Prednisone and blood clots
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Venous thromboembolism (VTE) is a common cause of morbidity and mortality in hospitalized patients that can be prevented. It is also a commonly used indicator of care quality. VTE has been linked to long-term corticosteroid therapy, which is normal in neurosurgical patients. Using a national database, we wanted to see whether corticosteroid usage for more than 10 days was an independent risk factor for DVT and pulmonary embolism (PE).
The rates of VTE in patients undergoing neurosurgical procedures were evaluated using the well-validated American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2013. To determine the impact of sustained corticosteroid usage on the frequency of PE and DVT by postoperative day 30, a multivariate regression model was developed.
Within 30 days after surgery, 565 (0.60 percent) of the 94,620 patients reported developed PE, and 1057 (1.12 percent) developed DVT. Patients taking corticosteroids were significantly more likely to develop PE (odds ratio = 1.47, 95 percent confidence interval = 1.13-1.90, P = 0.004) and DVT (odds ratio = 1.55, 95 percent confidence interval = 1.28-1.87, P 0.001) in the multivariate model. The involvement of malignancy, longer hospitalization, some illnesses (including pneumonia and urinary tract infections), and stroke with a neurologic deficiency were all separately linked to the development of PE and DVT.
Thrombophlebitis – an osmosis preview
On the second postoperative day, venography of the legs was performed on fifty patients who had received uncemented complete hip prostheses. Patients were randomly assigned to one of two groups: non-steroid (n = 26) or steroid (n = 24). Dextran thromboprophylaxis was given to both classes. High-dose corticosteroids were given to the patients in the steroid community. Deep vein thrombosis (DVT) occurred in 38 percent of patients (19/50). There were no clinical signs or symptoms of DVT in any of the patients. Many of the thrombi were found on the distal side of the leg. Nine patients had DVT in both legs, three in the operated leg and seven in the non-operated leg. The use of high-dose corticosteroids had no effect on the frequency or pattern of DVT. Up to 12 months after surgery, both patients were followed clinically and plethysmographically. Asymptomatic DVT with a distant location did not receive any care. Except for one patient in each group who developed clinically evident DVT more than 3 weeks after surgery, despite initial venographic tests being regular, the postoperative course was uneventful.
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Endogenous glucocorticoid excess has recently been discovered to be a risk factor for VTE. It’s uncertain if exogenous glucocorticoids are linked to an increased risk of VTE. The aim of this study was to determine the risk of symptomatic pulmonary embolism (PE) in patients who were taking corticosteroids.
The PHARMO Record Linkage System, a Dutch population-based pharmacy registry, was used in a case-control analysis. Between 1998 and 2008, 4,495 patients with a first hospital admission for PE were studied. 16,802 sex- and age-matched subjects without a history of PE served as control subjects. Details on underlying conditions was retrieved using International Classification of Diseases codes for hospitalization.
PE risk was greatest in the first 30 days after starting glucocorticoids (adjusted OR, 5.9; 95 percent CI, 2.3-3.9) and steadily decreased over time (OR, 1.9; 95 percent CI, 1.3-2.9) for long-term users (> 1 year). Low-dose glucocorticoid use (prednisolone regular dose equivalent < 5 mg) was associated with a twofold increased risk of PE (OR, 1.8; 95 percent CI, 1.3-2.4), while the maximum dose of glucocorticoids (prednisolone > 30 mg) was associated with a tenfold increased risk of PE (OR, 1.8; 95 percent CI, 1.3-2.4). (OR, 9.6; 95 percent CI, 4.3-20.5). Stratification by glucocorticoid length and dosage revealed that recently started users had the highest risk of PE relative to long-term users at the time of PE, regardless of dose.
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Who would need a lower dose of prednisolone or additional monitoring? While steroid therapy is necessary for a variety of diseases and conditions, it can also have side effects. Some individuals are more susceptible to these side effects, and some problems may be exacerbated by steroid side effects. Only if the advantages of taking prednisolone outweigh the risks of not managing the condition can your doctor prescribe it. In some cases, a lower prednisolone dosage might be required, or your doctor might want you to have daily check-ups. If you fall into any of the following categories, talk to your doctor about taking prednisolone: Who could avoid taking prednisolone? The date on which this page was last updated was January 12, 2021.
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