Perioperative corticosteroids and venous thromboembolism risk: a systematic review with exploratory pooled meta-analysis.

IF 3.4 3区医学 Q3 PHARMACOLOGY & PHARMACY

Expert Opinion on Pharmacotherapy Pub Date : 2026-09-01 Epub Date: 2026-08-26 DOI:10.1080/14656566.2026.2723581

Narat Srivali, Federica De Giacomi

{"title":"Perioperative corticosteroids and venous thromboembolism risk: a systematic review with exploratory pooled meta-analysis.","authors":"Narat Srivali, Federica De Giacomi","doi":"10.1080/14656566.2026.2723581","DOIUrl":null,"url":null,"abstract":"Background: Perioperative corticosteroids suppress pro-inflammatory pathways that drive postoperative coagulation, suggesting a potential anti-thrombotic effect. No prior systematic review has examined this relationship.Methods: We systematically reviewed studies reporting DVT or PE in patients receiving perioperative corticosteroids versus controls (MEDLINE, Embase, CENTRAL; inception-January 2026), performing an exploratory pooled analysis using a random-effects model with GRADE certainty assessment. Risk of bias was assessed using RoB 2 (RCT) and the Newcastle-Ottawa Scale (observational studies).Results: Four studies (78,282 patients) were included. Pooled DVT analysis showed a statistically significant reduction favoring corticosteroids (RR 0.85, 95% CI 0.75-0.96; p = 0.008; I2 = 0%); however, one observational study contributed 96.7% of patient-level weight, rendering the estimate functionally a single-study restatement. Excluding it reversed the effect direction. The only RCT trended toward DVT harm (RR 1.20). The PE estimate was non-significant (RR 0.55, 95% CI 0.23-1.31; p = 0.18; I2 = 47%). GRADE certainty was very low for all outcomes.Conclusions: The apparent DVT benefit reflects healthy-user confounding in a dominant observational study and is unsupported by randomized evidence. A dedicated, adequately powered RCT with pre-specified VTE endpoints, is urgently needed.Protocol registration: www.crd.york.ac.uk/prospero; identifier is CRD420261325249.","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1513-1526"},"PeriodicalIF":3.4000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Expert Opinion on Pharmacotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/14656566.2026.2723581","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/8/26 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Perioperative corticosteroids suppress pro-inflammatory pathways that drive postoperative coagulation, suggesting a potential anti-thrombotic effect. No prior systematic review has examined this relationship.

Methods: We systematically reviewed studies reporting DVT or PE in patients receiving perioperative corticosteroids versus controls (MEDLINE, Embase, CENTRAL; inception-January 2026), performing an exploratory pooled analysis using a random-effects model with GRADE certainty assessment. Risk of bias was assessed using RoB 2 (RCT) and the Newcastle-Ottawa Scale (observational studies).

Results: Four studies (78,282 patients) were included. Pooled DVT analysis showed a statistically significant reduction favoring corticosteroids (RR 0.85, 95% CI 0.75-0.96; p = 0.008; I² = 0%); however, one observational study contributed 96.7% of patient-level weight, rendering the estimate functionally a single-study restatement. Excluding it reversed the effect direction. The only RCT trended toward DVT harm (RR 1.20). The PE estimate was non-significant (RR 0.55, 95% CI 0.23-1.31; p = 0.18; I² = 47%). GRADE certainty was very low for all outcomes.

Conclusions: The apparent DVT benefit reflects healthy-user confounding in a dominant observational study and is unsupported by randomized evidence. A dedicated, adequately powered RCT with pre-specified VTE endpoints, is urgently needed.

Protocol registration: www.crd.york.ac.uk/prospero; identifier is CRD420261325249.

查看原文本刊更多论文

围手术期皮质类固醇与静脉血栓栓塞风险：一项探索性荟萃分析的系统综述。

背景：围手术期皮质类固醇可抑制推动术后凝血的促炎途径，提示其具有潜在的抗血栓作用。之前没有系统的综述研究过这种关系。方法：我们系统地回顾了报告接受围手术期皮质类固醇治疗的患者与对照组相比发生DVT或PE的研究（MEDLINE, Embase， CENTRAL； inception- 2026年1月），使用随机效应模型进行探索性汇总分析，并进行GRADE确定性评估。使用RoB 2 （RCT）和Newcastle-Ottawa量表（观察性研究）评估偏倚风险。结果：纳入4项研究（78,282例患者）。合并DVT分析显示，糖皮质激素降低具有统计学意义（RR 0.85, 95% CI 0.75-0.96; P = 0.008; I2 = 0%）；然而，一项观察性研究贡献了96.7%的患者水平体重，使得该估计在功能上是单一研究的重述。排除它会逆转效果方向。唯一的RCT倾向于DVT危害（RR 1.20）。PE估计无显著性（RR 0.55, 95% CI 0.23-1.31; P = 0.18; I2 = 47%）。所有结果的GRADE确定性都很低。结论：在一项主要观察性研究中，明显的DVT益处反映了健康使用者的混淆，并且没有随机证据支持。目前迫切需要一种专用的、功率充足的、具有预先指定的VTE端点的RCT。协议注册：http://www.crd.york.ac.uk/prospero；标识符为CRD420261325249。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Expert Opinion on Pharmacotherapy 医学-药学

CiteScore

5.60

自引率

3.10%

发文量

163

审稿时长

4-8 weeks

期刊介绍： Expert Opinion on Pharmacotherapy is a MEDLINE-indexed, peer-reviewed, international journal publishing review articles and original papers on newly approved/near to launch compounds mainly of chemical/synthetic origin, providing expert opinion on the likely impact of these new agents on existing pharmacotherapy of specific diseases.