@stonewheel So sorry to hear of your blood clot. There were observational studies with Prednisone and clots, but no proven cause and effect. The higher the Prednisone dose, the greater the risk. The Arthritis Foundation has a blog on that question if you are interested. As a retired family doc, I was not aware of the association, so good to know. Best of luck and hopefully, the clot resolves soon.

@stonewheel

So sorry to hear about this and I wish you a speedy recovery.

You probably don't need to read about the details of the blood clots I had while on prednisone. The blood clots in my lungs were described as massive, extensive, bilateral and multiple throughout both of my lungs. I was in intensive care for a few days.

My intensive care doctors congregated outside my door and discussed what might have caused such a pulmonary event. A doctor with many years of experience said he had never seen anything like it before. The way all of the doctors were talking, I wasn't sure I would survive! The doctors were not sure how the blood flow was getting through my lungs. There was a great deal of strain on my heart. A single pulmonary embolism is often fatal.

On a positive note ... my body had an incredible way of cleaning up the mess that was inside my lungs!

I listened to the conversations the doctors had. There was a lot of whispering but I distinctly heard that prednisone was the probable cause. I had prior high blood pressure and cardiac arrhythmias but those problems were likely prednisone related too. I was relatively young with no prior cardiac history before prednisone was started.

My medical records only say the multiple pulmonary embolisms were acute and unprovoked. There was no clear evidence for where the blood clots came from. I was told it was a "cascade of blood related events."

When I got out of the hospital, the plan was that I would need to be on warfarin for the rest of my life. Interestingly, about 10 years later after I got off prednisone, the warfarin for the rest of my life was discontinued. Furthermore, within a few years after prednisone was discontinued, all my other cardiac medications were also discontinued.

The following research is very technical statistically but it tries to control for confounding factors like our underlying inflammatory diseases and other causal factors for cardiovascular disease (CVD).
https://pmc.ncbi.nlm.nih.gov/articles/PMC7714202/
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In the author's summary you will find the following.

"What do these findings mean?
We have provided evidence that individuals receiving steroids have an increased risk of developing a broad spectrum of fatal and nonfatal CVDs and that this risk increases with the dose of steroids and with the duration of steroid treatment.

It was previously believed that less than 5 mg of prednisolone was safe long term, but even at this “low dose” patients with immune-mediated inflammatory diseases have a doubling of their underlying risk of CVD.

New treatment approaches that avoid the need for long-term steroid treatment and have better cardiovascular safety profile are required for immune-mediated inflammatory diseases.

All patients requiring long-term steroid treatment should be prescribed the lowest effective steroid dose and have a personalised CVD risk prevention plan that takes into account current and prior steroid use."