Narat Srivali: Chronic Preoperative Corticosteroid Use Associated with 51% Higher Postoperative VTE Risk
Narat Srivali, Assistant Professor at Duke University Medical Center, shared a post on LinkedIn:
“I’m pleased to share that our systematic review and meta-analysis, ‘Chronic Preoperative Corticosteroid Use and Postoperative Venous Thromboembolism Risk,’ has been accepted in Thrombosis and Haemostasis.
Chronic corticosteroid use is common among patients undergoing surgery, yet its specific relationship with postoperative venous thromboembolism (VTE) had not previously been quantified systematically.
Across 9 retrospective cohort studies including 2,678,513 surgical patients – including 97,201 chronic corticosteroid users – we found that chronic preoperative corticosteroid use was associated with a:
- 51% higher risk of postoperative VTE
- RR 1.51 (95% CI 1.31–1.73)
- 48% higher risk of deep vein thrombosis
- RR 1.48 (95% CI 1.19–1.84)
The association was particularly evident in colorectal surgery and lumbar/neurosurgical populations.
Importantly, these findings should not be interpreted as a call for automatic changes to thromboprophylaxis protocols.
The available evidence is observational, with important limitations – including residual confounding by steroid indication, dose, duration, comorbidity burden, and variations in prophylaxis practices.
Accordingly, certainty of evidence was low for composite VTE and DVT and very low for pulmonary embolism.
Nevertheless, the study highlights a practical perioperative question: should chronic corticosteroid exposure be more consistently documented and considered as part of individualized VTE risk assessment?
Future prospective studies should clarify how steroid indication, cumulative dose, treatment duration, and prophylaxis strategies influence postoperative thrombotic risk.”
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