King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Institute of Pharmaceutical Sciences, King's College London, London, UK.
Br J Haematol. 2018 Nov;183(3):346-363. doi: 10.1111/bjh.15608. Epub 2018 Oct 18.
The prevention and treatment of venous thromboembolism (VTE) poses distinct gender-specific challenges. Women of childbearing age are at an increased risk of VTE secondary to the transient risk factors of combined hormonal contraception (CHC) and pregnancy. Cancers specific to women are associated with a significant burden of VTE; whilst the incidence of VTE in localised breast cancer is 5 per 1000 person-years, more cases are seen due to the prevalence of breast cancer. Treatment of VTE in women can be complicated by abnormal uterine bleeding, now increasingly reported with direct oral anticoagulants (DOACs) as well as vitamin K antagonists. Divergence between international guidelines regarding the use of CHC following an oestrogen-associated VTE and appropriate withdrawal of such contraception requires clarification for clinicians. Additionally, there is uncertainty as to whether to consider such events provoked or unprovoked and, consequently, the optimal duration of treatment in these women remains unclear. During pregnancy and the puerperium, the traditional anticoagulants remain the agents of choice with no further advances in DOAC safety data, and similarly in lactation. Further studies evaluating the safety and optimal treatment strategies in these women are awaited.
静脉血栓栓塞症（VTE）的预防和治疗存在明显的性别特异性挑战。生育期妇女由于联合激素避孕药（CHC）和妊娠的一过性危险因素，VTE 风险增加。特定于女性的癌症与 VTE 负担显著相关；虽然局部乳腺癌的 VTE 发病率为每 1000 人年 5 例，但由于乳腺癌的流行，更多的病例被观察到。VTE 的治疗可能因异常子宫出血而变得复杂，目前越来越多的直接口服抗凝剂（DOAC）以及维生素 K 拮抗剂报告了这种情况。国际指南在雌激素相关 VTE 后使用 CHC 以及适当停用此类避孕方法方面存在分歧，这需要临床医生加以澄清。此外，对于这些事件是自发性还是诱发性尚不确定，因此，这些女性的最佳治疗持续时间仍不清楚。在妊娠和产褥期，传统抗凝剂仍然是首选药物，DOAC 安全性数据没有进一步进展，在哺乳期也是如此。仍需要进一步研究来评估这些女性的安全性和最佳治疗策略。
