Is there a correlation between corticosteroid (cortisone) injections and thrombosis (blood clots)?

From the Guidelines

There is no established direct correlation between cortisone shots and blood clots, and corticosteroid injections are not generally associated with an increased risk of thrombosis when administered locally for conditions like joint pain or inflammation. The evidence from recent studies, such as the American Society of Hematology 2019 guidelines for immune thrombocytopenia 1, suggests that the risk of bleeding or thrombosis is not significantly increased with the use of corticosteroids in most patient populations. However, it is essential to note that oral or high-dose systemic corticosteroids taken over extended periods may slightly increase the risk of clotting in some patients, particularly those with a history of blood clots or clotting disorders 1.

When considering the use of corticosteroid injections, it is crucial to weigh the potential benefits against the risks. The anti-inflammatory benefits of these injections generally outweigh the potential risks when used appropriately for conditions like arthritis, tendonitis, or bursitis. The localized nature of cortisone injections means they pose minimal risk for clotting complications, and the benefits of reduced inflammation and pain relief can significantly improve the quality of life for patients with these conditions. If you have a history of blood clots or clotting disorders, it is essential to discuss this with your healthcare provider before receiving cortisone injections, as they may recommend additional precautions or monitoring.

Some key points to consider when evaluating the risk of thrombosis with corticosteroid injections include:

• The type and dose of corticosteroid used
• The duration of treatment
• The patient's individual risk factors for thrombosis, such as a history of blood clots or clotting disorders
• The presence of other medical conditions that may increase the risk of thrombosis, such as cancer or immobilization
• The use of other medications that may increase the risk of thrombosis, such as erythropoiesis-stimulating agents or certain chemotherapeutic agents 1.

Overall, the current evidence suggests that corticosteroid injections are a safe and effective treatment option for many patients, and the risk of thrombosis is not a significant concern for most individuals. However, it is always essential to consult with a healthcare provider to determine the best course of treatment and to discuss any potential risks or concerns.

From the FDA Drug Label

CONTRAINDICATIONS Triamcinolone acetonide injectable suspension is contraindicated in patients who are hypersensitive to any components of this product (see WARNINGS: General). Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura. The answer to the question of a correlation between corticosteroid injections and thrombosis is not directly supported by the information in the drug label.

• No direct correlation is mentioned between corticosteroid injections and thrombosis (blood clots) in the provided text.
• The label does mention a contraindication for idiopathic thrombocytopenic purpura, but this is a condition related to low platelet count, not directly to thrombosis. 2

From the Research

Correlation Between Corticosteroid Injections and Thrombosis

• There is evidence to suggest a correlation between corticosteroid injections and an increased risk of thrombosis (blood clots) 3, 4, 5, 6.
• A study published in the Journal of Thrombosis and Haemostasis found that oral prednisolone induces a procoagulant state in healthy subjects, which may increase the thromboembolic risk in patients with inflammatory diseases 3.
• Another study published in Thrombosis Research found that current use of oral corticosteroids is associated with an increased risk of recurrent pulmonary embolism (OR 3.74; 95% CI 2.04-6.87) 4.
• A retrospective analysis of 15,100 adults with inflammatory bowel disease found that treatment with corticosteroids is associated with a nearly 5-fold increase in risk for venous thromboembolic events (VTEs) compared to treatment with biologic agents 5.
• A narrative review published in Seminars in Thrombosis and Hemostasis suggests that the use of exogenous glucocorticoids may induce a hypercoagulable state, which may further amplify the risk of VTE 6.

Mechanism of Increased Risk

• The exact mechanism of how corticosteroids increase the risk of thrombosis is not fully understood, but it is thought to be related to the procoagulant effects of corticosteroids on the body 3, 6.
• Corticosteroids may enhance coagulation by increasing the levels of certain coagulation factors, such as von Willebrand factor and plasminogen-activator inhibitor type-1 3.
• The risk of thrombosis may also be influenced by the underlying disease being treated, as well as other factors such as dose and duration of corticosteroid therapy 4, 5.

Clinical Implications

• Clinicians should be aware of the potential increased risk of thrombosis associated with corticosteroid therapy, particularly in patients with underlying inflammatory diseases 4, 5.
• Patients receiving corticosteroid therapy should be monitored for signs and symptoms of thrombosis, and prophylactic measures should be taken to reduce the risk of VTEs 5.
• Further research is needed to fully understand the relationship between corticosteroids and thrombosis, and to develop strategies to minimize the risk of VTEs in patients receiving corticosteroid therapy 7, 6.