Recent research has demonstrated that chronic steroid use increases the risk of deep venous thrombosis in the legs and pelvis.
The use of glucocorticoids may be associated with an increased risk for venous thromboembolism (VTE), according to the findings of a population-based case-control study.
Sigrun A. Johannesdottir, BSc, from Aarhus University Hospital in Denmark, and colleagues published there findings online April 1 in JAMA Internal Medicine.
"Experimental studies show that glucocorticoids increase levels of clotting factors and fibrinogen," the authors write. "Nevertheless, clinical data on the association between exogenous glucocorticoids and VTE are sparse, and comparison of available studies is hampered by their focus on specific patient populations."
In the current study, the authors used the Danish National Registry of Patients to identify diagnoses of VTE or pulmonary embolism (PE), excluding patients with an outpatient diagnosis of PE and a subsequent inpatient diagnosis of VTE, patients diagnosed in emergency departments, and patients with connective tissue disease.
Among the 38,765 patients with VTE and 387,650 healthy age- and sex-matched control patients, the present use (filled prescription within last 90 days) of systemic glucocorticoids was associated with an elevated risk for VTE (adjusted incidence risk ratio [IRR], 2.31; 95% confidence interval [CI], 2.18 - 2.45). Moreover, new use (first-ever prescription within last 90 days) was associated with a higher VTE risk (adjusted IRR, 3.06; 95% CI, 2.77 - 3.38) than continuing use (adjusted IRR, 2.02; 95% CI, 1.88 - 2.17).
In a multivariate analysis, the researchers found that oral glucocorticoid doses of more than 1000 to 2000 mg (adjusted IRR, 1.98; 95% CI, 1.78 - 2.20) and more than 2000 mg (adjusted IRR, 1.60; 95% CI, 1.49 - 1.71) were additionally linked to an increased risk for VTE. The investigators adjusted the model for several factors including age, sex, and classic risk factors such as cancer in pregnancy.
With inhaled glucocorticoids, only new use appeared to elevate the risk for VTE (adjusted IRR, 2.21; 95% CI, 1.72 - 2.86). Conversely, both new (adjusted IRR, 2.17; 95% CI, 1.27 - 3.71) and continuing (adjusted IRR, 1.76; 95% CI, 1.22 - 2.56) use of glucocorticoids targeting the intestines were associated with an increased VTE risk.
The limitations of the study included a lack of information on patient adherence, potential left centering of the exposure data, and a lack of information on glucocorticoid use in hospitals and outpatient cllinics."In conclusion, glucocorticoid users had an increased risk of VTE, especially PE," the authors write. "Although residual confounding might partially explain the results, clinicians should be aware of this association."
The study was supported by funding from the Clinical Epidemiological Research Foundation, Aarhus University Hospital. The authors and commentator have disclosed no relevant financial relationships.
JAMA Intern Med. Published online April 1, 2013. Article abstract,
