Battaglioli Tullia, Martinelli Ida
A. Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Medical Specialties, IRCCS Policlinico, Mangiagalli and Regina Elena Foundation, University of Milan, Italy.
Curr Opin Hematol. 2007 Sep;14(5):488-93. doi: 10.1097/MOH.0b013e32825f5302.
Hormone therapy increases the risk of venous thromboembolism (VTE). To reduce this risk, changes in dosage, composition and route of administration have been made over the years. This review provides a summary of the available evidence and an update on the most recent findings on the issue.
Contraceptives containing third-generation progestagens confer a higher risk of VTE than second-generation compounds. Little data are available on preparations containing less than 30 micarog of estrogen, new progestagens or levonorgestrel-releasing intrauterine devices. Hormone replacement therapy increases the risk of VTE by 2 to 3-fold. Transdermal administration may be less thrombogenic than oral administration, while different estrogens and progestagens may carry a different risk. VTE risk is further increased in carriers of inherited thrombophilia. Despite a similar increase in relative risk of thrombosis associated with hormone therapy, absolute risk is lower in fertile women and higher in postmenopausal ones. Universal screening for thrombophilia before prescribing hormone replacement therapy might be cost-effective.
Careful evaluation of individual risk factor is warranted before prescribing hormone therapy. Further investigations are needed to establish whether or not newer compounds are safer than older ones with respect to the risk of thrombosis.
激素疗法会增加静脉血栓栓塞（VTE）的风险。为降低此风险，多年来在剂量、成分和给药途径方面已做出改变。本综述总结了现有证据，并更新了关于该问题的最新研究结果。
含第三代孕激素的避孕药比第二代化合物导致VTE的风险更高。关于雌激素含量低于30微克的制剂、新型孕激素或左炔诺孕酮宫内节育器的数据较少。激素替代疗法使VTE风险增加2至3倍。经皮给药可能比口服给药的血栓形成性更低，而不同的雌激素和孕激素可能具有不同的风险。遗传性血栓形成倾向携带者的VTE风险会进一步增加。尽管激素疗法相关的血栓形成相对风险增加相似，但绝对风险在育龄女性中较低，在绝经后女性中较高。在开激素替代疗法处方前对血栓形成倾向进行普遍筛查可能具有成本效益。
在开激素疗法处方前，有必要仔细评估个体风险因素。需要进一步研究以确定就血栓形成风险而言，新型化合物是否比旧型化合物更安全。
