.]
S. Takahashi, H. Nakamura, M. Seki, Y. Shiraishi, M. Yamamoto, M. Furuuchi, et al.
Reversal of elastase-induced pulmonary emphysema and promotion of alveolar epithelial cell proliferation by simvastatin in mice.
Am J Physiol Lung Cell Mol Physiol, 294 (2008), pp. L882-L890
[50.]
J.H. Lee, D.S. Lee, E.K. Kim, K.H. Choe, Y.M. Oh, T.S. Shim, et al.
Simvastatin inhibits cigarette smoking-induced emphysema and pulmonary hypertension in rat lungs.
Am J Respir Crit Care Med, 172 (2005), pp. 987-993
[51.]
Irish Critical Care Trials Group.
Acute lung injury and the acute respiratory distress syndrome in Ireland: a prospective audit of epidemiology and management.
Crit Care, 12 (2008), pp. R30
[52.]
D.J. Kor, R. Iscimen, M. Yilmaz, M.J. Brown, D.R. Brown, O. Gajic.
Statin administration did not influence the progression of lung injury or associated organ failures in a cohort of patients with acute lung injury.
Intensive Care Med, 35 (2009), pp. 1039-1046
[53.]
R.J. Glynn, E. Danielson, F.A. Fonseca, J. Genest, A.M. Gotto, J.J. Kastelein, et al.
A randomized trial of rosuvastatin in the prevention of venous thromboembolism.
N Engl J Med, 360 (2009), pp. 1851-1861
[54.]
J.G. Abraldes, A. Albillos, R. Bañares, J. Turnes, R. González, J.C. García- Pagán, et al.
Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial.
Gastroenterology, 136 (2009), pp. 1651-1658
[55.]
J.E. Slotta, M.W. Laschke, Y. Wang, M.K. Schilling, M.D. Menger, H. Thorlacius.
Inhibition of 3-hydroxy-3-methyl-glutarylcoenzyme A reductase reduces leukocyte recruitment and hepatocyte apoptosis in endotoxin-induced liver injury.
J Investig Med, 57 (2009), pp. 645-649
[56.]
H.Y. Sun, N. Singh.
Antimicrobial and imnunomodulatory atributes of statins: Relevance in solid-organ transplant recipients.
CID, 48 (2009), pp. 745-754
[57.]
S.D. Navaneethan, S.U. Nigwekar, V. Perkovic, D.W. Johnson, J.C. Craig, G.F. Strippoli.
HMG CoA reductase inhibitors (statins) for dialysis patients.
Cochrane Database Syst Rev, 3 (2009),
[58.]
B.C. Fellström, A.G. Jardine, R.E. Schmieder, H. Holdaas, K. Bannister, J. Beutler, AURORA Study Group, et al.
Rosuvastatin and cardiovascular events in patients undergoinghemodialysis.
N Engl J Med, 360 (2009), pp. 1395-1407
[59.]
S. Jerwood, J. Cohen.
Unexpected antimicrobial effect of statins.
J Antimicrob Chemother, 61 (2008), pp. 362-364
[60.]
D.S. Felson.
Pandemic influeza: A potencial role for statins in treatment andprophylaxis.
CID, 34 (2006), pp. 199-205
[61.]
Z. Liu, Z. Guo, G. Wang, D. Zhang, H. He, G. Li, et al.
Evaluation of the efficacy and safety of a statin/caffeine combination against H5N1. H3N2 and H1N1 virus infection in BALB/c mice.
Eur J Pharm Sci, 38 (2009), pp. 215-223
[62.]
F. Winkler, B. Angele, H.W. Pfister, U. Koedel.
Simvastatin attenuates leukocyte recruitment in experimental bacterial meningitis.
Int Immunopharmacol, 9 (2009), pp. 371-374
[63.]
D. Hackam, M. Mamadani, P. Li, D.A. Redelmeier.
Statins and Sepsis in patients with cardiovascular disease: a ppulation-based cohort analysis.
Lancet, 367 (2006), pp. 413-418
[64.]
Y. Almog, A. Shefer, V. Novack, N. Maimon, L. Barski, M. Eizinger, et al.
Prior statin therapy is associated with a decreased rate of severe sepsis.
Circulation, 110 (2004), pp. 880-885
[65.]
E. Matthew, M.E. Falagas, G. Makris, D.K. Matthaiou, P.I. Rafailidis.
Statins for infection and sepsis: a systematic review of the clinical.
J Antimicrob Chemother, 61 (2008), pp. 774-785
[66.]
P. Kopterides, M.E. Falagas.
Statins for sepsis: a critical and updated review.
Clin Microbiol Infect, 15 (2009), pp. 325-334
[67.]
