Use of Glucocorticoids and Risk of Venous Thromboembolism

Johannesdottir, Sigrun Alba; Horváth‐Puhó, Erzsébet; Dekkers, Olaf M.; Cannegieter, Suzanne C.; Jørgensen, Jens Otto Lunde; Ehrenstein, Véra; Vandenbroucke, Jan P.; Pedersen, Lars; Sørensen, Henrik Toft

doi:10.1001/jamainternmed.2013.122

Cited by 354 publications

(121 citation statements)

References 45 publications

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“…A 3-year-old girl developed DVT and was treated with low-molecular-weight heparin and antiplatelet drugs [20]. We also avoid the use of corticosteroids for immunosuppressive therapy in AH13 patients during the acute stage of thrombosis because corticosteroids are associated with thromboembolism [21,22]. …”

Section: Resultsmentioning

confidence: 99%

Successful Management of a Patient with Autoimmune Hemorrhaphilia due to Anti-Factor XIII/13 Antibodies Complicated by Pulmonary Thromboembolism

Ogawa

Yanagisawa²,

Souri³

et al. 2017

Acta Haematol

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Autoimmune hemophilia-like disease (hemorrhaphilia) due to anti-factor XIII (FXIII) antibodies (AH13) is a very rare, life-threatening bleeding disorder. A 77-year-old woman developed macrohematuria and a right renal pelvic hematoma. The coagulation times were not prolonged, but FXIII activity and antigen levels were severely and moderately reduced to 9 and 29% of normal values, respectively. Accordingly, the FXIII-specific activity turned out to be low. FXIII inhibitor and anti-FXIII-A subunit autoantibodies were detected by a 1:1 crossmixing test and immunoblot and immunochromatographic assays. She was therefore diagnosed with “definite AH13” and treated with plasma-derived FXIII concentrates to arrest the hemorrhage. In addition to a highly compressed inferior vena cava by a huge renal pelvic hematoma, deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) were identified by systemic computed tomography. The patient was immediately started on anticoagulation therapy with low-dose heparin. Emboli disappeared quickly, probably because under-crosslinked thrombi caused by severe FXIII deficiency are vulnerable to fibrinolysis. After about 1.5 years, anti-FXIII-A subunit autoantibodies still remained despite the use of rituximab, steroid pulse therapy, oral prednisolone, and oral cyclophosphamide treatments. In conclusion, an extremely rare AH13 case complicated by DVT and PE was successfully managed by balancing anticoagulation therapy with hemostatic therapy.

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Section: Resultsmentioning

confidence: 99%

Successful Management of a Patient with Autoimmune Hemorrhaphilia due to Anti-Factor XIII/13 Antibodies Complicated by Pulmonary Thromboembolism

Ogawa

Yanagisawa²,

Souri³

et al. 2017

Acta Haematol

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“…While this, in part, likely reflects the association between inflammation and VTE, other studies have suggested that use of steroids in itself could be a risk factor for VTE. In a large cohort study, systemic glucocorticoids use was associated with a two-fold increase in risk for VTE 24 and oral glucocorticoids were associated with an increased risk of PE particularly within the first 30 days of use though the elevation in risk persisted for 1 year 25 . Low serum albumin is a well recognized risk factor for VTE in nephrotic syndrome 26 and chronic liver disease 27 .…”

Section: Discussionmentioning

confidence: 99%

Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

Ananthakrishnan

Cagan

Gainer

et al. 2014

Clinical Gastroenterology and Hepatology

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Background & Aims Patients with inflammatory bowel diseases (IBD) have increased risk for venous thromboembolism (VTE); those who require hospitalization have particularly high risk. Few hospitalized patients with IBD receive thromboprophylaxis. We analyzed the frequency of VTE following IBD-related hospitalization, risk factors for post-hospitalization VTE, and the efficacy of prophylaxis in preventing post-hospitalization VTE. Methods In a retrospective study, we analyzed data from a multi-institutional cohort of patients with Crohn's disease or ulcerative colitis and at least 1 IBD-related hospitalization. Our primary outcome was a VTE event. All patients contributed person time from the date of the index hospitalization to development of VTE, subsequent hospitalization, or end of follow-up. Our main predictor variable was pharmacologic thromboprophylaxis. Cox proportional hazard models adjusting for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results From a cohort of 2788 patients with at least 1 IBD-related hospitalization, 62 patients developed VTE following discharge (2%). Incidences of VTE at 30, 60, 90, and 180 days after the index hospitalization were 3.7/1000, 4.1/1000, 5.4/1000, and 9.4/1000 person-days respectively. Pharmacologic thromboprophylaxis during the index hospital stay was associated with a significantly lower risk of post-hospitalization VTE (HR, 0.46; 95% CI, 0.22–0.97). Increased numbers of co-morbidities (HR, 1.30; 95% CI, 1.16–1.47) and need for corticosteroids before hospitalization (HR 1.71, 95% CI 1.02 –2.87) were also independently associated with risk of VTE. Length of hospitalization or surgery during index hospitalization was not associated with post-hospitalization VTE. Conclusions Pharmacologic thromboprophylaxis during IBD-related hospitalization is associated with reduced risk of post-hospitalization VTE.

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“…It is also possible that an increased risk of VTE results, at least partially, from glucocorticoid therapy that may be associated with autoimmune diseases. A number of studies have indicated that glucocorticoids may increase the risk of VTE [20–24]. However, a review study reported that research findings showed that glucocorticoids had differential effects depending on the situation assessed [21].…”

Section: Discussionmentioning

confidence: 99%

Risk of venous thromboembolism among hospitalizations of adults with selected autoimmune diseases

Yusuf

Hooper

Beckman

et al. 2014

J Thromb Thrombolysis

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Previous research has suggested autoimmune diseases are risk factors for developing venous thromboembolism (VTE). We assessed whether having diagnoses of selected autoimmune diseases associated with anti-phospholipid antibodies—autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura (ITP), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE)—were associated with having a VTE diagnosis among US adult hospitalizations. A cross-sectional study was conducted using the 2010 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. VTE and autoimmune diseases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification coded diagnoses information. The percentages of hospitalizations with a VTE diagnosis among all non-maternal adult hospitalizations without any of the four autoimmune diseases of interest and among those with AIHA, ITP, RA, and SLE diagnoses were 2.28, 4.46, 3.35, 2.65 and 2.77 %, respectively. The adjusted odds ratios (OR) for having a diagnosis of VTE among non-maternal adult hospitalizations with diagnoses of AIHA, ITP, RA, and SLE were 1.25 [95 % confidence interval (CI) 1.05–1.49], 1.20 (95 % CI 1.07–1.34), 1.17 (95 % CI 1.13–1.21), and 1.23 (95 % CI 1.15–1.32), respectively, when compared to those without the corresponding conditions. The adjusted OR for a diagnosis of VTE associated with a diagnosis of any of the four autoimmune diseases was 1.20 (95 % CI 1.16–1.24). The presence of a diagnosis of AIHA, ITP, RA, and SLE was associated with an increased likelihood of having a VTE diagnosis among the group of all non-maternal adult hospitalizations.

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Use of Glucocorticoids and Risk of Venous Thromboembolism

Cited by 354 publications

References 45 publications

Successful Management of a Patient with Autoimmune Hemorrhaphilia due to Anti-Factor XIII/13 Antibodies Complicated by Pulmonary Thromboembolism

Successful Management of a Patient with Autoimmune Hemorrhaphilia due to Anti-Factor XIII/13 Antibodies Complicated by Pulmonary Thromboembolism

Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

Risk of venous thromboembolism among hospitalizations of adults with selected autoimmune diseases

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