Risk of venous thromboembolic disease in women

Romero, Alberto; Alonso, Carlos; Rincón, Manuel; Medrano, J.A. Núñez; Santos, J. Hermida; Calderón, E.; Marı́n, Irma; González, M Rodríguez

doi:10.1016/j.ejogrb.2004.11.023

Cited by 47 publications

(29 citation statements)

References 51 publications

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“…Silverstein et al [97] also reported that the incidence of DVT remained constant for males across all age strata, but it decreased for females younger than 55 years, and increased for women older than 60 years. However, in a recent qualitative systematic review of the available studies, Romero et al [98] concluded that gender is not an independent risk factor of VTE, and the absolute risk is frequently related to specific circumstances unique to women, such as pregnancy (1.23 cases per 1,000 women-year), puerperium (3.2 cases per 1,000 women-year), pregnancy in thrombophilic women (40 cases per 1,000 women-year), pregnancy and background of previous VTE (110 cases per 1,000 women-year), hormone replacement therapy (HRT) (0.2-5.9 cases per 1,000 women-year), tamoxifen (3.6-12 cases per 1,000 women-year) and raloxifene (9.5 cases per 1,000 women-year). As previously highlighted for ethnicity, the major drawback among the separate studies that have analyzed the incidence of VTE between genders is the remarkable diversity of several additional variables, including ethnicity, age, lifestyle, socioeconomic conditions and diet, which would thereby explain (at least partially) the different outcomes.…”

Section: Influence Of Gender On Vtementioning

confidence: 97%

The role of ethnicity, age and gender in venous thromboembolism

Montagnana

Favaloro

Franchini

et al. 2009

J Thromb Thrombolysis

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Venous thromboembolism, including both deep venous thrombosis and pulmonary embolism, is the leading cause of preventable in-hospital mortality. In the inexorable progress towards individualization of risk and personalized medicine, several congenital and acquired risk factors have been identified. However, the influence of some demographical variables, especially ethnicity, age and gender, has largely been under appreciated. Although the incidence of venous thromboembolism varies widely among diverse racial/ethnic cohorts, it appears globally highest in Blacks, is intermediate in Caucasians and is lowest in Asians. The incidence and prevalence of venous thromboembolism is also strongly age-related, increasing nearly 90 fold from <15 to >80 years old. Definitive data on the relative frequency of venous thromboembolism across genders is lacking. Some studies report that gender is not an independent risk factor of venous thromboembolism, while others conclude that female gender might be a protective variable. The purpose of this review is to assess the relationship between such demographic variables and venous thromboembolism.

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Section: Influence Of Gender On Vtementioning

confidence: 97%

The role of ethnicity, age and gender in venous thromboembolism

Montagnana

Favaloro

Franchini

et al. 2009

J Thromb Thrombolysis

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“…Die Inzidenz von VTE in der Schwangerschaft ist altersabhängig und gegenüber gesunden nichtschwangeren Frauen ohne OH um den Faktor 4-8 signifikant erhöht [22,24,40,48,50,51,53]. Sie liegt damit bei 8-40 Ereignissen pro 10.000 Schwangerschaften.…”

Section: Risiko In Der Schwangerschaft Und Im Postpartumunclassified

“…Sie liegt damit bei 8-40 Ereignissen pro 10.000 Schwangerschaften. Nach der Review von Heit et al [22] [22,24,26,40,48,50,51,53]. Auch das arterielle thrombembolische Risiko (Schlaganfälle und kardiale Ereignisse) steigt um das 3-bis 4-Fache an [24,25].…”

