Abstract Number: PB1197
Meeting: ISTH 2021 Congress
Theme: Venous Thromboembolism » VTE Epidemiology
Background: Anabolic androgenic steroids (AAS) are frequently used by amateur strength athletes to enhance muscle mass. An increased risk of cardiovascular events and venous thrombosis has been reported after AAS use, but the mechanism behind this association is unclear and the level of evidence is low. Also, no studies describe the extent of recovery of coagulation factor levels after AAS are withdrawn.
Aims: To assess the change of coagulation factor levels during AAS use and their recovery after.
Methods: The HAARLEM study enrolled 100 men intending to start a self-initiated AAS cycle between 2015-2018. Coagulation factors (factor[F]II, FVIII, FIX, von Willebrand factor [vWF], protein S [PS], D-Dimer [DD]) were measured before AAS use (T0), at the end of the cycle (T1) and 3 months after discontinuation (T2). Multivariable linear regression, adjusted for possible confounders, was used to assess the association between weekly AAS dose and cycle duration and changes in coagulation factors between T0 and T1, and between T0 and T2 to assess recovery.
Results: Subject performed an AAS cycle with a median duration of 13 weeks (range 2-52) and median dose of 900 mg (range 88-3721). Mean levels of procoagulant factors FII, FIX and DD increased at T1 compared to T0 (Table 1), whereas FVIII were unchanged and vWF levels decreased. Levels of the natural anticoagulant PS increased the most (22%, 95%CI 15-29). An increase of weekly AAS dose and a shorter cycle duration were associated with an adjusted increase in PS between T1 and T0. Coagulation factor levels returned to baseline at T2; neither weekly dose or cycle length were associated with the recovery of coagulation parameters.
T0 | T1 | ΔT1 = T1 – T0* | Mean ΔT1 increase by 100 mg increase of AAS weekly dose |
Mean ΔT1 increase by 1 week increase of cycle length |
|||
Mean (SD) |
Mean (SD) |
Mean difference (95%CI) |
Mean ΔT1 increase (95%CI) |
Adjusted Mean ΔT1 increase Ɨ (95%CI) |
Mean ΔT1 increase (95%CI) |
Adjusted Mean ΔT1 increase Ɨ (95%CI) |
|
FII [%] |
98.2 (11.2) |
112.0 (19.2) |
13.9 (10.2 to 17.5) |
0.7 (0.1 to 1.4) |
0.2 (-0.6 to 0.9) |
-0.09 (-0.4 to 0.3) |
-0.4 (-0.7 to 0.03) |
FVIII [%] |
121.0 (25.7) |
120.5 (23.7) |
-0.4 (-4.6 to 3.9) |
0.3 (-0.5 to 1.1) |
-0.2 (-1.1 to 0.7) |
-0.08 (-0.5 to 0.3) |
-0.7 (-0.7 to 0.3) |
FIX [%] |
107.7 (19.5) |
127.4 (26.7) |
19.9 (14.5 to 25.3) |
1.0 (0.02 to 2.0) |
0.4 (-0.8 to 1.5) |
-0.3 (-0.9 to 0.2) |
-0.4 (-1.0 to 0.2) |
vWF [%] |
136.7 (42.1) |
129.6 (39.9) |
-7.3 (-14.2 to -0.4) |
0.4 (-0.9 to 1.6) |
-0.3 (-1.9 to 1.2) |
-0.3 (-1.0 to 0.3) |
-0.4 (-1.2 to 0.4) |
PS [%] |
113.4 (30.5) |
134.8 (35.7) |
21.8 (14.9 to 28.5) |
2.1 (0.9 to 3.3) |
2.9 (1.4 to 4.3) |
-0.4 (-1.0 to 0.2) |
-0.06 (-0.8 to 0.7) |
