Ángeles Blanco-Molina1, Javier Trujillo-Santos2, Raffaele Pesavento3, Vladimir Rosa4, Conxita Falgá5, Carles Tolosa6, Lucia Mazzolai7, Ángel Sampériz8, Rita Duce9, Manuel Monreal10. 1. Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain. 2. Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain. 3. Department of Medicine - DIMED, 2nd Chair of Internal Medicine, University of Padua, Padua, Italy. 4. Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain. 5. Department of Internal Medicine, Consorci Hospitalari de Mataró, Barcelona, Spain. 6. Department of Internal Medicine, Corporación Sanitaria Parc Taulí, Barcelona, Spain. 7. Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. 8. Department of Internal Medicine, Hospital Reina Sofía, Tudela, Navarra, Spain. 9. Department of Laboratory of Analysis, Ospedale Galliera, Genoa, Italy. 10. Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.
Abstract
INTRODUCTION: Whether women developing venous thromboembolism (VTE) while using hormonal therapy should be classified as having "unprovoked" or "provoked" VTE is controversial. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic VTE recurrences after discontinuing anticoagulation in 3 subgroups of women aged ≤50years without cancer, pregnancy or puerperium: (1) those with hormonal therapy and no additional risk factors (hormonal users only); (2) those with unprovoked VTE; and (3) those with additional risk factors, with or without hormonal therapy. RESULTS: As of March 2016, 1513 women had been followed-up for at least one month after discontinuing anticoagulation. Of these, 654 (43%) were hormonal users only, 390 (26%) had unprovoked VTE and 469 (31%) had transient risk factors with or without hormonal therapy. After discontinuing anticoagulation, the rate of VTE recurrences in women with hormonal use only (2.44 per 100 patient-years; 95% CI: 1.53-3.69) was significantly lower than in those with unprovoked VTE (6.03; 95% CI: 3.97-8.77) and similar to those with transient risk factors (2.58; 95% CI: 1.50-4.13). Interestingly, the rate of VTE recurrences presenting as pulmonary embolism in women with hormonal use only (0.55 per 100 patient-years; 95% CI: 0.18-1.29) was similar to those with transient risk factors (0.46; 95% CI: 0.09-1.33) and 4-fold lower than in women with unprovoked VTE (2.23; 95% CI: 1.07-4.10). CONCLUSIONS: After discontinuing anticoagulation, the rate of VTE recurrences in hormonal users only was significantly lower than in women with unprovoked VTE and similar to the rate in women with additional risk factors.
INTRODUCTION: Whether women developing venous thromboembolism (VTE) while using hormonal therapy should be classified as having "unprovoked" or "provoked" VTE is controversial. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic VTE recurrences after discontinuing anticoagulation in 3 subgroups of women aged ≤50years without cancer, pregnancy or puerperium: (1) those with hormonal therapy and no additional risk factors (hormonal users only); (2) those with unprovoked VTE; and (3) those with additional risk factors, with or without hormonal therapy. RESULTS: As of March 2016, 1513 women had been followed-up for at least one month after discontinuing anticoagulation. Of these, 654 (43%) were hormonal users only, 390 (26%) had unprovoked VTE and 469 (31%) had transient risk factors with or without hormonal therapy. After discontinuing anticoagulation, the rate of VTE recurrences in women with hormonal use only (2.44 per 100 patient-years; 95% CI: 1.53-3.69) was significantly lower than in those with unprovoked VTE (6.03; 95% CI: 3.97-8.77) and similar to those with transient risk factors (2.58; 95% CI: 1.50-4.13). Interestingly, the rate of VTE recurrences presenting as pulmonary embolism in women with hormonal use only (0.55 per 100 patient-years; 95% CI: 0.18-1.29) was similar to those with transient risk factors (0.46; 95% CI: 0.09-1.33) and 4-fold lower than in women with unprovoked VTE (2.23; 95% CI: 1.07-4.10). CONCLUSIONS: After discontinuing anticoagulation, the rate of VTE recurrences in hormonal users only was significantly lower than in women with unprovoked VTE and similar to the rate in women with additional risk factors.
Authors: Gualtiero Palareti; Cristina Legnani; Emilia Antonucci; Benilde Cosmi; Daniela Poli; Sophie Testa; Alberto Tosetto; Walter Ageno; Anna Falanga; Piera Maria Ferrini; Vittorio Pengo; Paolo Prandoni Journal: Intern Emerg Med Date: 2019-11-05 Impact factor: 3.397
Authors: Hanke M G Wiegers; Jannet Knijp; Nick van Es; Michiel Coppens; Stephan Moll; Frederikus A Klok; Saskia Middeldorp Journal: J Thromb Haemost Date: 2022-02-13 Impact factor: 16.036