P.P. Dobesh, D.G. Klepser, T.R. McGuire, C.W. Morgan, K.M. Olsen.
Reduction in mortality associated with statin therapy in patients with severe sepsis.
Pharmacotherapy, 29 (2009), pp. 621-630
[68.]
E.M. Van de Garde, E. Hak, P.C. Souverein, A.W. Hoes, J.M. Van den Bosch, H.G. Leufkens.
Statin treatment and reduced risk of pneumonia in patients with diabetes.
Thorax, 61 (2006), pp. 957-961
[69.]
J.D. Chalmers, A. Singanayagam, M.P. Murray, A.T. Hill.
Prior statin use is associated with improved outcomes in communityacquired pneumonia.
Am J Med, 121 (2008), pp. 1002-1007
[70.]
E.M. Mortensen, M.I. Restrepo, A. Anzueto, J. Pugh.
The effect of prior statin use on 30-day mortality for patients hospitalized with community-adquired pneumonia.
Respir Res, 25 (2005), pp. 82
[71.]
V. Novack, M. Eisinger, A. Frenkel, M. Terblanche, N.K. Adhikari, A. Douvdevani, et al.
The effects of statin therapy on inflammatory cytokines in patients with bacterial infections: a randomized double-blind placebo controlled clinical trial.
Intensive Care Med, 35 (2009), pp. 1255-1260
[72.]
A. Kämäräinen, I. Virkkunen, T. Silfvast, J. Tenhunen.
Statins for post resuscitation syndrome.
Med Hypotheses, 73 (2009), pp. 97-99
[73.]
C.C. Lee, R.P. Lee, Y.M. Subeq, C.J. Lee, T.M. Chen, B.G. Hsu.
Fluvastatin attenuates severe hemorrhagic shock-induced organ damage in rats.
Resuscitation, 80 (2009), pp. 372-378
[74.]
J.L. Almeida, S.N. Sampietre, A.M. Mendonca Coelho, N.A. Trindade Molan, M.C. Machado, J.E. Monteiro da Cunha, et al.
Statin pretreatment in experimental acute pancreatitis.
JOP, 9 (2008), pp. 431-439
[75.]
H. Schmidt, R. Hennen, A. Keller, M. Russ, U. Müller-Werdan, K. Werdan, et al.
Association of statin therapy and increased survival in patients with multiple organ dysfunction syndrome.
Intensive Care Med, 32 (2006), pp. 1248-1251
[76.]
R. Carrillo-Esper, S. Rivera-Buendia, J.R. Carrillo-Córdova, L.D. Carrillo-Córdova.
Estatinas, ¿alternativa terapéutica en sepsis?.
Gac Med Mex, 143 (2007), pp. 499-503
[77.]
C. Emanueli, A. Monopoli, N. Kraenkel, M. Meloni, S. Gadau, I. Campesi, et al.
Nitropravastatin stimulates reparative neovascularisation and improves recovery from limb Ischaemia in type-1 diabetic mice.
Br J Pharmacol, 150 (2007), pp. 873-882
[78.]
C.C. McGown, Z.L.S. Brookes.
Beneficial effects of statins on the microcirdulation during sepsis: the role of nitric oxide.
Br J Anaesth, 98 (2007), pp. 163-175
[79.]
F. Gao, L. Linhartiva, A.Mc.D. Johnston, D.R. Thickett.
Statins and sepsis.
Br J Anaesth, 100 (2008), pp. 288-298
[80.]
S.R. Majumdar, F.A. McAlister, D.T. Eurich, R.S. Padwal, T.J. Marrie.
Statins and outcomes in patients admitted to hospital with community acquired pneumonia: population based prospective cohort study.
BMJ, 333 (2006), pp. 999
[81.]
I.M. Tleyjeh, T. Kashour, F.A. Hakim, V.A. Zimmerman, P.J. Erwin, A.J. Sutton, et al.
Statins for the prevention and treatment of infections: a systematic review and meta-analysis.
Arch Intern Med, 169 (2009), pp. 1658-1667
[82.]
L. Leibivici.
Non-antibiotic treatment for bacterial infections: how to vadilate change findings.
Clin Microbiol Infect, 15 (2009), pp. 298-301
[83.]
M. Ruiz Bailén.
Administración de estatinas durante la fase aguda del síndrome coronario agudo.
Med Intensiva, 34 (2010), pp. 56-63
[84.]
M. Ruiz Bailén.
Efecto de la retirada de estatinas durante el ingreso en Medicina Intensiva.
Med Intensiva, 34 (2010), pp. 268-272
[85.]
Z.L.S. Brookes, C.C. McGown, C.S. Reilly.
Statins for al: the new premed?.
Br J Anaesth, 103 (2009), pp. 99-107
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