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睾酮治疗作为静脉血栓形成的独立危险因素:一例报告

Testosterone Therapy as an Isolated Risk Factor for Venous Thrombosis: A Case Report.

作者信息

Bragg Kara, Miller Hailey, Buckshaw Ricky, Simon Leslie V, King Courtney

机构信息

Emergency Medicine, Mayo Clinic, Jacksonville, USA.

Internal Medicine, Mayo Clinic, Jacksonville, USA.

出版信息

Cureus. 2024 Jul 1;16(7):e63611. doi: 10.7759/cureus.63611. eCollection 2024 Jul.

DOI:10.7759/cureus.63611
PMID:39087198
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11290813/
Abstract

Healthcare providers in the emergency department (ED) diagnose and treat venous thrombus embolism (VTE). Current VTE clinical decision tools specifically mention estrogen but do not include the use of testosterone replacement therapy (TRT). A male in the early third decade of life presented to the ED with complaints of left calf pain and subjective swelling for one week. The patient was low risk using VTE scoring tools. The patient had multiple occlusive VTE on lower-extremity ultrasound and extensive central, bilateral segmental, and subsegmental pulmonary emboli. He was admitted to the hospital and placed on a heparin drip. TRT may be seen in clinical practice in both male and female patients. This bodes the question of whether TRT should be added to the risk analysis tools used to evaluate and predict the risk for VTE. There have been conflicting reports in research, with more recent studies indicating the risk associated with TRT. This case study demonstrates the risk of VTE with TRT. Further investigation is needed to determine if there is a correlation between VTE and TRT. Clinical decision tools should be updated to include TRT accordingly.

摘要

急诊科的医护人员负责诊断和治疗静脉血栓栓塞症(VTE)。当前的VTE临床决策工具特别提到了雌激素,但未包括睾酮替代疗法(TRT)的使用情况。一名30岁出头的男性因左小腿疼痛和主观肿胀一周就诊于急诊科。使用VTE评分工具评估该患者为低风险。患者下肢超声显示多处闭塞性VTE,并有广泛的中央型、双侧节段性和亚节段性肺栓塞。他被收治入院并接受肝素静脉滴注治疗。在临床实践中,男性和女性患者都可能会使用TRT。这就引发了一个问题,即TRT是否应被纳入用于评估和预测VTE风险的分析工具中。研究报告存在相互矛盾的情况,最近的研究表明TRT存在相关风险。本病例研究证明了TRT会导致VTE风险。需要进一步调查以确定VTE与TRT之间是否存在关联。临床决策工具应相应更新,将TRT纳入其中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99e8/11290813/5f2d2a0a2243/cureus-0016-00000063611-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99e8/11290813/096c1bda5cb3/cureus-0016-00000063611-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99e8/11290813/5f2d2a0a2243/cureus-0016-00000063611-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99e8/11290813/096c1bda5cb3/cureus-0016-00000063611-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99e8/11290813/5f2d2a0a2243/cureus-0016-00000063611-i02.jpg

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本文引用的文献

1
Testosterone replacement therapy and vascular thromboembolic events: a systematic review and meta-analysis.睾酮替代疗法与血管血栓栓塞事件:系统评价和荟萃分析。
Asian J Androl. 2024 Mar 1;26(2):144-154. doi: 10.4103/aja202352. Epub 2023 Oct 27.
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Cardiovascular Safety of Testosterone-Replacement Therapy.睾酮替代疗法的心血管安全性。
N Engl J Med. 2023 Jul 13;389(2):107-117. doi: 10.1056/NEJMoa2215025. Epub 2023 Jun 16.
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Testosterone Usage Leading to Pulmonary Embolisms and Deep Vein Thrombosis: A Case Report and Review of the Literature.
睾酮使用导致肺栓塞和深静脉血栓形成:一例报告及文献综述
Hematol Rep. 2023 Apr 26;15(2):290-297. doi: 10.3390/hematolrep15020029.
4
Derivation and Validation of a 4-Level Clinical Pretest Probability Score for Suspected Pulmonary Embolism to Safely Decrease Imaging Testing.疑似肺栓塞临床预测试验概率评分 4 级模型的推导与验证,有助于安全减少影像学检查。
JAMA Cardiol. 2021 Jun 1;6(6):669-677. doi: 10.1001/jamacardio.2021.0064.
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Association of Testosterone Therapy With Risk of Venous Thromboembolism Among Men With and Without Hypogonadism.睾酮治疗与性腺功能减退症男性和非性腺功能减退症男性静脉血栓栓塞风险的关联。
JAMA Intern Med. 2020 Feb 1;180(2):190-197. doi: 10.1001/jamainternmed.2019.5135.
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Testosterone therapy and venous thromboembolism: A systematic review and meta-analysis.睾酮治疗与静脉血栓栓塞症:系统评价和荟萃分析。
Thromb Res. 2018 Dec;172:94-103. doi: 10.1016/j.thromres.2018.10.023. Epub 2018 Oct 28.
7
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease.临床政策:疑似急性静脉血栓栓塞性疾病成年患者到急诊科就诊评估与管理中的关键问题
Ann Emerg Med. 2018 May;71(5):e59-e109. doi: 10.1016/j.annemergmed.2018.03.006.
8
Pulmonary Embolism Secondary to Testosterone-Enhancing Herbal Supplement Use.使用增强睾酮的草药补充剂继发肺栓塞
Cureus. 2017 Aug 6;9(8):e1545. doi: 10.7759/cureus.1545.
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Testosterone treatment and cardiovascular and venous thromboembolism risk: what is 'new'?睾酮治疗与心血管及静脉血栓栓塞风险:有何“新情况”?
J Investig Med. 2017 Aug;65(6):964-973. doi: 10.1136/jim-2017-000411. Epub 2017 May 10.
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Chest. 2016 Sep;150(3):563-71. doi: 10.1016/j.chest.2016.05.007. Epub 2016 May 12.