Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/109581

In Collections

This item can be found in the following collections:

Zaane, B. van; Nur, E.; Squizzato, A.; Gerdes, V.E.A.; Buller, H.R.; Dekkers, O.M.; Brandjes, D.P.M. (2010)

Systematic review on the effect of glucocorticoid use on procoagulant, anti-coagulant and fibrinolytic factors

Article / Letter to editor
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...Show moreBackground: 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.Show less
coagulation fibrinolysis glucocorticoid thrombosis von-willebrand-factor plasminogen-activator-inhibitor giant-cell arteritis vonwillebrand-factor antigen renal-transplant recipients total hip-replacement c-reactive protein disease-activity polymyalgia-rheumatica lupus-erythematosus
All authors
Zaane, B. van; Nur, E.; Squizzato, A.; Gerdes, V.E.A.; Buller, H.R.; Dekkers, O.M.; Brandjes, D.P.M.
Date
2010-11-30
Journal
Journal of Thrombosis and Haemostasis
Volume
8
Issue
11
Pages
2483 - 2493