Expert Q&A: Steroids and Clot Risk

Q: I came across a report from a few years ago that suggested corticosteroids might raise the risk of deep vein thrombosis. I take prednisone for my rheumatoid arthritis. Should I be concerned about this?

Since that earlier study, additional information seems to confirm the risk. A 2018 study published in the Journal of Thrombosis and Haemostasis found an association of the use of glucocorticoids — a type of corticosteroid — with cardiovascular events, including deep vein thrombosis (DVT), in patients who had suffered an ischemic stroke. Deep vein thrombosis (a blood clot that forms, usually in the leg, blocking blood flow) and pulmonary embolism (a life-threatening condition that occurs when the clot breaks away and travels to the lungs) are known as venous thromboembolism (VTE).

People who have rheumatoid arthritis (RA) are already at higher risk of VTE, and corticosteroids are an important tool in treating RA and other inflammatory forms of arthritis.

Additionally, a 2016 study in Clinical Rheumatology found that in patients with systemic lupus erythematosus (SLE), chronic high dose glucocorticoids worsened several outcomes, including the formation of blood clots in veins.

A caveat with all these studies is that they were observational and cannot prove causality. Various confounding factors could account for the association between glucocorticoids and thrombosis.

Overall, this information does not change the decision to use glucocorticoids in rheumatic disease very much. Doctors are well aware that long-term use of these drugs carries many adverse effects. The bottom line is that, despite the large benefits in fighting acute inflammation, glucocorticoids should be used in the lowest effective dose for the shortest possible time.

Donald Miller, PharmD
Professor of Pharmacy Practice
North Dakota State University