Scarabin Pierre-Yves, Oger Emmanuel, Plu-Bureau Geneviève
INSERM Cardiovascular Epidemiology Unit U258, Villejuif, France.
Lancet. 2003 Aug 9;362(9382):428-32. doi: 10.1016/S0140-6736(03)14066-4.
Oral oestrogen-replacement therapy (ERT) activates blood coagulation and increases the risk of venous thromboembolism (VTE) in postmenopausal women. Transdermal ERT has little effect on haemostasis, but data assessing its effect on thrombotic process are scarce. We aimed to examine the effect of the route of oestrogen administration on VTE risk.
We did a multicentre hospital-based case-control study of postmenopausal women in France. During 1999-2002, we recruited 155 consecutive cases with a first documented episode of idiopathic VTE (92 with pulmonary embolisms and 63 with deep venous thrombosis), and 381 controls matched for centre, age, and time of recruitment.
Overall, 32 (21%) cases and 27 (7%) controls were current users of oral ERT, whereas 30 (19%) cases and 93 (24%) controls were current users of transdermal ERT. After adjustment for potential confounding variables, the odds ratio for VTE in current users of oral and transdermal ERT compared with non-users was 3.5 (95% CI 1.8-6.8) and 0.9 (0.5-1.6), respectively. Estimated risk for VTE in current users of oral ERT compared with transdermal ERT users was 4.0 (1.9-8.3).
Oral but not transdermal ERT is associated with risk of VTE in postmenopausal women. These data suggest that transdermal ERT might be safer than oral ERT with respect to thrombotic risk.
口服雌激素替代疗法（ERT）会激活血液凝固，增加绝经后女性发生静脉血栓栓塞（VTE）的风险。经皮ERT对止血作用甚微，但评估其对血栓形成过程影响的数据却很匮乏。我们旨在研究雌激素给药途径对VTE风险的影响。
我们在法国开展了一项基于医院的多中心绝经后女性病例对照研究。在1999年至2002年期间，我们连续招募了155例首次记录有特发性VTE发作的病例（92例肺栓塞和63例深静脉血栓形成），以及381例在中心、年龄和招募时间方面相匹配的对照。
总体而言，32例（21%）病例和27例（7%）对照为口服ERT的当前使用者，而30例（19%）病例和93例（24%）对照为经皮ERT的当前使用者。在对潜在混杂变量进行调整后，口服和经皮ERT当前使用者与非使用者相比，VTE的比值比分别为3.5（95%CI 1.8 - 6.8）和0.9（0.5 - 1.6）。与经皮ERT使用者相比，口服ERT当前使用者的VTE估计风险为4.0（1.9 - 8.3）。
绝经后女性中，口服而非经皮ERT与VTE风险相关。这些数据表明，就血栓形成风险而言，经皮ERT可能比口服ERT更安全。
