Glucocorticoid use and risk of first and recurrent venous thromboembolism: self-controlled case-series and cohort study

Author(s)

Orsi, Fernanda A. ^{[1, 2]} ; Lijfering, Willem M. ^[1] ; Geersing, Geert-Jan ^[3] ; Rosendaal, Frits R. ^[1] ; Dekkers, Olaf M. ^{[1, 4]} ; le Cessie, Saskia ^{[1, 5]} ; Cannegieter, Suzanne C. ^{[1, 6]}

Affiliation

^[1] Leiden Univ, Med Ctr, Dept Clin Epidemiol, POB 9600, NL-2300 RC Leiden - Netherlands

^[2] Univ Campinas UNICAMP, Sch Med Sci, Dept Clin Pathol, Campinas - Brazil

^[3] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht - Netherlands

^[4] Leiden Univ, Med Ctr, Dept Internal Med, Leiden - Netherlands

^[5] Leiden Univ, Med Ctr, Dept Biomed Data Sci, Leiden - Netherlands

^[6] Leiden Univ, Med Ctr, Sect Thrombosis & Hemostasis, Dept Internal Med, Leiden - Netherlands

• Document type: Journal article
• Source: British Journal of Haematology; v. 193, n. 6, p. 1194-1202, JUN 2021.
• Web of Science Citations: 0

Abstract

Glucocorticoid treatment increases venous thromboembolism (VTE) risk. Whether this is due to the medication or the underlying disease, or affects the risk of VTE recurrence, has been difficult to determine. The aim of our present study was to quantify the risk for first and recurrent VTE associated with oral glucocorticoids use, considering the underlying disease. A total of 2547 patients with VTE from the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA) study were linked to the Dutch Pharmaceutical Statistics register. The risk of first VTE during periods of exposure with oral glucocorticoids was estimated by the self-controlled case series method and that of recurrent VTE was examined in a cohort design. The incidence rate ratio (IRR) of first VTE in the period of glucocorticoid treatment was 3 center dot 51 {[}95% confidence interval (CI) 2 center dot 55-4 center dot 80]. This IRR was 2 center dot 53 (95% CI 1 center dot 10-5 center dot 72) in the week before treatment started, 5 center dot 28 (95% CI 2 center dot 89-9 center dot 53) in the first 7 days of treatment, remained elevated afterwards and decreased to 1 center dot 55 (95% CI 0 center dot 85-3 center dot 12) after 6 months, as compared to unexposed periods. The hazard ratio for recurrence was 2 center dot 72 (95% CI 1 center dot 64-4 center dot 78) in treatment periods as compared with no treatment. The increased risk of VTE associated with oral glucocorticoid treatment is due to a combined effect of the treatment and the underlying disease, remaining high during the first months of prescription. (AU)

• FAPESP's process: 17/09506-5 - Identification of novel targets for therapy with PCSK9: From LDL lowering to decreased inflammation and coagulation
• Grantee: Fernanda Loureiro de Andrade Orsi
• Support Opportunities: Scholarships abroad - Research