Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Hormones and Cardiovascular Disease, Université Paris Sud, UMRS 1018, Villejuif, France.
Curr Opin Hematol. 2010 Sep;17(5):457-63. doi: 10.1097/MOH.0b013e32833c07bc.
Venous thromboembolism (VTE) is a main harmful effect of oral estrogen therapy among postmenopausal women. Transdermal estrogens may be safer but early results need to be confirmed. This review provides a summary of the most recent findings regarding the VTE risk among oral versus transdermal estrogens users.
Since 2008, we identified five relevant observational studies. Among them, two large cohort studies confirmed that oral but not transdermal estrogens were associated with VTE risk among postmenopausal women. In an updated meta-analysis of current data, pooled risk ratios for VTE were 1.9 [95% confidence interval (CI) 1.3-2.3] and 1.0 (95% CI 0.9-1.1) among oral and transdermal estrogens users, respectively. In addition, one recent cohort study showed that transdermal estrogens did not confer an excess risk of recurrent VTE among postmenopausal women with a history of VTE. The difference in VTE risk between oral and transdermal estrogen users is supported by biological data. Whereas oral estrogens can increase thrombin generation and induce a resistance to activated protein C, transdermal estrogens have minimal effects on hemostatic variables.
Transdermal estrogens may improve substantially the benefit/risk ratio of postmenopausal hormone therapy and should be considered as a safer option, especially for women at high risk for VTE.
静脉血栓栓塞症（VTE）是绝经后女性口服雌激素治疗的主要不良影响。透皮雌激素可能更安全，但早期结果尚需证实。本综述总结了关于口服与透皮雌激素使用者 VTE 风险的最新发现。
自 2008 年以来，我们确定了五项相关的观察性研究。其中两项大型队列研究证实，口服而非透皮雌激素与绝经后女性的 VTE 风险相关。在对现有数据的更新荟萃分析中，口服和透皮雌激素使用者的 VTE 风险比分别为 1.9（95%可信区间 1.3-2.3）和 1.0（95%可信区间 0.9-1.1）。此外，最近的一项队列研究表明，对于有 VTE 病史的绝经后女性，透皮雌激素不会增加复发性 VTE 的风险。口服和透皮雌激素使用者之间 VTE 风险的差异得到了生物学数据的支持。虽然口服雌激素可以增加凝血酶生成并导致对活化蛋白 C 的抵抗，但透皮雌激素对止血变量几乎没有影响。
透皮雌激素可能会极大地改善绝经后激素治疗的获益/风险比，应被视为更安全的选择，尤其是对于 VTE 风险较高的女性。
