Effects of short-term glucocorticoids on hemostatic factors in healthy volunteers.
OBJECTIVE
Increased circulating levels of hemostatic factors have been associated with arterial and venous thrombosis. Although in vitro evidence suggests that glucocorticoids may activate hemostasis and inhibit thrombolysis, no controlled in vivo studies have examined the effects of glucocorticoids on hemostatic factors. We hypothesized that a 5-day treatment course of dexamethasone would increase circulating levels of hemostatic and anti-fibrinolytic factors.


METHODS
We randomized 24 healthy men ages 19-39 to receive either dexamethasone 3 mg twice daily versus placebo for 5 days. Parameters examined before and after the intervention included: clotting factors VII, VIII, and XI, von Willebrand factor (vWF), D-dimer, PAI-1, soluble CD40-ligand (sCD40-ligand), and fibrinogen.


RESULTS
Dexamethasone tended to modestly increase clotting factors levels and fibrinogen without significantly affecting PAI-1, D-dimer or sCD40-ligand. Factor VII increased by a mean of 13% (p = 0.04 versus placebo), factor VIII by 27% (p = 0.0008), factor XI by 6% (p = 0.01), and fibrinogen by 13% (p = 0.05).


CONCLUSIONS
Glucocorticoids may increase the activity of clotting factors in vivo. This may contribute to the reported increased risk of thrombosis in patients with sustained exposure to glucocorticoids.
Brotman
Daniel J
DJ
Department of General Internal Medicine, Cleveland Clinic Foundation, OH, USA.
Girod
John P
JP
Posch
Amy
A
Jani
Jayesh T
JT
Patel
Jeetesh V
JV
Gupta
Manjula
M
Lip
Gregory Y H
GY
Reddy
Sethu
S
Kickler
Thomas S
TS
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects; D003907:Dexamethasone / Q000494:pharmacology*; D004311:Double-Blind Method; D005167:Factor VII / Q000378:metabolism; D005169:Factor VIII / Q000378:metabolism; D005172:Factor XI / Q000378:metabolism; D005215:Fasting; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D008297:Male
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; C078147:F8 protein, human; D005167:Factor VII; D005169:Factor VIII; D005340:Fibrinogen; D005172:Factor XI