Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, 90035-003 Porto Alegre, RS, Brazil.
Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, 90035-003 Porto Alegre, RS, Brazil; Division of Obstetrics & Gynecology, Hospital de Clínicas de Porto Alegre, 90035-003 Porto Alegre, RS, Brazil.
Thromb Res. 2018 Aug;168:83-95. doi: 10.1016/j.thromres.2018.06.014. Epub 2018 Jun 19.
Hormone therapy (HT) is an effective treatment for climacteric symptoms. Nevertheless, combined estrogen-progestin therapy and the oral route seem to entail higher risk of venous thromboembolism (VTE) than estrogen-only therapy and transdermal administration. The present study aimed to investigate the risk of thromboembolic events in postmenopausal women using non-oral estrogen compared to women using oral estrogen and control groups (women receiving placebo or non-users of HT), as well as to assess the thrombotic impact of estrogens alone vs. combined estrogen-progestin therapy.
Systematic review of MEDLINE, Cochrane CENTRAL, EMBASE, and ClinicalTrials.gov according to PRISMA guidelines.
Twenty-two studies were included in the meta-analyses (9 case-control studies, 9 cohort studies, and 4 randomized controlled trials). As compared to control groups, VTE risk was not increased with non-oral HT, including users of estrogens and estrogens plus progestins (OR 0.97 [0.9-1.06]), non-oral estrogen therapy (ET)-only (OR 0.95 [0.81-1.10]), and non-oral combined estrogen-progestin therapy (OR 0.92 [0.77-1.09]). Conversely, increased risk of VTE was observed as compared with control groups in users of oral HT, including users of estrogens and estrogens plus progestins HT (OR 1.72 [1.47-2.01]), oral ET-only (OR 1.43 [1.34-1.53]), and combined oral estrogen-progestin HT (OR 2.35 [1.9-2.9]). The comparison of non-oral vs. oral HT showed increased VTE risk with oral HT (OR 1.66 [1.39-1.98]).
VTE risk was increased in postmenopausal women with no previous thromboembolic events using oral HT. Non-oral HT did not significantly affect this risk. The quality of the evidence produced in our meta-analyses is low to moderate, and further clinical trials are needed to sort out the impact of different types of progestin and different estrogen doses and administration routes on VTE risk.
激素治疗（HT）是治疗更年期症状的有效方法。然而，与单独使用雌激素治疗和经皮给药相比，联合雌激素-孕激素治疗和口服途径似乎会增加静脉血栓栓塞（VTE）的风险。本研究旨在调查使用非口服雌激素的绝经后妇女与使用口服雌激素和对照组（接受安慰剂或不使用 HT 的妇女）的血栓栓塞事件风险，并评估雌激素单独与联合雌激素-孕激素治疗的血栓形成影响。
根据 PRISMA 指南，对 MEDLINE、Cochrane CENTRAL、EMBASE 和 ClinicalTrials.gov 进行系统评价。
22 项研究被纳入荟萃分析（9 项病例对照研究、9 项队列研究和 4 项随机对照试验）。与对照组相比，非口服 HT 并未增加 VTE 风险，包括雌激素使用者和雌激素加孕激素使用者（OR 0.97 [0.9-1.06]）、非口服雌激素治疗（ET）仅使用者（OR 0.95 [0.81-1.10]）和非口服联合雌激素-孕激素治疗（OR 0.92 [0.77-1.09]）。相反，与对照组相比，口服 HT 使用者的 VTE 风险增加，包括雌激素和雌激素加孕激素 HT 使用者（OR 1.72 [1.47-2.01]）、口服 ET 仅使用者（OR 1.43 [1.34-1.53]）和联合口服雌激素-孕激素 HT 使用者（OR 2.35 [1.9-2.9]）。非口服与口服 HT 的比较显示，口服 HT 使用者 VTE 风险增加（OR 1.66 [1.39-1.98]）。
无先前血栓栓塞事件的绝经后妇女使用口服 HT 会增加 VTE 风险。非口服 HT 并未显著影响这种风险。我们的荟萃分析产生的证据质量为低到中等，需要进一步的临床试验来理清不同类型的孕激素和不同剂量和给药途径的雌激素对 VTE 风险的影响。
