Hospitalization for pulmonary embolism associated with antecedent testosterone or estrogen therapy in patients found to have familial and acquired thrombophilia

Abstract

BackgroundIn patients hospitalized over a 4 year period for pulmonary embolism (PE), we assessed relationships of testosterone (TT) and estrogen therapy (ET) anteceding PE in patients found to have familial-acquired thrombophilia.MethodsFrom 2011 through 2014, 347 patients were hospitalized in Cincinnati Mercy Hospitals with PE. Retrospective chart review was used to identify patients receiving TT or ET before PE; coagulation studies were done prospectively if necessary.ResultsPreceding hospitalization for PE, 8 of 154 men (5 %) used TT, and 24 of 193 women (12 %) used ET. The median number of months from the initiation of TT or ET to development of PE was 7 months in men and 18 months in women. Of the 6 men having coagulation measures, all had ≥ 1 thrombophilia, and of the 18 women having measures of coagulation, 16 had ≥ 1 thrombophilia. The sensitivity of a previous history of thrombosis to predict PE was low, 25 % (2/8 men), 4 % (1/24 women).ConclusionsOf 154 men hospitalized for PE, 8 (5 %) used TT, and of 193 women, 24 (12 %) used ET. Our data suggests that PE is an important complication of TT in men and ET in women, in part reflecting an interaction between familial and acquired thrombophilia and exogenous hormone use.

Four Thrombotic Events Over 5 Years, Two Pulmonary Emboli and Two Deep Venous Thrombosis, When Testosterone-HCG Therapy Was Continued Despite Concurrent Anticoagulation in a 55-Year-Old Man With Lupus Anticoagulant

“…Particularly since our recent retrospective study of men and women hospitalized for VTE 44 revealed that personal and family history were nonspecific and insensitive to effectively identify subjects in whom TT and estrogen replacement therapy should not be given, prescreening for thrombophilia is realistic. However, it is expensive, with average laboratory costs in our center $1200.…”

“…36 Use of TT in men affected by late onset hypogonadism (LOH), 37,38 where low T has no definable etiology beyond aging and/or chronic disease, is controversial, with concerns over its effectiveness and safety. 2,[39][40][41][42] Indiscriminate use of TT for LOH is a real issue, 2,4,5,[43][44][45] as this form of therapy is administered to almost 1 in 25 American men over the age of 60. 46 Increasing use of TT may have thrombotic 12,13,[47][48][49][50] and cardiovascular ramifications.…”

Interventions for improving adherence to iron chelation therapy in people with sickle cell disease or thalassaemia

“…We also identified five ongoing RCTs (IRCT2015101218603N2; EudraCT 2012-000353-31; Madderom 2016; NCT02173951; NCT02435212), and two studies awaiting classification (Antmen 2013; NCT00004982). We did not identify any cluster-randomised trials, NRSIs, CBA or ITS studies that met the inclusion criteria.…”

“…Of the five ongoing trials, two compare medication interventions in thalassaemia and two in SCD and thalassaemia (EudraCT 2012-000353-31; IRCT2015101218603N2; NCT02173951; NCT02435212), and one assesses the effectiveness of group medical appointments on self-efficacy and adherence in SCD (Madderom 2016). Of the two studies awaiting classification, one is an educational study (Antmen 2013), and one is a medication intervention (NCT00004982).…”

“…QoL Starting date Not stated Contact information Consorzio per le Valutazioni Biologiche e Farmacologichevia Luigi Porta, 14Pavia 27100 Italydeep.2@deep-project.net Notes IRCT2015101218603N2 Trial name or title To assess compliance, efficacy and satisfaction with two different formulation of deferasirox in people with transfusion-dependent beta-thalassaemia Methods RCT; parallel group Participants Inclusion criteria: signing informed consent; male or female aged ≥ 2 years at screening; people with transfusion-dependent thalassaemia major; regular transfusion indicated by a blood requirement ≥ 8 blood transfusions per year at screeningExclusion criteria: people with mean levels of ALT above 5-fold the ULN; people with serum creatinine above ULN; significant proteinuria as indicated by a urinary protein/creatinine ratio > 0.6 (mg/mg); creatinine clearance ≤ 60 mL/min; chronic hepatitis B infection; active hepatitis C infection; pregnancy or breastfeeding; non-transfusion dependent thalassaemia Interventions DFX (new formulation Jadenu ™ ), DFX (Exjade ® ) Outcomes Participants compliance and satisfaction; 3 months after drug consumption; designed questionnaire to assess participant compliance and satisfaction; ferritin serum amount; safety; possible GI side effects, including diarrhoea, and dermatologic symptoms Starting date 22 December 2015 Contact information Vice chancellor of research, Shiaz Univeisity of Medical SciencesCOUNTRY: IranSETTING: multicentre (outpatient)Dr. Sezaneh HaghpanahINSTITUTION:Hematology Research Center, Nemazee Hospital, Shiraz, IranEMAIL: haghpanah@sums.ac.irADDRESS: Dr Sezaneh Haghpan Professor of community medicine Hematology Research Center, Nemazee Hospital, Zand Street, Shiraz, Ira Notes Madderom 2016 Trial name or title A randomised controlled trial studying the effectiveness of group medical appointments on self-efficacy and adherence in sickle cell disease (TEAM study): study protocol Methods RCT; parallel group Participants...…”