Key result
Corticosteroids and nonsteroidal anti-inflammatory drugs exhibit complex effects on coagulation, with corticosteroids reducing thrombosis in inflammatory states and NSAIDs varying by COX selectivity.
Understanding the distinct effects of corticosteroids and various NSAID classes on COX isoforms is crucial for balancing bleeding and cardiovascular thrombotic risks in clinical practice.
Requires caution extrapolating corticosteroid or NSAID thrombotic effects by inflammatory state; leaves open targeted trials in IBD.
The immune and coagulation systems have numerous interactions, as evidenced by the increased risk of venous thromboembolism in inflammatory bowel disease. In general, proinflammatory states are prothrombotic, while a reduction in inflammation reduces thrombotic risk. Corticosteroids, such as hydrocortisone and prednisone, tend to reduce inflammation and thus thrombosis, while being prothrombotic in non-inflammatory states, e.g. Cushing’s syndrome. The nonsteroidal anti-inflammatory drugs also have a dual effect, through interaction with different cyclo-oxygenase enzyme isoforms, on platelets and the vascular endothelium.
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Eric J. Hodgson (2015) conducted a review in Coagulation and thrombosis. Corticosteroids and NSAIDs was evaluated. Corticosteroids and nonsteroidal anti-inflammatory drugs exhibit complex effects on coagulation, with corticosteroids reducing thrombosis in inflammatory states and NSAIDs varying by COX selectivity.
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