Venous Thromboembolism Issues in Women

Abstract

The lifetime risk of venous thromboembolism (VTE) is slightly higher in women than in men. There are several issues related to VTE that are unique to women. Combined hormonal contraceptives and pregnancy increase the risk of VTE in women of childbearing age, whereas hormone replacement therapy increases the VTE risk of postmenopausal women. Hereditary thrombophilia and risk factors such as older age, obesity, or smoking contribute to the risk increase. In women diagnosed with acute hormone-related VTE who are treated with oral anticoagulants, adequate contraception is mandatory to avoid unwanted pregnancies. According to current knowledge, hormonal contraception may be continued during anticoagulant therapy but must be switched to an estrogen-free contraception method at least 6 weeks before the termination of anticoagulation. VTE is also a major cause of maternal morbidity and mortality during pregnancy and the postpartum period. Currently, assisted reproduction technologies such as in vitro fertilization are widely used to treat couples affected by infertility. Complications of fertility treatment comprise VTE cases, especially in women with ovarian hyperstimulation syndrome. With this review, we intended to focus on VTE issues in women and summarize current evidence and guideline recommendations.

Outline of Hospitalization Due to Venous Thromboembolism in Brazil Between 2010 and 2020

“…Regarding the use of oral contraceptives , although pills currently have a lower concentration of estrogen, especially ethinyl estradiol, their use increases the risk of VTE by up to six times compared to those that do not use hormonally based contraceptives. The absolute risk, however, in women aged less than 35 years and without associated risk factors remains between low and moderate (Linnemann, et al, 2022).…”

Evaluating Thromboprophylaxis Strategies for High-Risk Pregnancy: A Current Perspective

“…Currently, the risk of venous thromboembolism (VTE) is higher in women than in men. Along with the use of combined oral contraceptives, pregnancy belongs to the clinical states increasing the risk of thromboembolic complications in women of childbearing age [ 2 ].…”

Risk Factors for Venous Thromboembolism in Women of Childbearing Age

“…Large epidemiological studies in various populations have shown increasing age, a family history of VTE, presence of acquired and inherited thrombophilia, COC use, pregnancy, and smoking to be independent risk factors for VTE, 8,9 and, in pregnant women, advanced maternal age, family history, caesarean section, multiparity, and multifetal pregnancies were found to be risk factors for pregnancy-associated VTE. 10,11 Ethnic differences have also been observed in risk factors and the incidence of pregnancy-associated VTE. 12 Other studies indicate that family history of VTE is an important risk factor for VTE in women who are pregnant or who are taking COC, irrespective of thrombophilia status.…”