тромбогенность ЗГТ после менопаузы

[Dr.Vad]

результаты The Million Women Study Collaborators

Background: Current use of menopausal hormone therapy (HT) increases venous thromboembolism (VTE) risk and the formulations used may affect risk. Methods: 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 3.3million years of follow-up, 2200 women had an incident VTE, diagnosed 1.5 years, on average, after last reporting HT use. RRs in current versus never users at last reporting varied by HT formulation: risk was significantly greater for oral estrogen-progestin than oral estrogen-only therapy (RR=2.07 [95%CI:1.86-2.31] versus 1.42 [1.21-1.66]), with no increased risk with transdermal estrogen-only therapy (0.82 [0.64-1.06]). Among users of oral estrogen-progestin, HT risk varied by progestin type, with significantly greater risks for preparations containing medroxyprogesterone acetate than other progestins (2.67 [2.25-3.17] versus 1.91 [1.69-2.17];P/heterogeneity=0.0007). Current users of oral HT at last reporting had twice the risk of VTE in the first two years after starting than later (P/heterogeneity=0.0006). Associations were similar for deep vein thrombosis with and without pulmonary embolism. Over five years, 1 in 660 never users of HT were admitted to hospital for (or died from) pulmonary embolism, compared to 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: VTE risk varied considerably by HT formulation, being greatest in users of oral estrogen-progestin HT, especially formulations containing medroxyprogesterone acetate.

Venous thromboembolism risk in relation to use of different types of postmenopausal hormone therapy in a large prospective study
S. Sweetland и соавт. JTH 2012

[Dr.Vad]

J Thromb Haemost. 2012 Nov 8.
The risk of venous thrombosis in women over 50 years old using oral contraception or postmenopausal hormone therapy.
Roach RE, Lijfering WM, Helmerhorst FM, Cannegieter SC, Rosendaal FR, van Hylckama Vlieg A.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands Einthoven Laboratory for Experimental Vascular Medicine, Leiden, University Medical Center Department of Gynecology and Reproductive Medicine, Leiden University Medical Center Department of Thrombosis and Haemostasis, Leiden, University Medical Center.
Background: Oral contraception (OC) and postmenopausal hormone therapy (HT) can be used to alleviate menopausal symptoms. However, the risk of venous thrombosis (VT) associated with OC use in women over 50 years old has never been assessed and the two preparations have not been directly compared. Objectives: To determine and compare the risk of VT associated with OC and HT use.
Methods: From a large case-control study, 2550 women over 50 years old, 1082 patients with a first VT and 1468 controls, were included. Odds ratios (OR) and 95% confidence intervals for VT were calculated for OC-users (164 patients and 54 controls) and HT-users (88 patients and 102 controls) compared with non-hormone users (823 patients and 1304 controls).
Results: OC-users had a 6.3-fold (4.6-9.8) increased risk of VT. This ranged from 5.4 (3.3-8.9) for preparations containing levonorgestrel to 10.2 (4.8-21.7) for desogestrel. The VT-risk associated with oral HT use was 4.0 (1.8-8.2) for conjugated equine estrogen combined with medroxyprogesterone acetate and 3.9 (1.5-10.7) for micronized estradiol combined with norethisterone acetate. Non-oral HT did not increase the risk of VT: OR 1.1 (0.6-1.8). Relative risk estimates were further increased in hormone users with factor V Leiden, prothrombin G20210A or blood group non-O and hormone users with a family history of VT.
Conclusions: In this study, non-oral HT seemed to be the safest hormonal preparation in women over 50 years old, OC use increased the VT risk the most, especially in women with inherited thrombophilia or a family history of VT.