Brotman Daniel J, Girod John P, Posch Amy, Jani Jayesh T, Patel Jeetesh V, Gupta Manjula, Lip Gregory Y H, Reddy Sethu, Kickler Thomas S
Department of General Internal Medicine, Cleveland Clinic Foundation, OH, USA.
Thromb Res. 2006;118(2):247-52. doi: 10.1016/j.thromres.2005.06.006. Epub 2005 Jul 11.
Increased circulating levels of hemostatic factors have been associated with arterial and venous thrombosis. Although in vitro evidence suggests that glucocorticoids may activate hemostasis and inhibit thrombolysis, no controlled in vivo studies have examined the effects of glucocorticoids on hemostatic factors. We hypothesized that a 5-day treatment course of dexamethasone would increase circulating levels of hemostatic and anti-fibrinolytic factors.
We randomized 24 healthy men ages 19-39 to receive either dexamethasone 3 mg twice daily versus placebo for 5 days. Parameters examined before and after the intervention included: clotting factors VII, VIII, and XI, von Willebrand factor (vWF), D-dimer, PAI-1, soluble CD40-ligand (sCD40-ligand), and fibrinogen.
Dexamethasone tended to modestly increase clotting factors levels and fibrinogen without significantly affecting PAI-1, D-dimer or sCD40-ligand. Factor VII increased by a mean of 13% (p = 0.04 versus placebo), factor VIII by 27% (p = 0.0008), factor XI by 6% (p = 0.01), and fibrinogen by 13% (p = 0.05).
Glucocorticoids may increase the activity of clotting factors in vivo. This may contribute to the reported increased risk of thrombosis in patients with sustained exposure to glucocorticoids.
止血因子循环水平升高与动脉和静脉血栓形成有关。尽管体外证据表明糖皮质激素可能激活止血并抑制溶栓，但尚无对照的体内研究考察糖皮质激素对止血因子的影响。我们假设地塞米松5天的治疗疗程会增加止血和抗纤溶因子的循环水平。
我们将24名年龄在19 - 39岁的健康男性随机分组，一组每天两次接受3毫克地塞米松治疗，另一组接受安慰剂治疗，为期5天。干预前后检测的参数包括：凝血因子VII、VIII和XI、血管性血友病因子（vWF）、D - 二聚体、纤溶酶原激活物抑制剂 - 1（PAI - 1）、可溶性CD40配体（sCD40 - 配体）和纤维蛋白原。
地塞米松有适度增加凝血因子水平和纤维蛋白原的趋势，但对PAI - 1、D - 二聚体或sCD40 - 配体无显著影响。因子VII平均增加13%（与安慰剂相比，p = 0.04），因子VIII增加27%（p = 0.0008），因子XI增加6%（p = 0.01），纤维蛋白原增加13%（p = 0.05）。
糖皮质激素可能在体内增加凝血因子的活性。这可能导致长期暴露于糖皮质激素的患者血栓形成风险增加。
