Prevalence and thrombotic risk of SGLT-2 inhibitor-associated erythrocytosis: a retrospective cohort study
Ji Yun Lee, Ju-Hyun Lee, Eun-Jung Jung, Woo Chan Park, Jeongmin Seo, Mingu Kang, Eun Hee Jung, Sang‐A Kim, Koung Jin Suh, Jiwon Kim, Se Hyun Kim, Jeong‐Ok Lee, Jin Won Kim, Yu Jung Kim, Keun‐Wook Lee, Jee Hyun Kim, Soo‐Mee Bang
Abstract
BACKGROUND: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, widely used for type 2 diabetes and cardiorenal conditions, may induce erythrocytosis, potentially increasing cardiovascular risk. This study investigates its prevalence, risk factors, and thrombotic implications. METHODS: In a single-center retrospective study, we analyzed 6787 patients prescribed SGLT-2 inhibitors (2014-2024). Erythrocytosis was defined as hemoglobin > 16.5 g/dL or hematocrit > 49% in men, > 16.0 g/dL or > 48% in women. We assessed prevalence, risk factors, and thrombotic events using logistic regression. RESULTS: (OR 1.97, 95% CI 1.63-2.39), and current smoking (OR 2.41, 95% CI 1.96-2.96) significantly increased risk (all p < 0.001), while age ≥ 70 years, hypertension, dyslipidemia, and chronic kidney disease were associated with reduced risk. Thrombosis was rare (0.5%, 33 patients) and associated with antiplatelet use (OR 3.57, 95% CI 1.60-7.97), anticoagulant use (OR 5.93, 95% CI 2.60-13.57), and baseline erythrocytosis (OR 3.75, 95% CI 1.41-9.96). Among 33 patients with thrombosis, five exhibited erythrocytosis at the time of the event and within the prior six months; all had arterial thrombosis associated with underlying conditions (atrial fibrillation, coronary calcification, atherosclerosis), not directly attributable to SGLT-2-induced erythrocytosis. CONCLUSIONS: SGLT-2 inhibitors are associated with a 16.9% prevalence of erythrocytosis, but thrombotic risk appears primarily driven by pre-existing conditions.