Thrombotic complications of glucocorticoids and anabolic steroids

Glucocorticoids and anabolic-androgenic steroids are used for medical and nonmedical purposes. There are thrombotic risks associated with both classes of steroids. Glucocorticoid therapy has been shown to increase the relative risk of venous thromboembolism. Glucocorticoids are also associated with arterial events. The mechanisms involve the exacerbation of cardiovascular risk factors and its effects on coagulation, platelet function, and endothelial integrity. Anabolic-androgenic steroids use similarly predisposes users to both venous thromboembolism and arterial thromboses. It is driven by androgen-induced polycythemia, platelet hyper-aggregability, procoagulant shifts in haemostatic proteins, and vascular injury. Preventive strategies involve minimizing steroid exposure. When thrombosis does occur, standard anticoagulant regimens are indicated. The preference is for low-molecular-weight heparin or direct oral anticoagulants to avoid warfarin-steroid interactions. The management of thrombotic events also involves re-evaluation of ongoing steroid need, close monitoring for bleeding, and multidisciplinary coordination. Current evidence largely derives from observational and pharmacologic studies. Nonetheless, clinicians must adopt a vigilant and individualized approach to balance the benefits of steroid therapy against its potential for serious thromboembolic complications.