TY - JOUR
T1 - Coagulation profiles during and after anabolic androgenic steroid use
T2 - data from the HAARLEM study
AU - Camilleri, Eleonora
AU - Smit, Diederik L.
AU - van Rein, Nienke
AU - le Cessie, Saskia
AU - de Hon, Olivier
AU - den Heijer, Martin
AU - Lisman, Ton
AU - Cannegieter, Suzanne C.
AU - de Ronde, Willem
N1 - Funding Information: The authors thank Petra Noordijk, Lejla Mahic, and Jelle Adelmeijer for their work in the laboratory and Ingeborg de Jonge for her work in the data management. E.C. D.L.S. N.v.R. S.C.C. and W.d.R. designed the research. D.L.S. and W.d.R. collected the data. E.C. and N.v.R analyzed the data. E.C. and N.v.R. wrote the manuscript. E.C. D.L.S. N.v.R. S.L.C. O.d.H. M.d.H. T.L. S.C.C. and W.d.R. revised the paper for important intellectual content. The HAARLEM study was funded by the Spaarne Gasthuis Academy. This work was supported by the Netherlands Thrombosis Foundation (2019-01). There are no competing interests to disclose. Funding Information: The HAARLEM study was funded by the Spaarne Gasthuis Academy. This work was supported by the Netherlands Thrombosis Foundation (2019-01). Publisher Copyright: © 2023 The Authors
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Background: Anabolic androgenic steroids (AAS) are thought to increase venous thromboembolism (VTE) risk. Objectives: We investigated whether AAS influence coagulation parameters associated with VTE by assessing their changes during and after AAS use. Methods: The HAARLEM study enrolled 100 male amateur athletes voluntarily starting an AAS cycle between 2015 and 2018. We measured procoagulant and anticoagulant protein levels, D-dimer levels, endogenous thrombin potential (ETP), and clot lysis time (CLT) at baseline and during 2 years of follow-up. Changes in coagulation during AAS cycle, 3 months after its discontinuation, and 1 year after its inclusion compared with baseline were estimated using linear mixed models. The associations between AAS dose and duration of use with these outcomes were studied through adjusted multivariable linear regression. Results: Participants used AAS for a median of 13 weeks (IQR: 10-23) with a median weekly dose of 901 mg (IQR: 634-1345 mg). Mean levels of multiple coagulation factors (F) increased during use compared with baseline, whereas FVIII and von Willebrand factor levels remained unchanged. Protein S and D-dimer showed the biggest increase (22% [95% CI: 15-29] and 1.3-fold [95% CI: 1.2-1.5], respectively). CLT was 8 minutes longer (95% CI: 5-10) and ETP was 165 nM∗min (95% CI: −205 to −124) lower during the AAS cycle. A high weekly AAS dose and short cycle duration were associated with changes in protein S and ETP during use. All parameters returned to baseline values 3 months after discontinuation and remained similar after. Conclusion: During AAS use, procoagulant and anticoagulant protein levels increased in a reversible manner. The overall balance did not suggest a clear procoagulant state.
AB - Background: Anabolic androgenic steroids (AAS) are thought to increase venous thromboembolism (VTE) risk. Objectives: We investigated whether AAS influence coagulation parameters associated with VTE by assessing their changes during and after AAS use. Methods: The HAARLEM study enrolled 100 male amateur athletes voluntarily starting an AAS cycle between 2015 and 2018. We measured procoagulant and anticoagulant protein levels, D-dimer levels, endogenous thrombin potential (ETP), and clot lysis time (CLT) at baseline and during 2 years of follow-up. Changes in coagulation during AAS cycle, 3 months after its discontinuation, and 1 year after its inclusion compared with baseline were estimated using linear mixed models. The associations between AAS dose and duration of use with these outcomes were studied through adjusted multivariable linear regression. Results: Participants used AAS for a median of 13 weeks (IQR: 10-23) with a median weekly dose of 901 mg (IQR: 634-1345 mg). Mean levels of multiple coagulation factors (F) increased during use compared with baseline, whereas FVIII and von Willebrand factor levels remained unchanged. Protein S and D-dimer showed the biggest increase (22% [95% CI: 15-29] and 1.3-fold [95% CI: 1.2-1.5], respectively). CLT was 8 minutes longer (95% CI: 5-10) and ETP was 165 nM∗min (95% CI: −205 to −124) lower during the AAS cycle. A high weekly AAS dose and short cycle duration were associated with changes in protein S and ETP during use. All parameters returned to baseline values 3 months after discontinuation and remained similar after. Conclusion: During AAS use, procoagulant and anticoagulant protein levels increased in a reversible manner. The overall balance did not suggest a clear procoagulant state.
KW - anabolic androgenic steroids
KW - blood coagulation
KW - fibrin clot lysis time
KW - testosterone
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85175620801&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.rpth.2023.102215
DO - https://doi.org/10.1016/j.rpth.2023.102215
M3 - Article
C2 - 38077826
SN - 2475-0379
VL - 7
JO - Research and practice in thrombosis and haemostasis
JF - Research and practice in thrombosis and haemostasis
IS - 7
M1 - 102215
ER -