0
Correspondence |

Steroids and Arteriovenous ThrombosisSteroid Induced Thrombosis: The Role of Underlying Disease FREE TO VIEW

Jecko Thachil, MD
Author and Funding Information

From the Department of Haematology, Manchester Royal Infirmary.

Correspondence to: Jecko Thachil, MD, Department of Haematology, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, England; e-mail: jecko.thachil@cmft.nhs.uk


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1836. doi:10.1378/chest.12-3096
Text Size: A A A
Published online
To the Editor:

Recently in CHEST (May 2013), Stuijver and colleagues1 suggested that iatrogenic corticosteroids are risk factors for pulmonary embolism as much as endogenous steroids are associated with an increased risk of thrombosis. In this context, it is useful to note that thrombotic risk with corticosteroids not only is restricted to venous circulation but also involves the arterial side. A recent study by Fardet and colleagues2 suggested that iatrogenic corticosteroids are risk factors for cardiovascular disease. This analysis, as in the present study, possibly reflects the increased cardiovascular risk associated with the disease conditions for which steroids are prescribed. Subclinical atherosclerosis is noted in many conditions where chronic inflammation is a pathophysiologic factor.3 However, Fardet and colleagues2 noted cardiovascular events with long-term use of corticosteroids but not venous thrombosis. In these cases, long-term suppression of the underlying inflammatory state would have been necessary. In other words, steroid use in the initial period of the prescription and at higher doses is an additional risk factor for venous thrombosis, whereas smaller-dose, long-term prescriptions are risk factors for arterial thrombosis.

What does this signify? In both cases, the underlying disease condition matters as much as the steroid usage, but development of venous thrombosis also suggests high levels of inflammation associated with the underlying disease, whereas arterial thrombosis denotes low-grade inflammation and secondary atherosclerosis. In summary, the venous and arterial thrombotic risks associated with steroids most possibly reflect the severity of the underlying diseases that required these drugs, with the contribution from these drugs itself being an additive effect.

References

Stuijver DJF, Majoor CJ, van Zaane B, et al. Use of oral glucocorticoids and the risk of pulmonary embolism: a population-based case-control study. Chest. 2013;143(5):1337-1342. [PubMed]
 
Fardet L, Petersen I, Nazareth I. Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing’s syndrome: cohort study. BMJ. 2012;345:e4928. [CrossRef] [PubMed]
 
Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685-1695. [CrossRef] [PubMed]
 

Figures

Tables

References

Stuijver DJF, Majoor CJ, van Zaane B, et al. Use of oral glucocorticoids and the risk of pulmonary embolism: a population-based case-control study. Chest. 2013;143(5):1337-1342. [PubMed]
 
Fardet L, Petersen I, Nazareth I. Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing’s syndrome: cohort study. BMJ. 2012;345:e4928. [CrossRef] [PubMed]
 
Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685-1695. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543