Procoagulant State in Current and Former Anabolic Androgenic Steroid Abusers

Simon Chang; Jon J. Rasmussen; Mikkel N. Frandsen; Morten Schou; Marie L. Johansen; Jens Faber; Anna Marie B. Münster; Johannes J. Sidelmann; Caroline Kistorp

doi:10.1055/s-0038-1636540

Procoagulant State in Current and Former Anabolic Androgenic Steroid Abusers

Simon Chang^*, Jon J. Rasmussen, Mikkel N. Frandsen, Morten Schou, Marie L. Johansen, Jens Faber, Anna Marie B. Münster, Johannes J. Sidelmann, Caroline Kistorp

^*Corresponding author for this work

Department of Clinical Medicine

12 Citations (Scopus)

Abstract

Background Anabolic androgenic steroid (AAS) abusers are considered at increased risk of cardiovascular morbidity and mortality. We hypothesized that current and former AAS abuse would induce a procoagulant shift in the haemostatic balance. Methods Men 18 to 50 years of age were included as current AAS abusers, former AAS abusers or controls. Morning blood samples were collected after overnight fasting. Thrombin generation (lag time, time to peak, peak height, and endogenous thrombin potential [ETP]) and coagulation factor II (prothrombin), VII and X, antithrombin, protein C, free protein S and tissue factor pathway inhibitor (TFPI) were assessed. Groups were compared by ANOVA or Kruskal-Wallis test and probabilities were corrected for multiple comparisons. Associations were evaluated using linear regression models. Results ETP was increased around 15% in current (n = 37) and former (n = 33) AAS abusers compared with controls (n = 30; p < 0.001). Prothrombin and factor X were increased ≥10% in AAS abusers and prothrombin was a predictor of ETP (p < 0.0005). Lag time and time to peak were increased 10 to 30% in current AAS abusers (p < 0.001) and associated with higher concentrations of TFPI, antithrombin, protein C and protein S (p < 0.0005; = 0.005). Multivariate linear regression, with all coagulation inhibitors as covariates, identified TFPI to be independently associated with lag time and time to peak (p < 0.0005). Conclusion Thrombin generation is augmented in current and former AAS abusers, reflecting a procoagulant state, with altered concentrations of coagulation proteins. Prospective studies are needed to clarify whether these findings translate into an increased thrombotic risk in AAS abusers potentially even after cessation.

Original language	English
Journal	Thrombosis and Haemostasis
Volume	118
Issue number	4
Pages (from-to)	647-653
ISSN	0340-6245
DOIs	https://doi.org/10.1055/s-0038-1636540
Publication status	Published - 2018

Keywords

blood coagulation
substance-related disorders
testosterone
thrombin

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10.1055/s-0038-1636540

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@article{ed9d69433df44210834a5fd1d9bc4118,

title = "Procoagulant State in Current and Former Anabolic Androgenic Steroid Abusers",

abstract = "Background Anabolic androgenic steroid (AAS) abusers are considered at increased risk of cardiovascular morbidity and mortality. We hypothesized that current and former AAS abuse would induce a procoagulant shift in the haemostatic balance. Methods Men 18 to 50 years of age were included as current AAS abusers, former AAS abusers or controls. Morning blood samples were collected after overnight fasting. Thrombin generation (lag time, time to peak, peak height, and endogenous thrombin potential [ETP]) and coagulation factor II (prothrombin), VII and X, antithrombin, protein C, free protein S and tissue factor pathway inhibitor (TFPI) were assessed. Groups were compared by ANOVA or Kruskal-Wallis test and probabilities were corrected for multiple comparisons. Associations were evaluated using linear regression models. Results ETP was increased around 15% in current (n = 37) and former (n = 33) AAS abusers compared with controls (n = 30; p < 0.001). Prothrombin and factor X were increased ≥10% in AAS abusers and prothrombin was a predictor of ETP (p < 0.0005). Lag time and time to peak were increased 10 to 30% in current AAS abusers (p < 0.001) and associated with higher concentrations of TFPI, antithrombin, protein C and protein S (p < 0.0005; = 0.005). Multivariate linear regression, with all coagulation inhibitors as covariates, identified TFPI to be independently associated with lag time and time to peak (p < 0.0005). Conclusion Thrombin generation is augmented in current and former AAS abusers, reflecting a procoagulant state, with altered concentrations of coagulation proteins. Prospective studies are needed to clarify whether these findings translate into an increased thrombotic risk in AAS abusers potentially even after cessation.",

keywords = "blood coagulation, substance-related disorders, testosterone, thrombin",

author = "Simon Chang and Rasmussen, {Jon J.} and Frandsen, {Mikkel N.} and Morten Schou and Johansen, {Marie L.} and Jens Faber and M{\"u}nster, {Anna Marie B.} and Sidelmann, {Johannes J.} and Caroline Kistorp",

year = "2018",

doi = "10.1055/s-0038-1636540",

language = "English",

volume = "118",

pages = "647--653",

journal = "Thrombosis et diathesis haemorrhagica",

issn = "0340-6245",

publisher = "Schattauer",

number = "4",

}

TY - JOUR

T1 - Procoagulant State in Current and Former Anabolic Androgenic Steroid Abusers

AU - Chang, Simon

AU - Rasmussen, Jon J.

