Влияние приема анаболических андрогенных стероидов на риск развития венозных тромбоэмболических осложнений: систематический обзор литературы

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.

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