Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Avenida de Córdoba s/n, 28041 Madrid, Spain.
Department of Internal Medicine, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n, Poniente Sur, 14004, Córdoba, Spain.
Thromb Res. 2024 Sep;241:109087. doi: 10.1016/j.thromres.2024.109087. Epub 2024 Jul 6.
Hormone therapy (HT) for breast cancer is associated with an increased risk of venous thromboembolism (VTE). This study examines the effects of continuing versus discontinuing HT on VTE recurrence, major bleeding, and mortality, after an acute VTE event.
Using data in the RIETE-registry from March 2001 through September 2021, we calculated incidence rates and rate-ratios (RR) for VTE events in patients on- and off HT. Cox regression models assessed the impact of HT continuation.
Among 479 women with breast cancer on HT who developed VTE (pulmonary embolism 279, isolated deep vein thrombosis 200), 350 (73 %) continued HT. These women were slightly older (70 ± 13 vs. 67 ± 16 years) than those discontinuing HT, with no significant differences in other baseline characteristics. Over a median follow-up of 294 days, 25 (5.2 %) developed VTE recurrences, 18 (3.7 %) had major bleeding, and 73 (15.2 %) died. Rates of VTE recurrence did not differ significantly between groups (RR: 1.28, 95 % CI 0.44-3.75), except in the first three months post-VTE, where a higher rate was observed in those continuing HT (6.02/100 patients-year vs. no events). On multivariable analysis, HT continuation showed no association with VTE recurrences after adjusting for other thromboembolic risk factors (adjusted hazard ratio [aHR] 1.49, 95 % CI 0.5-4.45).
Continuing HT after a VTE event in women with breast cancer does not generally affect the long-term risk of VTE recurrences but is associated with a higher risk in the first three months. These findings highlight the need for careful monitoring during this period.
乳腺癌的激素治疗（HT）会增加静脉血栓栓塞症（VTE）的风险。本研究旨在探讨急性 VTE 事件后继续或停止 HT 对 VTE 复发、大出血和死亡率的影响。
利用 2001 年 3 月至 2021 年 9 月期间 RIETE 登记处的数据，我们计算了接受 HT 和未接受 HT 的患者 VTE 事件的发生率和发生率比（RR）。Cox 回归模型评估了 HT 持续使用的影响。
在 479 名患有乳腺癌且正在接受 HT 的 VTE 患者中（肺栓塞 279 例，单纯深静脉血栓形成 200 例），350 例（73%）继续接受 HT。与停止 HT 的患者相比，这些患者年龄稍大（70±13 岁 vs. 67±16 岁），但其他基线特征无显著差异。中位随访 294 天后，25 例（5.2%）发生 VTE 复发，18 例（3.7%）发生大出血，73 例（15.2%）死亡。两组间 VTE 复发率无显著差异（RR：1.28，95%CI 0.44-3.75），但在 VTE 后前三个月，继续 HT 的患者复发率较高（6.02/100 患者年 vs. 无事件）。多变量分析显示，在调整其他血栓栓塞风险因素后，继续 HT 与 VTE 复发无关（调整后的危险比[aHR]1.49，95%CI 0.5-4.45）。
在乳腺癌女性 VTE 事件后继续 HT 通常不会影响 VTE 复发的长期风险，但在最初三个月内风险较高。这些发现强调了在此期间需要仔细监测。
