asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-024asurgery-471Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYВлияние приема анаболических андрогенных стероидов на риск развития венозных тромбоэмболических осложнений: систематический обзор литературыEffects of anabolic androgenic steroid use on the risk of venous thromboembolic events: systematic literature reviewhttps://orcid.org/0000-0003-1092-1762КовальчукА. В.KovalchukA. V.

Ковальчук Анна Викторовна, старший лаборант кафедры общей хирургии лечебного факультета 

117997, Россия, Москва, ул. Островитянова, д. 1 

Anna V. Kovalchuk, Senior Lab Analyst of the Department of General Surgery of the Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997, Russia 

dr.kovalchuk.a.v@mail.ruhttps://orcid.org/0000-0003-3811-5156ДженинаО. В.DzheninaO. V.

Дженина Ольга Вадимовна, к.м.н., флеболог 

117447, Россия, Москва, ул. Дмитрия Ульянова, д. 31 

Olga V. Dzhenina, Cand. Sci. (Med.), Phlebologist

31, Dmitry Ulyanov St., Moscow, 117447, Russia 

dzhenina@rambler.ruhttps://orcid.org/0000-0002-5358-7218ЛобастовК. В.LobastovK. V.

Лобастов Кирилл Викторович, д.м.н., доцент кафедры общей хирургии лечебного факультета 

117997, Россия, Москва, ул. Островитянова, д. 1 

Kirill V. Lobastov, Dr. Sci. (Med.), Associate Professor of the Department of General Surgery of the Faculty of Medicine 

1, Ostrovityanov St., Moscow, 117997, Russia 

lobastov_kv@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationПервый флебологический центрРоссияFirst Phlebological CenterRussian Federation2024171120242127080Copyright © Ковальчук А.В., Дженина О.В., Лобастов К.В., 20242024Ковальчук А.В., Дженина О.В., Лобастов К.В.Kovalchuk A.V., Dzhenina O.V., Lobastov K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/471

Венозные тромбоэмболические осложнения (ВТЭО) рассматриваются в качестве побочных эффектов применения анаболических андрогенных стероидов (ААС), однако систематические данные по этому вопросу отсутствуют. Целью данного исследования явилась оценка влияния злоупотребления тестостероном и ААС на риск развития ВТЭО у здоровых людей, принимающих препараты без медицинских показаний. Проведен систематический поиск литературы по базе данных Pubmed в марте 2024 г. В анализ включались исследования любого дизайна, описывающие развитие венозного тромбоза, включая тромбоз глубоких вен (ТГВ), тромбоэмболию легочной артерии (ТЭЛА), тромбоз спланхнических вен, тромбоз мозговых синусов, у здоровых лиц, принимающих ААС или препараты тестостерона при отсутствии медицинских показаний. В соответствии со сформированным поисковым запросом было обнаружено 537 ссылок, из которых в анализ включено 14 полнотекстовых статей, содержащих описание 15 клинических случаев. ВТЭО наблюдались у мужчин в возрасте от 18 до 56 лет (средний возраст 28 ± 12 лет) на фоне использования разнообразных ААС в различных дозах и комбинациях и были представлены тромбозом мозговых синусов (n = 6, 40%), ТЭЛА c наличием или отсутствием ТГВ (n = 5, 33,4%), тромбозом вен сетчатки глаза (n = 2, 13,3%) и комбинацией артериального тромбоза и ТЭЛА (n = 2, 13,3%). Среди дополнительных факторов риска были выявлены дефицит естественных антикоагулянтов (n = 2, 13,3%), гипергомоцистеинемия (n = 1, 7%), повышение гемоглобина или гематокрита (n = 2, 13,3%). На фоне лечения наблюдались следующие исходы: смерть (n = 1, 7%), остаточный неврологический дефицит (n = 3, 20%), прогрессирование тромбоза с окклюзией кава-фильтра и развитием синдрома нижней полой вены (n = 1, 7%), полное восстановление (n = 8, 53%), в 2 случаях отдаленные результаты не представлены. Риск развития ВТЭО на фоне злоупотребления ААС оценить невозможно, т. к. в литературе имеются лишь описания спорадических случаев с преобладанием венозного тромбоза атипичной локализации, поэтому требуются проспективные когортные исследования для уточнения данного вопроса.

Venous thromboembolic events (VTE) are regarded as side effects from anabolic androgenic steroids (AAS), however, systematic data on this matter are missing. The aim of this study was to evaluate the effects related to testosterone and AAS abuse on the risk of VTE in healthy individuals who use medications without medical reasons. A systematic literature search via PubMed was performed in March 2024. The analysis included studies of any design which described the development of venous thrombosis and specifically deep vein thrombosis (DVT), pulmonary embolism (PE), splanchnic vein thrombosis, and cerebral sinus thrombosis in healthy individuals taking AAS or testosterone medications in the absence of medical indications. The generated search query retrieved 537 references, of which 14 full-text articles containing descriptions of 15 clinical cases were included in the analysis. VTE were observed in men aged 18 to 56 years (mean age 28 ± 12 years) using various AAS at different doses and combinations. VTE were represented by cerebral sinus venous thrombosis (n = 6, 40%), PE with or without concomitant DVT (n = 5, 33.4%), retinal vein thrombosis (n = 2, 13.3%) and arterial thrombosis combined with PE (n = 2, 13.3%). Among additional risk factors, deficiencies of natural anticoagulants (n = 2, 13.3%), hyperhomocysteinemia (n = 1, 7%), and high levels of hemoglobin or hematocrit (n = 2, 13.3%) were identified. The therapy resulted in the following outcomes: death (n = 1, 7%), residual neurological deficit (n = 3, 20%), thrombosis progression with vena cava filter occlusion and development of inferior vena cava syndrome (n = 1, 7%), complete recovery (n = 8, 53%), no long-term results were provided on 2 patients. The risk of developing VTE in patients who abuse AASs cannot be assessed, as the literature contains only descriptions of sporadic cases among which venous thrombosis in atypical locations prevail, therefore, prospective cohort studies are needed to clarify this matter.

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The authors declare that there are no conflicts of interest present.