Cardiovascular Epidemiology Team, Hôpital Paul Brousse, Villejuif, Cedex, France.
Climacteric. 2009;12 Suppl 1:76-80. doi: 10.1080/13697130903006837.
Venous thromboembolism, either deep vein thrombosis or pulmonary embolism, is a serious side-effect of postmenopausal hormone therapy. Current use of oral estrogens increases the risk of venous thromboembolism, especially during the first year of treatment, but past users of hormone therapy have a similar risk as never-users. Among women at high risk for venous thromboembolism (for example, thrombogenic mutations, obesity), oral estrogens use further enhances the thrombotic risk. Recent studies have shown that transdermal estrogens might be safe with respect to thrombotic risk. The difference in thrombotic risk between oral and transdermal estrogens may be partially explained by changes in hemostasis. Few data are currently available regarding the impact of progestogens on venous thromboembolism risk, but norpregnane derivatives might be thrombogenic. Individual assessment of the benefit-risk ratio is needed before initiating treatment and oral estrogens should be avoided among women at high risk for venous thromboembolism.
静脉血栓栓塞症，无论是深静脉血栓形成还是肺栓塞，都是绝经后激素治疗的严重副作用。目前使用口服雌激素会增加静脉血栓栓塞的风险，特别是在治疗的第一年，但过去使用过激素治疗的女性与从未使用者的风险相似。在静脉血栓栓塞风险较高的女性中（例如，血栓形成突变、肥胖），口服雌激素的使用会进一步增加血栓形成的风险。最近的研究表明，透皮雌激素在血栓形成风险方面可能是安全的。口服雌激素和透皮雌激素之间血栓形成风险的差异可能部分归因于止血的变化。目前关于孕激素对静脉血栓栓塞风险的影响的数据很少，但孕烷衍生物可能具有血栓形成性。在开始治疗之前，需要对获益-风险比进行个体评估，并且应避免在静脉血栓栓塞风险较高的女性中使用口服雌激素。
