Table 2.

Medications associated with increased risk of arterial thrombosis^33-41

Medication	Sites	Proposed mechanism(s)	Notes
Estrogens33	Stroke, MI	Increased platelet activation and procoagulant factors, decreased anticoagulant and fibrinolysis factors	Variable risk reported, likely low absolute risk with commonly used lower estrogen doses. Higher risk in patients with HTN, smoking
Androgenic anabolic steroids34	Stroke, MI	Accelerated atherosclerosis, coagulation abnormalities, elevated hematocrit	General term for performance-enhancing drugs with promyogenic and androgenic effects
Heparin35	PA > stroke, MI	Autoimmune response to heparin-PF4 complex causing heparin-induced thrombocytopenia	Well-documented arterial thrombotic risk, but venous thrombosis more common
Intravenous immunoglobulin36	Stroke, MI	Many proposed: hyperviscosity, platelet activation, vasospasm, factor XI content	Risk factors: older age, hypertension, hypercholesterolemia. Consider lower dose, slower infusion rate
Cocaine37	Stroke, MI, PA	Platelet activation, vasoconstriction, accelerated atherosclerosis	Contributes to acute thrombosis risk and chronic arterial remodeling
Tobacco, cannabis38	PA	Thromboangiitis obliterans (Buerger disease)	Inflammatory vascular disease of the small- and medium-sized vessels of the extremities
Erythropoiesis-stimulating agents39	Stroke, MI	Platelet activation, hyperviscosity, hypertension, increased procoagulant factors	Risk most clearly documented in patients with renal disease treated to higher hemoglobin targets
Anticancer therapies40
VEGF inhibitors*	Stroke, MI	Endothelial dysfunction, increased procoagulant factors, accelerated atherosclerosis, HTN	Also associated with hemorrhage
Tamoxifen	Stroke	Unknown	Initial trials suggested increased stroke risk but decreased cardiac mortality, but variable in later trials
Fluorouracil	MI	Vasospasm, endothelial damage, increased procoagulant factors	Cardiotoxicity incidence 4% to 19%, but role of thrombosis vs other mechanisms unclear
Immune checkpoint inhibitors41	Stroke, MI, PA	Increased procoagulant factors, platelets activation, impaired fibrinolysis, accelerated atherosclerosis	Venous thrombosis more common than arterial (reported 13% vs 2%)

^* Includes bevacizumab, tyrosine kinase inhibitors (eg, sorafenib), aflibercept.

HTN, hypertension; MI, myocardial infarction; PA, peripheral artery; PF4, platelet factor 4; VEGF, vascular endothelial growth factor.