From the Guidelines
Prolonged use of corticosteroids can lead to severe adverse events, including weight gain, cataract, mood alterations, hypertension, infections, and osteoporosis, highlighting the need for careful consideration and monitoring in clinical practice. The risks associated with prolonged corticosteroid use are well-documented, with studies showing that initial responsiveness is observed in about 60–80% of patients, but sustained responses are seen only in 20–40% of cases 1. This loss of efficacy in the long-term, combined with the potential for severe adverse events, underscores the importance of using the lowest effective dose for the shortest necessary duration.
Some of the key risks associated with prolonged corticosteroid use include:
- Weight gain
- Cataract
- Mood alterations
- Hypertension
- Infections
- Osteoporosis, particularly in elderly patients These risks can be mitigated by regularly reviewing medications with healthcare providers, monitoring for side effects, and considering non-pharmacological alternatives when appropriate 1. It is also recommended that initial corticosteroid treatment should be administered for no longer than 6–8 weeks, and excessively fast tapering should never be performed as it can lead to undesired effects 1.
In contrast to the provided evidence on other topics, such as the prevention and control of seasonal influenza with vaccines 1 and primary care guidelines for the management of persons infected with human immunodeficiency virus 1, the most recent and highest quality study on the topic of prolonged corticosteroid use is the 2020 study published in Blood Reviews 1. This study provides the most relevant and up-to-date guidance on the risks associated with prolonged corticosteroid use and should be prioritized in clinical decision-making.
Overall, the potential risks associated with prolonged corticosteroid use highlight the need for careful consideration and monitoring in clinical practice, and healthcare providers should prioritize the use of alternative treatments and non-pharmacological interventions whenever possible.
From the FDA Drug Label
Reported risk factors for bleeding include ... long duration of warfarin therapy
- Prolonged use of warfarin sodium tablets may increase the risk of bleeding due to the long duration of therapy.
- The FDA drug label identifies long duration of warfarin therapy as a reported risk factor for bleeding 2.
From the Research
Risks of Prolonged Use
The risks of prolonged use of non-vitamin K oral anticoagulants (NOACs) and warfarin are as follows:
- Increased risk of bleeding, including fatal bleeding, major bleeding, and gastrointestinal bleeding 3
- Higher risk of myocardial infarction with direct thrombin inhibitors (DTIs) than with factor Xa (FXa) inhibitors 3
- Increased bleeding risk in persons older than 75 years or those receiving warfarin who have good control 3
- Higher risk of thromboembolism but a lower risk of major bleeding for treatment with NOACs compared with warfarin in patients with atrial fibrillation and aortic stenosis 4
- Comparable major bleeding risk between NOACs and warfarin 5
- Reduced hemorrhagic stroke rates with NOACs, possibly due to superior embolic infarct prevention and fewer consequential hemorrhagic transformations 5
Specific Risks Associated with NOACs
- Dabigatran may have a higher risk of myocardial infarction compared to FXa inhibitors 3
- Edoxaban 60 mg and 30 mg, and dabigatran 110 mg may reduce the risk of major bleeding compared to usual warfarin care 6
- Apixaban may yield a lower number needed to treat (NNT) per year for preventing death than for primary-outcome prevention 5