Anabolic–Androgenic Steroid Abuse Impairs Fibrin Clot Lysis

Johannes Jakobsen Sidelmann; Jørgen Brodersen Gram; Jon J. Rasmussen; Caroline Kistorp

doi:10.1055/s-0040-1714398

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2021; 47(01): 011-017
DOI: 10.1055/s-0040-1714398

Review Article

Anabolic–Androgenic Steroid Abuse Impairs Fibrin Clot Lysis

Authors

Johannes Jakobsen Sidelmann

¹Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark

²Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
Jørgen Brodersen Gram

¹Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark

²Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
Jon J. Rasmussen

³Department of Endocrinology and Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Copenhagen, Denmark

⁴Department of Internal Medicine, Holbæk Hospital, Region Zealand, Denmark
Caroline Kistorp

³Department of Endocrinology and Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Copenhagen, Denmark

⁵Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

Abstract

Abuse of anabolic–androgenic steroids (AASs) is suspected to increase the risk of cardiovascular disease (CVD) and cardiovascular mortality in otherwise healthy individuals. AAS abuse may increase the incidence of CVD by altering the hemostatic balance toward a procoagulant state. Studies on the effect of AAS abuse on the fibrinolytic system, however, have either demonstrated a profibrinolytic effect or no effect of AAS abuse, but the overall effect of AAS on fibrinolysis has not been addressed so far. This cross-sectional study investigated the effect of AAS on fibrin clot lysis, fibrin structure, and the hemostatic proteins, potentially affecting these measures in current and former AAS abusers and healthy age-matched controls. The study population consisted of 37 current and 33 former AAS abusers, along with 30 healthy age-matched controls. Fibrin clot lysis, fibrin structure properties, fibrinogen, coagulation factor XIII (FXIII) plasminogen, plasmin inhibitor, plasminogen activator inhibitor-1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI) were determined. Fibrin clot lysis was significantly reduced in participants abusing AAS compared with former abusers and controls (p < 0.001). Plasma fibrinogen, plasminogen, and plasmin inhibitor were significantly increased in current abusers (p < 0.05). No significant differences were observed with respect to measures of fibrin structure properties, PAI-1, and TAFI (p > 0.05). In conclusion, AAS abuse depresses fibrin clot lysis. This effect is not associated with alterations in fibrin structure but is rather caused by increased plasma concentrations of fibrinogen, FXIII, and plasmin inhibitor. These findings suggest that AAS abuse may be associated with increased thrombotic disease.

Keywords

anabolic–androgenic steroids - fibrinolysis - fibrin clot structure - coagulation

Full Text

References

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