title: Inherited antithrombin deficiency and anabolic steroids: a risky combination.
abstract: A 20-year-old male with asymptomatic inherited type 1 antithrombin deficiency and a family history of thrombosis started injecting himself with testosterone 250 mg intramuscularly twice weekly for 5 weeks. He presented to the hospital with progressive dyspnea on exertion, chest pain and hemoptysis. Workup revealed bilateral submassive pulmonary embolism and proximal right lower extremity deep vein thrombosis. He was treated with intravenous (IV) unfractionated heparin and underwent catheter-directed thrombolysis with alteplase to the main pulmonary arteries. Postprocedure, he remained on IV alteplase infusion for 24 h and unfractionated heparin in the intensive care unit. Concomitantly he received plasma-derived antithrombin concentrate. He was transitioned to subcutaneous enoxaparin twice daily and discharged from the hospital on oral rivaroxaban 15 mg twice a day. This case highlights the heightened thrombogenic effect of anabolic steroids in the setting of underlying thrombophilia especially in younger subjects.
authors.affiliation: aDivision of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York, USA bRotating Medical Student, Alexandria Main University Hospital, Egypt.
authors.forename: Hannah
authors.initials: H
authors.lastname: Choe
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elfil
authors.forename: Maria T
authors.initials: MT
authors.lastname: DeSancho
mesh_terms: D000991:Antithrombins / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D004417:Dyspnea / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D017984:Enoxaparin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006469:Hemoptysis / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D011655:Pulmonary Embolism / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D013739:Testosterone / Q000009:adverse effects*; D045165:Testosterone Congeners / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000379:methods*; D019851:Thrombophilia / Q000097:blood / Q000139:chemically induced* / Q000151:congenital / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000991:Antithrombins; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D045165:Testosterone Congeners; D013739:Testosterone; D010959:Tissue Plasminogen Activator