CO042 | BLEEDING RISK IN PATIENTS RECEIVING CONCURRENT TREATMENT WITH DIRECT ORAL ANTICOAGULANTS AND CORTICOSTEROIDS: A SYSTEMATIC REVIEW

M.A. Capparella¹, R. Talerico², C. Cavallaro², M. Iorio², F. Bossi¹, A. Porfidia², K. Abe³, M. Biglietto⁴, A. Chistolini⁴, A. Holt⁵, L. Lahousse^6|7, R. Pola², C. Becattini¹, M.C. Vedovati¹ | ¹Internal, Vascular and Emergency Medicine – Stroke Unit, University of Perugia, Italy; ²Thrombosis Unit, Department of Geriatric, Orthopedic, and Rheumatologic Sciences, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italy; ³Division of Gastroenterology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan; ⁴Hematology, Department of Translational and Precision Medicine, Sapienza University of Roma, Italy; ⁵Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark; ⁶Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium; ⁷Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands

Background and Aims. Direct oral anticoagulants (DOACs) and corticosteroids are frequently co-prescribed in clinical practice. While both drug classes independently increase bleeding risk, the impact of their concomitant use remains unclear. The aim of this study was to systematically review the literature on bleeding outcomes associated with concomitant DOAC and corticosteroid therapy.
Methods. We conducted a systematic review following PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies reporting bleeding in patients receiving both DOACs and corticosteroids. Cumulative incidences of any bleeding and major bleeding (MB) were estimated using a random-effects model, and study quality assessed using the Newcastle–Ottawa Scale and the Cochrane RoB2. Subgroup analyses were performed for patients treated for atrial fibrillation (AF) and venous thromboembolism (VTE).
Results. Ten studies including 87,256 patients were included. The weighted cumulative incidence of any bleeding was 7.1% (95% CI 4.2–11.7%), and of MB, 6.6% (95% CI 6.2–7.0%). Heterogeneity was high for any bleeding in the overall and in the AF populations, likely reflecting differences in patient characteristics, corticosteroid exposure, follow-up duration, and study design, whereas heterogeneity was minimal in the VTE subgroup. Variability in bleeding definitions, limited reporting of corticosteroid dose and duration, and absence of stratification by DOAC type/dose or bleeding site further contributed to differences in observed incidences.
Conclusions. Concomitant DOAC and corticosteroid therapy is associated with a nonnegligible risk of bleeding. Clinicians should carefully evaluate the risk–benefit profile, monitor patients closely, and consider preventive strategies. Future studies are needed to improve risk characterization in this common clinical scenario.