Key result
Perioperative corticosteroids are linked to ~15% lower DVT risk, driven by healthy-user confounding.
Why the study?
Perioperative corticosteroids suppress pro-inflammatory pathways that drive postoperative coagulation, suggesting a potential anti-thrombotic effect, but no prior systematic review had evaluated this relationship.
Do perioperative corticosteroids reduce the risk of DVT or PE in surgical patients?
Systematic Review (n=78,282)
Do perioperative corticosteroids reduce the risk of DVT or PE in surgical patients?
The apparent reduction in DVT risk with perioperative corticosteroids is driven by observational confounding and lacks support from randomized trials.
Answers are grounded in this paper and cite their sources.
This exploratory analysis suggests perioperative corticosteroids may reduce venous thromboembolism risk; leaves open the need for.
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 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 http://www.crd.york.ac.uk/prospero; identifier is CRD420261325249.
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Srivali et al. (2026) conducted a systematic review in Perioperative patients (n=78,282). Perioperative corticosteroids vs. Controls was evaluated on Deep vein thrombosis (DVT) (RR 0.85, 95% CI 0.75-0.96, p=0.008). Perioperative corticosteroids were associated with a reduced risk of DVT (RR 0.85; 95% CI 0.75-0.96; P=0.008), though this apparent benefit was driven by healthy-user confounding in one study.
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