Division of Hematology/Oncology, Department of Medicine and Surgery, Children’s Hospital Boston, Boston, Massachusetts 02115, USA.
Pediatrics. 2011 Feb;127(2):347-57. doi: 10.1542/peds.2010-2221. Epub 2011 Jan 3.
Heightened publicity about hormonal contraception and thrombosis risk and the publication of new guidelines by the World Health Organization in 2009 and the Centers for Disease Control and Prevention in 2010 addressing this complex issue have led to multidisciplinary discussions on the special issues of adolescents cared for at our pediatric hospital. In this review of the literature and new guidelines, we have outlined our approach to the complex patients referred to our center. The relative risk of thrombosis on combined oral contraception is three- to fivefold, whereas the absolute risk for a healthy adolescent on this therapy is only 0.05% per year. This thrombotic risk is affected by estrogen dose, type of progestin, mechanism of delivery, and length of therapy. Oral progestin-only contraceptives and transdermal estradiol used for hormone replacement carry minimal or no thrombotic risk. Transdermal, vaginal, or intrauterine contraceptives and injectable progestins need further study. A personal history of thrombosis, persistent or inherited thrombophilia, and numerous lifestyle choices also influence thrombotic risk. In this summary of one hospital's approach to hormone therapies and thrombosis risk, we review relative-risk data and discuss the application of absolute risk to individual patient counseling. We outline our approach to challenging patients with a history of thrombosis, known thrombophilia, current anticoagulation, or family history of thrombosis or thrombophilia. Our multidisciplinary group has found that knowledge of the guidelines and individualized management plans have been particularly useful for informing discussions about hormonal and nonhormonal options across varied indications.
关于激素避孕和血栓风险的宣传力度加大，世界卫生组织（WHO）和美国疾病控制与预防中心（CDC）分别于 2009 年和 2010 年发布了新指南，对这一复杂问题进行了阐述，这导致了多学科对我们儿科医院照顾的青少年特殊问题的讨论。在对文献和新指南的回顾中，我们概述了我们对转至我们中心的复杂患者的处理方法。联合口服避孕药的血栓形成相对风险为 3 至 5 倍，而健康青少年接受这种治疗的绝对风险仅为每年 0.05%。这种血栓形成风险受雌激素剂量、孕激素类型、给药机制和治疗时间的影响。口服孕激素避孕药和用于激素替代的经皮雌二醇的血栓形成风险最小或没有。经皮、阴道或宫内避孕器和孕激素注射剂需要进一步研究。个人血栓形成史、持续性或遗传性血栓形成倾向以及许多生活方式选择也会影响血栓形成风险。在总结一家医院对激素治疗和血栓形成风险的处理方法时，我们回顾了相对风险数据，并讨论了绝对风险在个体患者咨询中的应用。我们概述了我们对有血栓形成史、已知血栓形成倾向、当前抗凝治疗或家族性血栓形成或血栓形成倾向的挑战性患者的处理方法。我们的多学科小组发现，对指南的了解和个体化管理计划对于讨论各种适应症下的激素和非激素选择特别有用。