Section: Risiko In Der Schwangerschaft Und Im Postpartumunclassified

Hormonale Kontrazeptiva der zweiten, dritten und vierten Generation

Birkhäuser

2010

Gynäkologische Endokrinologie

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Risiko venöser und arterieller Thrombembolie Arzneimitteltherapie AusgangslageDas thrombembolische Risiko unter kombinierten Ovulationshemmern (OH) wurde in den letzten 30 Jahren durch die Entwicklung der Mikropillen (≤35 µg Ethinylestradiol, EE) signifikant gesenkt. Nach einigen, aber nicht allen Studien beeinflussen neben EE auch die Gestagene die Hämostase und spielen daher beim Thromboserisiko eine Rolle [3, 27, 28, 67,71, 72]. Eine leicht vermehrte Resistenz auf aktiviertes Protein C, ein Anstieg von Prothrombin oder Faktor VII und ein Abfall des Faktors V bei Drittgenerationspillen und OH mit Drospirenon (gelegentlich als "vierte Generation" bezeichnet) könnten zu einer höheren Koagulabilität führen [3, 67,71]. Danach wären OH mit solchen Gestagenen im Vergleich zu OH der zweiten Generation, die meist Levonorgestrel enthalten, mit einem hö-heren Thromboserisiko assoziiert [28]. Reanalysen dieser Daten und neuere Untersuchungen zu den 14, 15,19, 20,21, 27, 30, 37,56,57, 59] sind allerdings widersprüchlich. Bei den geringen Risikounterschieden könnte es sich um einen Bias durch eine für ältere und neuere OH unterschiedliche Verschreibungspraxis handeln, in dem neue OH als "Hoffnungsträ-ger" v. a. bei Patientinnen mit Nebenwirkungen unter älteren OH und bei Erstanwenderinnen mit relativen Kontraindikationen eingesetzt wurden. > Das Risiko für VTE ist immer entscheidend durch die Prädisposition der einzelnen Frau mitbestimmt Da OH mit dem Gestagen Drospirenon erst etwa 10 Jahre später als diejenigen mit den sog. Drittgenerationsgestagenen auf den Markt kamen, wurden sie in den äl-teren Diskussionen zum Risiko für venöse Thrombembolie (VTE) noch nicht einbezogen. Die seither publizierten Daten zu Drospirenon [9, 12, 36, 56, 70] werfen für das VTE-Risiko dieser neueren Pillen wiederum ähnliche Fragen zur Ursache eines möglicherweise erhöhten VTE-Risikos auf [8, 20, 29, 30, 33]. Es muss aber bereits hier festgehalten werden, dass das Risiko für VTE immer entscheidend durch die Prädisposition der einzelnen Frau mitbestimmt ist.

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“…15 Currently, there are no recommendations for discontinuation of OCPs prior to elective surgery. Appropriate prophylactic measures should be taken according to those recommended routinely for surgical procedures.…”

Section: Prevention Of Vtementioning

confidence: 99%

“…This risk is influenced by various factors including the presence of thrombophilia, age, weight, estrogen dose, progestin dose and preparation, and route of administration. Overall, with use of OCPs, the risk of VTE is increased two-to eightfold in users compared with non-users, [11][12][13][14][15][16] translating into an absolute annual risk of 0.48% in women without thrombophilia and 4.6% in those with hereditary protein C, S or antithrombin deficiency. 17 This elevation in risk must be put into context with the very low absolute risk of VTE with OCP use.…”

Section: Epidemiology Of Venous Thromboembolism In Womenmentioning

confidence: 99%

Venous thromboembolism in women

Rathbun

2008

Vasc Med

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The risk of venous thromboembolism (VTE) varies throughout a woman's life and is associated primarily with underlying hormonal exposure. Alteration in hemostatic mechanisms, including resistance to activated protein C, may explain this altered risk. Initially, development of VTE with the use of contraception in young adulthood may reveal inherited thrombophilia. Pregnancy, and particularly the postpartum period, likely confer the greatest risk of VTE, but the absolute risk is small. Guidelines for prevention of VTE during pregnancy are based on personal or family history of VTE, and known inherited thrombophilia. Use of hormone replacement therapy later in life is associated with increased risk of VTE, and may be safest if given as an estrogen-only preparation to young postmenopausal women for less than 5 years. Universal screening for thrombophilia prior to pregnancy or initiating hormonal therapy is not recommended; however, selected testing in high-risk groups may be warranted. The lack of firm recommendations for the prevention of VTE in women highlights the need for future investigation aimed at identifying high-risk groups and evaluating the efficacy of prophylactic measures.Key words: contraception; hormone replacement therapy; pregnancy; venous thrombosis; women Epidemiology of venous thromboembolism in womenVenous thromboembolism (VTE) risk varies throughout a woman's life, with hormonal exposure likely underlying this risk. This varying risk may be dependent on both the dose and duration of estrogen exposure including use of contraceptive therapy, pregnancy and hormone replacement therapy (HRT). In addition, the risk of VTE in women is influenced by innate factors of age, race, weight, and thrombophilia, as well as external factors such as the formulation, dose and duration of estrogen and progestin administration. Venous thromboembolism should be carefully considered as an important women's health issue.Most studies report the overall risk of VTE as similar in women compared with men, but there are specific trends related to sex. In a multi-center, cross-sectional, observational study performed on more than 1,500 general surgical patients in Italy, more women than men had risk factors for VTE, most commonly varicose veins, obesity and estrogen therapy. 1 Eighty percent of women and 67% of men had at least one risk factor, and 51% of women and 35% of men had at least two risk factors. Simon and colleagues in a recent retrospective case-control study reported that lifetime estrogen exposure may be related to the overall risk of VTE. 2 After statistical adjustment for other common risk factors for VTE, it was found that the risk of VTE increased by 6% for each year's delay in menopause. Moreover, women with higher parity, especially those with more than two children, were at higher risk. The combination of late menopause and oral estrogen use had the highest risk of VTE. Other studies have confirmed an association of late menopause and increased parity with risk of VTE. 3,4 A 3-year European st...

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Risk of venous thromboembolic disease in women

Cited by 47 publications

References 51 publications

The role of ethnicity, age and gender in venous thromboembolism

The role of ethnicity, age and gender in venous thromboembolism

Hormonale Kontrazeptiva der zweiten, dritten und vierten Generation

Venous thromboembolism in women

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