Oral and inhaled corticosteroid use has a time-dependent association with recurrent pulmonary embolism

Rationale: Chronic inflammatory diseases and pulmonary diseases such as asthma and COPD predispose to development of venous thromboembolism. Inhaled and oral corticosteroids are used as treatment for asthma and COPD. Previous studies showed that patients using inhaled/oral corticosteroids have an increased risk of first venous thromboembolism. It is not known whether these patients are also at increased risk for recurrent events. Aim: To analyse the association between oral/inhaled corticosteroid use and the risk of recurrent pulmonary embolism (PE). Method: A nested case-control study was performed using the PHARMO Record Linkage System, which combines drug prescription data, hospital admission and discharge codes. All patients had primary diagnosis of PE and prescription for vitamin K antagonists and had a median follow-up of 14 months. Patients with diagnosis of recurrent PE were matched to controls without recurrent PE. Conditional logistic regression analysis was used. Results: We analysed 384 cases of recurrent PE and 1030 controls. Patients using oral corticosteroids 6 months prior to the event (OR 0.5; p 6 months OR 0.5; p=0.02). Combination of inhaled and oral corticosteroids increased recurrent PE risk for use Conclusion: Oral and inhaled corticosteroid use is time-dependently associated with recurrent PE.