Lee Cheng-Han, Cheng Ching-Lan, Kao Yang Yea-Huei, Lin Li-Jen
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University.
Circ J. 2015;79(5):1107-14. doi: 10.1253/circj.CJ-14-1227. Epub 2015 Mar 4.
The incidence of venous thromboembolism (VTE) in Asians is lower than in Caucasians, but the risk of VTE associated with hormone therapy (HT) in Taiwanese postmenopausal women has not been determined.
From Taiwan's National Health Insurance Research Database, we established matched cohorts (HT users and nonusers) of postmenopausal women aged ≥50 years between 1 January 1998 and 31 December 2008. We calculated the 2-year incidence of VTE in HT users and nonusers. HT users and nonusers were matched 1:1 based on propensity-score matching. Cox regression hazard model was used to identify risk factors of VTE. We initially identified 499,594 HT users and 424,963 nonusers. There were higher percentages of cancer and cardiovascular events among the HT nonusers. After matching, the VTE incidence was 4.4 vs. 2.6 per 10,000 patient-years (adjusted hazard ratio 1.796, 95% confidence interval 1.272-2.537) in HT users and nonusers, respectively. The Cox regression hazard model showed that HT use, older age, malignancy, heart failure, and recent major surgery were independent risk factors for VTE.
Although the incidence of VTE was very low among this cohort of Taiwanese postmenopausal women, oral HT was still associated with an increased risk of VTE. Therefore, physicians should be aware of other potential VTE risk factors when prescribing oral HT to postmenopausal women.
亚洲人静脉血栓栓塞症（VTE）的发病率低于白种人，但台湾绝经后女性激素治疗（HT）相关的VTE风险尚未确定。
我们从台湾国民健康保险研究数据库中，建立了1998年1月1日至2008年12月31日期间年龄≥50岁的绝经后女性匹配队列（HT使用者和非使用者）。我们计算了HT使用者和非使用者中VTE的2年发病率。根据倾向得分匹配，将HT使用者和非使用者按1:1进行匹配。采用Cox回归风险模型识别VTE的风险因素。我们最初识别出499,594名HT使用者和424,963名非使用者。HT非使用者中癌症和心血管事件的百分比更高。匹配后，HT使用者和非使用者的VTE发病率分别为每10,000患者年4.4例和2.6例（调整后的风险比为1.796，95%置信区间为1.272 - 2.537）。Cox回归风险模型显示，使用HT、年龄较大、恶性肿瘤、心力衰竭和近期大手术是VTE的独立风险因素。
尽管在这组台湾绝经后女性中VTE的发病率非常低，但口服HT仍与VTE风险增加相关。因此，医生在为绝经后女性开口服HT处方时，应了解其他潜在的VTE风险因素。