DD [ng/mL] |
285.9 (212.8) |
404.5 (580.5) |
119.9 (18.9 to 220.9) |
-5.6 (-24.7 to 13.4) |
-10.5 (-32.1 to 11.1) |
-3.7 (-13.5 to 6.1) |
-2.8 (-14.1 to 8.5) |
*T0 = before the start of the cycle, T1 = in the last week of the cycle, T2 = 3 months after the cycle Ɨ adjusted for number of different agents used, the use of AAS at time of T1, the use of other performance and image-enhancing drugs (e.g. growth hormone, anti-estrogenic, aromatase inhibitors), recreational drugs use, previous AAS use, age and weight |
T0 | T2 | ΔT2 = T2 – T0* | Mean ΔT2 increase by 100 mg increase of AAS weekly dose |
Mean ΔT2 increase by 1 week increase of cycle length |
|||
Mean (SD) |
Mean (SD) |
Mean difference (95%CI) |
Mean ΔT2 increase (95%CI) |
Adjusted Mean ΔT2 increase ˣ (95%CI) |
Mean ΔT2 increase (95%CI) |
Adjusted Mean ΔT2 increase ˣ (95%CI) |
|
FII [%] |
98.2 (11.2) |
96.8 (12.0) |
-1.2 (-3.3 to 0.9) |
0.1 (-0.3 to 0.5) |
0.07 (-0.4 to 0.5) |
-0.1 (-0.3 to 0.09) |
-0.3 (-0.5 to 0.01) |
FVIII [%] |
121.0 (25.7) |
123.3 (28.2) |
2.6 (-1.5 to 6.7) |
0.2 (-0.6 to 1.0) |
-0.3 (-1.2 to 0.6) |
-0.2 (-0.7 to 0.2) |
-0.4 (-1.0 to 0.1) |
FIX [%] |
107.7 (19.5) |
110.1 (17.9) |
3.0 (-0.7 to 6.7) |
0.3 (-0.4 to 1.0) |
-0.08 (-0.9 to 0.7) |
-0.2 (-0.6 to 0.1) |
-0.5 (-1.0 to -0.03) |
vWF [%] |
136.7 (42.1) |
138.6 (41.6) |
0.8 (-4.6 to 6.3) |
0.3 (-0.7 to 1.3) |
-0.3 (-1.6 to 0.9) |
-0.5 (-1.1 to 0.04) |
-0.6 (-1.4 to 0.1) |
PS [%] |
113.4 (30.5) |
111.6 (28.1) |
-0.8 (-5.9 to 4.3) |
0.2 (-0.8 to 1.2) |
0.7 (-0.5 to 1.8) |
0.09 (-0.4 to 0.6) |
0.5 (-0.2 to 1.2) |
DD [ng/mL] |
285.9 (212.8) |
351 (643.2) |
56.9 (-54.7 to 168.5) |
-7.7 (-30.2 to 14.9) |
-11.6 (-37.2 to 14.0) |
-3.9 (-16.0 to 8.2) |
-5.4 (-21.0 to 10.1) |
*T0 = before the start of the cycle, T1 = in the last week of the cycle, T2 = 3 months after the cycle ˣ adjusted for number of different agents used, the use of post-cycle therapy (e.g. anti-estrogen therapy), the use of other performance and image-enhancing drugs during the cycle, recreational drugs use, previous AAS use, age and weight |
Conclusions: AAS use was associated with increased levels of both procoagulant and anticoagulant factors. A higher weekly AAS dose and shorter cycle durations were associated with a stronger increase in PS.
To cite this abstract in AMA style:
Camilleri E, Smit DL, van Rein N, Le Cessie S, de Hon O, den Heijer M, Cannegieter SC, de Ronde W. Coagulation Factors Levels during and after Anabolic Androgenic Steroid Use: Data from the HAARLEM Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/coagulation-factors-levels-during-and-after-anabolic-androgenic-steroid-use-data-from-the-haarlem-study/. Accessed March 22, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/coagulation-factors-levels-during-and-after-anabolic-androgenic-steroid-use-data-from-the-haarlem-study/