Manuscript handled by: F. R. Rosendaal
The risk of recurrence in women with venous thromboembolism while using estrogens: a prospective cohort study
Version of Record online: 22 MAY 2014
© 2014 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 12, Issue 5, pages 635–640, May 2014
How to Cite
The risk of recurrence in women with venous thromboembolism while using estrogens: a prospective cohort study. J Thromb Haemost 2014; 12: 635–40., , .
Final decision: F. R. Rosendaal, 8 February 2014
- Issue online: 22 MAY 2014
- Version of Record online: 22 MAY 2014
- Accepted manuscript online: 18 FEB 2014 06:47AM EST
- Manuscript Accepted: 8 FEB 2014
- Manuscript Received: 24 OCT 2013
- Medizinisch-wissenschaftlicher Fonds des Bürgermeisters der Bundeshauptstadt Wien
- Jubiläumsfonds of the Austrian National Bank
- hormone replacement therapy;
- pulmonary embolism;
- venous thrombosis
The optimal duration of anticoagulation for women who had venous thromboembolism (VTE) associated with estrogen use is unknown.
To test the hypothesis that women who had a first VTE while using estrogens have a low risk of recurrence.
A Prospective cohort study of 630 women (333 estrogen users, 297 non-users) with a first VTE, who were followed for an average of 69 months after anticoagulation withdrawal. Women with a previous or secondary VTE, coagulation inhibitor deficiency, lupus anticoagulant, cancer, pregnancy, requirement of long-term antithrombotic therapy or homozygosity or double heterozygosity for factor V Leiden and/or the G20210A prothrombin mutation were excluded. The endpoint was objectively documented symptomatic recurrent VTE.
VTE recurred in 22 (7%) estrogen users and in 49 (17%) non-users. After 1, 2 and 5 years, the cumulative probability of recurrence was 1% (95% confidence interval [CI], 0–2), 1% (95% CI, 0–2) and 6% (95% CI, 3–9) among estrogen users and 5% (95% CI, 2–7), 9% (95% CI, 6–13) and 17% (95% CI, 12–22) among non-users. Compared with non-users, estrogen users had an adjusted relative risk (RR) of recurrent VTE of 0.4 (95% CI, 0.2–0.8). Compared with non-users in the respective age groups, the RR of recurrence was 0.4 (95% CI, 0.2–0.8) among estrogen-containing-contraceptive users and 0.7 (95% CI, 0.3–1.5) among women using estrogen-containing menopausal hormone therapy.
Women who had their first VTE while using estrogens have a low risk of recurrent VTE. These women might not benefit from extended anticoagulant therapy.