Glucocorticoid therapy and risk of venous thromboembolism: a systematic review and meta-analysis with exploration of dose, duration, and route-specific effects

INTRODUCTION: Glucocorticoids (GCs) are among the most widely prescribed medications globally. Despite biological plausibility for procoagulant effects, the magnitude of venous thromboembolism (VTE) risk has not been rigorously quantified. We conducted a systematic review and meta-analysis to address this gap. METHODS: MEDLINE, EMBASE, and Cochrane CENTRAL were searched from inception to January 2026. Eligible studies reported adjusted effect estimates for VTE in adults receiving systemic or inhaled GCs versus unexposed comparators. Surgical populations and unadjusted studies were excluded. Quality was assessed using the Newcastle-Ottawa Scale. Pooled risk ratios (RRs) were calculated using a random-effects model with Knapp-Hartung correction. RESULTS: = 93%). Sensitivity analyses were consistent (RR range: 2.47-3.00). Risk was highest at treatment initiation and higher doses; systemic GCs conferred greater risk than inhaled formulations. CONCLUSIONS: GC use is associated with an approximately 2.6-fold increased VTE risk, highest with early, high-dose, systemic therapy. Limitations include observational study designs, potential residual confounding, substantial heterogeneity, and few eligible studies. Prospective research evaluating targeted thromboprophylaxis is needed before firm clinical recommendations can be made. PROTOCOL REGISTRATION: www.crd.york.ac.uk/prospero; identifier is CRD420261330101.