Platelet activity, coagulation, and fibrinolysis in long-term users of anabolic-androgenic steroids compared to strength-trained athletes

Thromb Res. 2024 Jun:238:60-66. doi: 10.1016/j.thromres.2024.04.027. Epub 2024 Apr 24.


Introduction: Use of anabolic-androgenic steroids (AAS) is associated with adverse cardiovascular (CV) effects, including potential prothrombotic effects. This study aimed to assess platelet activation and aggregation, coagulation, and fibrinolysis, in long-term AAS users compared to non-using strength-trained athletes.

Materials and methods: Thirty-seven strength-trained men using AAS were compared to seventeen non-using professional strength-trained athletes at similar age (median 33 years). AAS use was verified by blood and urine analyses. Platelet Function Analyzer 100 (PFA-100) and whole blood impedance aggregometry with thrombin, arachidonic acid, and ADP as agonists, were performed to evaluate platelet aggregation. ELISA methods were used for markers of platelet activation. Fibrinogen, D-dimer, the coagulation inhibitors protein S and C activity, and antithrombin were measured by routine. Fibrinolysis was evaluated by Plasminogen Activator Inhibitor-1 (PAI-1) activity.

Results: There were no significant differences in platelet aggregation between the two groups. Von Willebrand factor was lower among the AAS users (p < 0.01), and P-Selectin was slightly higher (p = 0.05), whereas CD40 Ligand, β-thromboglobulin, and thrombospondin did not differ significantly. No differences were found in the assessed coagulation inhibitors. Higher D-dimer levels (p < 0.01) and lower PAI-1 activity (p < 0.01) were found among the AAS users.

Conclusions: The investigated long-term users of AAS did not exhibit elevated platelet activity compared to strength-trained non-using athletes. However, AAS use was associated with higher D-dimer levels and lower PAI-1 activity. These findings suggest that any prothrombotic effect of long-term AAS use may predominantly involve other aspects of the hemostatic system than blood platelets.

Keywords: Anabolic-androgenic steroids; Cardiovascular disease; Coagulation; Fibrinolysis; Hemostasis; Platelet activity.

MeSH terms

  • Adult
  • Anabolic Agents / pharmacology
  • Androgens
  • Athletes*
  • Blood Coagulation* / drug effects
  • Blood Platelets / drug effects
  • Blood Platelets / metabolism
  • Fibrinolysis* / drug effects
  • Humans
  • Male
  • Platelet Activation* / drug effects
  • Platelet Aggregation / drug effects
  • Resistance Training