Cancer Epidemiology Unit, University of Oxford, Oxford, UK The Kirby Institute, University of New South Wales, Sydney, Australia Inserm Unit 1018, Hormone and Cardiovascular Disease Section, Villejuif, France.
J Thromb Haemost. 2012 Nov;10(11):2277-86. doi: 10.1111/j.1538-7836.2012.04919.x.
Current use of menopausal hormone therapy (HT) increases the risk of venous thromboembolism (VTE) and the formulations used may affect risk.
A total of 1,058,259 postmenopausal UK women were followed by record linkage to routinely collected National Health Service hospital admission and death records. HT use and risk of VTE was examined using Cox regression to estimate relative risks (RRs) and 95% confidence intervals (CIs).
During 3.3 million years of follow-up, 2200 women had an incident VTE, diagnosed, on average, 1.5 years after last reporting HT use. RRs in current vs. never users at last reporting varied by HT formulation: the risk was significantly greater for oral estrogen-progestin than oral estrogen-only therapy (RR = 2.07 [95%CI, 1.86-2.31] vs. 1.42 [1.21-1.66]), with no increased risk with transdermal estrogen-only therapy (0.82 [0.64-1.06]). Among users of oral estrogen-progestin, the risk from HT varied by progestin type, with significantly greater risks for preparations containing medroxyprogesterone acetate than other progestins (2.67 [2.25-3.17] vs. 1.91 [1.69-2.17]; Pheterogeneity = 0.0007). Current users of oral HT at last reporting had twice the risk of VTE in the first 2 years after starting HT than later (Pheterogeneity = 0.0006). Associations were similar for deep vein thrombosis with and without pulmonary embolism. Over 5 years, 1 in 660 who had never used HT were admitted to hospital for (or died from) pulmonary embolism, compared with 1 in 475 current users of oral estrogen-only HT,1 in 390 users of estrogen-progestin HT containing norethisterone/norgestrel, and 1 in 250 users of estrogen-progestin HT containing medroxyprogesterone acetate.
The risk of VTE varied considerably by HT formulation, being greatest in users of oral estrogen-progestin HT, especially formulations containing medroxyprogesterone acetate.
目前使用的绝经激素治疗（HT）会增加静脉血栓栓塞（VTE）的风险，且所用制剂可能会影响风险。
通过记录链接，对 1058259 名英国绝经后妇女进行了随访，以获得常规收集的国民保健服务医院入院和死亡记录。使用 Cox 回归估计相对风险（RR）和 95%置信区间（CI）来检查 HT 的使用与 VTE 的风险。
在 330 万年的随访期间，有 2200 名女性发生了 VTE，平均在最后一次报告 HT 使用后 1.5 年确诊。在最后一次报告时，当前使用者与从不使用者的 RR 因 HT 制剂而异：与口服雌激素-孕激素治疗相比，口服雌激素单药治疗的风险显著更高（RR=2.07[95%CI，1.86-2.31]比 1.42[1.21-1.66]），而经皮雌激素单药治疗无增加风险（0.82[0.64-1.06]）。在使用口服雌激素-孕激素的患者中，孕激素类型不同，使用含有醋酸甲羟孕酮的制剂的风险显著更高（RR=2.67[2.25-3.17]比 1.91[1.69-2.17]；P 异质性=0.0007）。在最后一次报告时，当前口服 HT 使用者在开始 HT 后前 2 年的 VTE 风险是之后的两倍（P 异质性=0.0006）。深静脉血栓形成伴或不伴肺栓塞的相关性相似。在 5 年以上的时间里，从未使用 HT 的女性中有 1/660 因（或死于）肺栓塞住院，而使用口服雌激素单药 HT 的女性中有 1/475，使用含有炔诺酮/去氧孕烯或含有醋酸甲羟孕酮的 HT 的女性中有 1/390，使用含有醋酸甲羟孕酮的 HT 的女性中有 1/250。
VTE 的风险因 HT 制剂而异，使用口服雌激素-孕激素 HT 的患者风险最大，尤其是使用含有醋酸甲羟孕酮的制剂。
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