Stephanie Edwin, PharmD, BCPS,
Clinical Pharmacy Specialist - Cardiac ICU
Ascension Saint John Hospital
Livonia, MI
Disclosure information not submitted.
Carrie Hartner, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist, Medical ICU
Ascension St. John Hospital, United States
Disclosure information not submitted.
Brian Feldpausch, PharmD
Clinical Pharmacist
Ascension St. John Hospital, United States
Disclosure information not submitted.
Christopher Giuliano, PharmD, MPH
Clinical Pharmacy Specialist - Internal Medicine
Ascension St. John Hospital, United States
Disclosure information not submitted.
Title: In-Hospital Venous Thromboembolism - Are Glucocorticoids a Prime Suspect?
Introduction: Glucocorticoids have been associated with an increased risk of developing venous thromboembolism (VTE) in the outpatient setting, however, a lack of data exists surrounding the impact of recent steroids on in-hospital VTE risk. The goal of this study is to determine whether glucocorticoid use is associated with an increased incidence of in-hospital VTE.
Methods: We conducted a case-control study of patients with an in-hospital VTE from October 2015 to December 2019. Adult patient cases were identified by ICD-10 codes for acute venous thromboembolism. Controls were selected from all patients without a VTE diagnosis and matched by hospital length of stay and admission type (medical/surgical). Patients were excluded if they had a history of VTE, received therapeutic anticoagulation, or were pregnant. All patients were evaluated to determine the presence or absence of glucocorticoid exposure. Glucocorticoid dose, duration, and route of administration were assessed for patients with steroid exposure.
Results: Overall, 78 patients with VTE and 234 controls were included. Pharmacologic VTE prophylaxis was prescribed in greater than 90% of each group. Receipt of glucocorticoids within the preceding 90 days was similar between the VTE cases and controls (39.7% vs. 38.9%, p=0.89). In the multivariable analysis, no difference was observed for the association between VTE and systemic glucocorticoids, OR=0.80; (95% CI, 0.44-1.45). No differences were noted with regard to oral (21.8% vs. 19.2%, p=0.62), intravenous (30.8% vs. 29.1%. p=0.77), or inhaled (6.4% vs. 10.3%, p=0.31) routes of administration between VTE case and control patients. Cumulative prednisone equivalent doses were similar between cases and controls (877 ± 1366 mg vs. 697 ± 1963 mg, p=0.44). Patients in the VTE group had a similar rate of in-hospital steroid initiation compared to controls (61.3% vs. 71.4%). No relationship was observed with timing of glucocorticoid exposure for cases versus controls, respectively (0-15 days: 50.6% vs. 51%; 16-30 days: 16.1% vs 24.1%; 31-90 days: 32.3% vs 25.3%).
Conclusion: The risk of in-hospital venous thromboembolism was not influenced by glucocorticoid exposure within the past 90 days. These results were consistent across all routes of administration, exposure time, and steroid dose.