Rosendaal F R, Helmerhorst F M, Vandenbroucke J P
Department of Hematology, Leiden University Medical Center, The Netherlands.
Thromb Haemost. 2001 Jul;86(1):112-23.
Oral contraceptives and hormone replacement therapy are used by hundreds of millions of women worldwide. Since the early 1960s it is known that female hormones increase the risk of venous thrombosis, myocardial infarction and stroke. This risk is still present with current low-dose oral contraceptives and, even though in absolute terms the risk is small, oral contraceptives form the major cause of thrombotic disease in young women. The risk is higher during the first year of use (up to I per 1000 per year), with the use of desogestrel- or gestodene-containing oral contraceptives ("third generation progestogens") and among women with a prothrombotic predispositon. Hormone replacement therapy increases the risk of venous thrombosis, while results of randomised trials so far do not substantiate the expectation of a beneficial effect on the risk of arterial cardiovascular disease. First results are emerging that specific subgroups of women, with prothrombotic or other abnormalities, may be at risk, especially during the first years of use of hormone substitution.
全球有数亿女性使用口服避孕药和激素替代疗法。自20世纪60年代初以来，人们就知道女性激素会增加静脉血栓形成、心肌梗死和中风的风险。目前的低剂量口服避孕药仍存在这种风险，尽管从绝对数值来看风险较小，但口服避孕药仍是年轻女性血栓性疾病的主要原因。在使用的第一年风险较高（每年高达千分之一），使用含去氧孕烯或孕二烯酮的口服避孕药（“第三代孕激素”）以及有血栓形成倾向的女性中风险更高。激素替代疗法会增加静脉血栓形成的风险，而迄今为止随机试验的结果并未证实其对动脉心血管疾病风险有有益作用的预期。初步结果显示，有血栓形成倾向或其他异常的特定女性亚组可能有风险，尤其是在使用激素替代疗法的最初几年。
