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激素的使用与静脉血栓栓塞风险。

Use of hormones and risk of venous thromboembolism.

机构信息

Clínica Obstétrica Hospital das Clínicas Universidade de São Paulo São PauloSP Brasil Clínica Obstétrica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.

Departamento de Obstetrícia e Ginecologia Faculdade de Medicina Universidade Federal do Paraná CuritibaPR Brasil Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade Federal do Paraná, Curitiba, PR, Brasil.

出版信息

Rev Bras Ginecol Obstet. 2024 Apr 2;46. doi: 10.61622/rbgo/2024FPS02. eCollection 2024.

Abstract

•The risk of venous thromboembolism (VTE) is not increased in women using long-acting reversible contraceptive methods (LARCs) with progestogens. •Oral contraceptives with levonorgestrel or norgestimate confer half the risk of VTE compared to oral contraceptives containing desogestrel, gestodene or drospirenone. •Progestogen-only pills do not confer an increased risk of VTE. •Women using transdermal contraceptive patches and combined oral contraceptives (COCs) are at an approximately eight times greater risk of VTE than non-users of hormonal contraceptives (HCs), corresponding to 9.7 events per 10,000 women/years. •Vaginal rings increase the risk of VTE by 6.5 times compared to not using HC, corresponding to 7.8 events per 10,000 women/years. •Several studies have demonstrated an increased risk of VTE in transgender individuals receiving hormone therapy (HT). •Hormone therapy during menopause increases the risk of VTE by approximately two times, and this risk is increased by obesity, thrombophilia, age over 60 years, surgery and immobilization. •The route of estrogen administration, the dosage and type of progestogen associated with estrogen may affect the risk of VTE in the climacteric. •Combined estrogen-progesterone therapy increases the risk of VTE compared to estrogen monotherapy. •Postmenopausal HT increases the risk of thrombosis at atypical sites.

摘要

•使用含孕激素的长效可逆避孕方法(LARC)不会增加静脉血栓栓塞症(VTE)的风险。

•与含有去氧孕烯、孕二烯酮或屈螺酮的口服避孕药相比,左炔诺孕酮或诺孕酯的口服避孕药将 VTE 的风险降低一半。

•单纯孕激素避孕药不会增加 VTE 的风险。

•使用透皮避孕贴片和复方口服避孕药(COC)的女性发生 VTE 的风险比非激素避孕药(HC)使用者高约 8 倍,相当于每 10000 名女性/年发生 9.7 例。

•与不使用 HC 相比,阴道环使 VTE 的风险增加 6.5 倍,相当于每 10000 名女性/年发生 7.8 例。

•几项研究表明,接受激素治疗(HT)的跨性别者发生 VTE 的风险增加。

•绝经后激素治疗使 VTE 的风险增加约两倍,肥胖、血栓形成倾向、年龄超过 60 岁、手术和固定都会增加这种风险。

•雌激素给药途径、与雌激素相关的孕激素剂量和类型可能会影响更年期 VTE 的风险。

•雌孕激素联合治疗比单独雌激素治疗增加 VTE 的风险。

•绝经后 HT 增加非典型部位血栓形成的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7835/11075397/8ce0617eb7e6/1806-9339-rbgo-46-e-FPS02-gf01.jpg

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