Case reportThe cost of seeking an edge: Recurrent renal infarction in setting of recreational use of anabolic steroids

- Consideration of earlier CT study with contrast.
- Thorough history taking including gym supplements.
- The use of NOACs.
- The need for further understanding of how anabolic steroids affect coagulation.
- Educating patients using anabolic steroids regarding the risks of continued use.

IntroductionAnabolic-androgenic steroid (AAS) use and testosterone therapy have been well established risk factors for the creation of a pro-thrombotic state, and to precipitate formation of thromboemboli in individuals already predisposed to thrombosis.Case reportHere, we present the case of an amateur bodybuilder, with a negative thrombophilia workup, who experienced primary renal infarction while using the AAS trenbolone acetate and testosterone, as well as a subsequent renal infarction while anticoagulated with apixaban.DiscussionThe development of subsequent infarctions in an anticoagulated patient with discontinued recreational steroid use poses a unique situation and challenges the current understanding of a thrombophilic state associated with steroids. The lifetime prevalence of anabolic steroid use is estimated to be 1% in the male population in the United States which is significant.ConclusionFurther understanding and recommendations of appropriate anticoagulant should be further elucidated to appropriately medically manage patients from this confounding social and medical history.