Prothrombotic mutations, hormone therapy, and venous thromboembolism among postmenopausal women - Impact of the route of estrogen administration

Article

关键词: FACTOR-V-LEIDEN;    TRANSDERMAL ESTROGEN/PROGESTERONE REGIMENS;    ACTIVATED PROTEIN-C;    REPLACEMENT THERAPY;    CONTROLLED-TRIAL;    RISK;    THROMBOSIS;    DISEASE;   

DOI  :  10.1161/CIRCULATIONAHA.105.565556

来源: SCIE

【 摘 要 】

Background - Oral estrogen increases the risk of venous thromboembolism ( VTE) in postmenopausal women, particularly in those with a prothrombotic mutation. Transdermal estrogen may be safe with respect to VTE. We investigated the impact of the route of estrogen administration on the association between a prothrombotic mutation ( factor V Leiden or prothrombin G20210A mutation) and VTE risk. Methods and Results - We performed a multicenter case- control study of VTE among postmenopausal women who were enrolled in 1999 through 2004 at 7 clinical centers in France. We recruited 235 consecutive patients with a first documented episode of idiopathic VTE and 554 controls. Factor V Leiden was associated with a 3.4- fold - increased risk of VTE ( 95% confidence interval [ CI], 2.0 to 5.8), and a prothrombin mutation was associated with a 4.8- fold - increased risk of VTE ( 95% CI, 2.5 to 9.4). Oral but not transdermal estrogen was associated with an increased risk of VTE ( odds ratio [ OR], 4.3; 95% CI, 2.6 to 7.2; and OR, 1.2; 95% CI, 0.8 to 1.7, respectively). After adjustment for potential confounding factors, the combination of either factor V Leiden or prothrombin G20210A mutation and oral estrogen gave a 25- fold - increased risk of VTE compared with nonusers without mutation ( 95% CI, 6.9 to 95.0). However, the risk for women with prothrombotic mutation using transdermal estrogen was similar to that of women with a mutation who were not using estrogen ( OR, 4.4; 95% CI, 2.0 to 9.9; and OR, 4.1; 95% CI, 2.3 to 7.4, respectively). Conclusions - In contrast to oral estrogen, transdermal estrogen does not confer additional risk on women who carry a prothrombotic mutation. The safety of transdermal estrogen has to be confirmed in randomized trials.

【 授权许可】

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