If ALT <100 - start statin treatment with repeat LFTs
Liver function tests
Liver function tests, also referred to as a hepatic panel, are groups of blood tests that provide information about the state of a patient's liver. These tests include prothrombin time, aPTT, albumin, bilirubin, and others. The liver transaminases aspartate transaminase and alanine transaminase are useful biomarkers of liver injury in a patient with some degree of intact liver function. Most liver diseases cause only …
Full Answer
When to recheck LFTs after statin?
A yearly check of LFTs is not required for patients who are stable on long-term treatment. If ALT <150: continue statin but recheck LFTs within 4 weeks to exclude further increase in ALT. No extra monitoring required if ALT remains stable.
Should patients with abnormal LFTs be excluded from statins?
Patients with abnormal LFTs prior to starting statins Patients with abnormal LFTs should not be routinely excluded from statin treatment. There is evidence that statins are safe and have beneficial effects for patients with NAFLD. If ALT <100 - start statin treatment with repeat LFTs as usual in 6 weeks to check ALT remains stable.
When to stop statins for high ALT levels?
If ALT >150: stop statin and recheck LFTs within 4 weeks to ensure values settle. If they return to normal consider re-introducing a different statin at a later date with repeat LFTs at 2, 6 and 12 weeks. If the LFTs do not improve after stopping statin treatment perform initial liver screen and continue as per abnormal ALT pathway.
When should patients with elevated liver enzymes be excluded from statin therapy?
people who have liver enzymes (transaminases) that are raised but are less than 3 times the upper limit of normal should not be routinely excluded from statin therapy treatment should be discontinued if serum transaminase concentrations rise to, and persist at, 3x normal range
When should statin therapy be elevated for liver enzymes?
We recommend stopping statin therapy if AST or ALT levels rise to two or more times the baseline level; after AST or ALT levels return to normal, we consider a trial of anoth- er statin.
When do you recheck LFTs after starting statin?
LFTs should be checked 6 to 8 weeks after commencing treatment or any dosage increase. A yearly check of LFTs is not required for patients who are stable on long-term treatment. If ALT <150: continue statin but recheck LFTs within 4 weeks to exclude further increase in ALT.
When should statin LFT be stopped?
If the levels of transaminases increase to more than 3 times baseline values, discontinuation of the drug should be considered. Clinical correlation with worsening of underlying disease, as well as exclusion of alcohol abuse and drug interactions, should be done before attempting permanent discontinuation of the drug.
Do you need to monitor LFTs on statins?
Current liver function testing for statin monitoring is largely unnecessary and costly. Statins do not cause liver disease. Both reduction in test frequency and use of a single alanine transaminase (ALT) rather than a full seven analyte liver function test (LFT) array would reduce cost and may benefit patients.
How often should LFTs be checked?
It is recommended that you check your liver function if you have abnormal symptoms, you're worried about medical conditions that may cause liver dysfunction or if you're taking medication that may cause liver damage. There are no specific guidelines on the frequency of testing or at what age you might be.
What labs should I check after starting statins?
Before starting to take statins, you should have a blood test to ensure your liver is in a relatively good condition. You should also have a routine blood test to check the health of your liver 3 months after treatment begins, and again after 12 months.
Can statins raise LFT?
Statins cause dose-dependent borderline elevations of liver function tests over time. These elevations are clinically and statistically insignificant and should not deter physicians from prescribing or continuing statins.
Can statins raise AST and ALT levels?
Clinical trials have shown that statin use has been associated with elevations in serum alanine aminotransferase (ALT) levels in approximately 3% of persons who take the drugs.
When is a statin contraindicated?
Statins are contraindicated for use by patients with active hepatic disease or unexplained persistent elevations in aminotransferase levels. Statins are contraindicated during pregnancy and while breastfeeding because of the effects on the cholesterol pathway.
Abstract
Statins: time to rationalise LFTs? ● Limited evidence for low-cost devices to improve adherence ● MHRA safety alert: hyoscine butylbromide (Buscopan) injection ● Faecal microbiota transplantation for ulcerative colitis ● Magnesium for nocturnal leg cramps ● NSAIDs and risk of out-of-hospital cardiac arrest ● Off-label antidepressant prescribing
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The authors of an observational comparison of two clinical commissioning groups (CCGs) advocate rationalising the use of liver function tests (LFTs) in people taking statins. 1
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