AU - Frandsen, Mikkel N.

AU - Schou, Morten

AU - Johansen, Marie L.

AU - Faber, Jens

AU - Münster, Anna Marie B.

AU - Sidelmann, Johannes J.

AU - Kistorp, Caroline

PY - 2018

Y1 - 2018

N2 - Background Anabolic androgenic steroid (AAS) abusers are considered at increased risk of cardiovascular morbidity and mortality. We hypothesized that current and former AAS abuse would induce a procoagulant shift in the haemostatic balance. Methods Men 18 to 50 years of age were included as current AAS abusers, former AAS abusers or controls. Morning blood samples were collected after overnight fasting. Thrombin generation (lag time, time to peak, peak height, and endogenous thrombin potential [ETP]) and coagulation factor II (prothrombin), VII and X, antithrombin, protein C, free protein S and tissue factor pathway inhibitor (TFPI) were assessed. Groups were compared by ANOVA or Kruskal-Wallis test and probabilities were corrected for multiple comparisons. Associations were evaluated using linear regression models. Results ETP was increased around 15% in current (n = 37) and former (n = 33) AAS abusers compared with controls (n = 30; p < 0.001). Prothrombin and factor X were increased ≥10% in AAS abusers and prothrombin was a predictor of ETP (p < 0.0005). Lag time and time to peak were increased 10 to 30% in current AAS abusers (p < 0.001) and associated with higher concentrations of TFPI, antithrombin, protein C and protein S (p < 0.0005; = 0.005). Multivariate linear regression, with all coagulation inhibitors as covariates, identified TFPI to be independently associated with lag time and time to peak (p < 0.0005). Conclusion Thrombin generation is augmented in current and former AAS abusers, reflecting a procoagulant state, with altered concentrations of coagulation proteins. Prospective studies are needed to clarify whether these findings translate into an increased thrombotic risk in AAS abusers potentially even after cessation.

AB - Background Anabolic androgenic steroid (AAS) abusers are considered at increased risk of cardiovascular morbidity and mortality. We hypothesized that current and former AAS abuse would induce a procoagulant shift in the haemostatic balance. Methods Men 18 to 50 years of age were included as current AAS abusers, former AAS abusers or controls. Morning blood samples were collected after overnight fasting. Thrombin generation (lag time, time to peak, peak height, and endogenous thrombin potential [ETP]) and coagulation factor II (prothrombin), VII and X, antithrombin, protein C, free protein S and tissue factor pathway inhibitor (TFPI) were assessed. Groups were compared by ANOVA or Kruskal-Wallis test and probabilities were corrected for multiple comparisons. Associations were evaluated using linear regression models. Results ETP was increased around 15% in current (n = 37) and former (n = 33) AAS abusers compared with controls (n = 30; p < 0.001). Prothrombin and factor X were increased ≥10% in AAS abusers and prothrombin was a predictor of ETP (p < 0.0005). Lag time and time to peak were increased 10 to 30% in current AAS abusers (p < 0.001) and associated with higher concentrations of TFPI, antithrombin, protein C and protein S (p < 0.0005; = 0.005). Multivariate linear regression, with all coagulation inhibitors as covariates, identified TFPI to be independently associated with lag time and time to peak (p < 0.0005). Conclusion Thrombin generation is augmented in current and former AAS abusers, reflecting a procoagulant state, with altered concentrations of coagulation proteins. Prospective studies are needed to clarify whether these findings translate into an increased thrombotic risk in AAS abusers potentially even after cessation.

KW - blood coagulation

KW - substance-related disorders

KW - testosterone

KW - thrombin

U2 - 10.1055/s-0038-1636540

DO - 10.1055/s-0038-1636540

M3 - Journal article

C2 - 29618151

AN - SCOPUS:85044938643

SN - 0340-6245

VL - 118

SP - 647

EP - 653

JO - Thrombosis et diathesis haemorrhagica

JF - Thrombosis et diathesis haemorrhagica

IS - 4

ER -

Procoagulant State in Current and Former Anabolic Androgenic Steroid Abusers

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Keywords

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