Systematic review on the effect of glucocorticoid use on procoagulant, anti-coagulant and fibrinolytic factors.
BACKGROUND
Whether glucocorticoid use contributes to a hypercoagulable state, and thereby enhances the thrombotic risk, is controversial.


OBJECTIVE
We aimed to examine the effects of glucocorticoid use on coagulation and fibrinolysis.


METHODS
MEDLINE and EMBASE databases were searched to identify published studies comparing glucocorticoid treatment with a glucocorticoid-free control situation. Subjects could be either patients or healthy volunteers. Two investigators independently performed study selection and data extraction. Results were expressed as standardized mean difference, if possible; data were pooled with a random-effects model.


RESULTS
Of the 1967 identified publications, 36 papers were included. In healthy volunteers, a clear rise in factor (F)VII, VIII and XI activity was observed after glucocorticoid treatment, but these data alone provided insufficient evidence to support hypercoagulability. However, during active inflammation, glucocorticoids significantly increased levels of plasminogen activator inhibitor-1 (PAI-1), whereas levels of von Willebrand factor (VWF) and fibrinogen decreased. Peri-operative use of glucocorticoids inhibited the increase in tissue-type plasminogen activator induced by surgery.


CONCLUSIONS
The present study showed differential effects of glucocorticoids depending on the clinical situation in which it is given, most likely as a result of their disease modifying properties. Clinical outcome studies are needed to adequately assess the risk-benefit of glucocorticoid use per population when thrombotic complication is the focus.
van Zaane
B
B
Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. b.vanzaane@amc.uva.nl
Nur
E
E
Squizzato
A
A
Gerdes
V E A
VE
Büller
H R
HR
Dekkers
O M
OM
Brandjes
D P M
DP
D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000378:metabolism; D003029:Coagulants / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003430:Cross-Sectional Studies; D005260:Female; D005342:Fibrinolysis; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011786:Quality Control; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013927:Thrombosis / Q000097:blood
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D003029:Coagulants; D005938:Glucocorticoids