Venous thromboembolism risk in relation to use of different types of postmenopausal hormone therapy in a large prospective study

Abstract

Summary. Background: Current use of menopausal hormone therapy (HT) increases the risk of venous thromboembolism (VTE) and the formulations used may affect risk. Methods: A total of 1 058 259 postmenopausal UK women were followed by record linkage to routinely collected National Health Service hospital admission and death records. HT use and risk of VTE was examined using Cox regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results: During 3.3 million years of follow-up, 2200 women had an incident VTE, diagnosed, on average, 1.5 years after last reporting HT use. RRs in current vs. never users at last reporting varied by HT formulation: the risk was significantly greater for oral estrogen-progestin than oral estrogen-only therapy (RR = 2. P heterogeneity = 0.0007). Current users of oral HT at last reporting had twice the risk of VTE in the first 2 years after starting HT than later (P heterogeneity = 0.0006). Associations were similar for deep vein thrombosis with and without pulmonary embolism. Over 5 years, 1 in 660 who had never used HT were admitted to hospital for (or died from) pulmonary embolism, compared with 1 in 475 current users of oral estrogen-only HT,1 in 390 users of estrogen-progestin HT containing norethisterone/norgestrel, and 1 in 250 users of estrogen-progestin HT containing medroxyprogesterone acetate. Conclusions: The risk of VTE varied considerably by HT formulation, being greatest in users of oral estrogen-progestin HT, especially formulations containing medroxyprogesterone acetate.

Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

“…VTE events which resulted in hospital admission and/or death during follow‐up were identified using the same approach as in our previous VTE analyses 21, 22, 23, 24…”

Recommendations for Thrombopropylaxis in Obstetrics and Gynaecology-A SASOG Guideline

“…There is lower associated risk with transdermal and intra-uterine hormonal therapy as well as the progesterone-only oral contraceptive. [11,12] Gynaecological surgery and VTE risk Table 1 provides a practical risk assessment for VTE in patients undergoing gynaecological surgery. Patient-and procedure-related risk factors should be considered when assessing the risk of VTE.…”

“…There is lower associated risk with transdermal and intra-uterine hormonal therapy as well as the progesterone-only oral contraceptive. [11,12] Gynaecological surgery and VTE risk …”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…2015; 25 (5): 525-552 группах было низким (3,0 случая vs 0,4 случая на 10 000 беременных в I триместре и 8,1 случая vs 6,0 случая на 10 000 беременных в целом) [24]. У женщин в постменопаузе, которые получают заместительную гормонотерапию, риск ВТЭ широко варьируется в зависимости от используемого препарата [25].…”

“…2015; 25 (5): 525-552 группах было низким (3,0 случая vs 0,4 случая на 10 000 беременных в I триместре и 8,1 случая vs 6,0 случая на 10 000 беременных в целом) [24]. У женщин в постменопаузе, которые получают заместительную гормонотерапию, риск ВТЭ широко варьируется в зависимости от используемого препарата [25].Распространенным триггером госпитализаций по поводу ВТЭ являются инфекции [15,26,27]. Гемо трансфузии и стимуляторы эритропоэза также свя заны с повышением риска ВТЭ [15,28].…”