Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Eur J Haematol. 2024 Dec;113(6):745-750. doi: 10.1111/ejh.14287. Epub 2024 Aug 8.
Whether vaginal estradiol use is associated with an increased risk of recurrent venous thromboembolism (VTE) in women with prior VTE is unknown. We sought to evaluate the association between vaginal estradiol use and recurrent VTE in women with prior VTE.
We performed a nationwide nested case-control study among 44 024 women aged ≥45 years who developed a first VTE without a history of vaginal estrogen use prior to VTE diagnosis. Cases with recurrent VTE were matched 1:2 on birth year with controls using incidence density sampling. Exposure to vaginal estradiol tablets was categorized into current use (0-2 months before index), prior use (2-24 months before index) and past use (more than 24 months prior to index).
We identified 5066 cases and 10 127 age-matched controls. In fully adjusted analysis vaginal estrogen was not associated with recurrent VTE with a hazard ratio of 0.75, p = .07 for current use, 0.83, p = .13 for prior use, and 1.24, p = .06 for past use.
Use of vaginal estradiol tablets in women with prior VTE was not associated with an increased rate of recurrent VTE. Our study indicates that vaginal estradiol therapy is unlikely to increase risk of recurrent VTE in women with prior VTE.
既往有静脉血栓栓塞症（VTE）病史的女性使用阴道用雌激素是否会增加复发性 VTE 的风险尚不清楚。我们旨在评估既往有 VTE 病史的女性使用阴道用雌激素与复发性 VTE 之间的关联。
我们在全国范围内进行了一项巢式病例对照研究，纳入了 44024 名年龄≥45 岁的女性，这些女性在 VTE 诊断前无阴道雌激素使用史，但发生了首次 VTE。将复发性 VTE 病例按出生年份与对照组进行 1:2 匹配，采用密度抽样法进行匹配。阴道用雌二醇片的暴露分为当前使用（在 VTE 发生前 0-2 个月）、既往使用（在 VTE 发生前 2-24 个月）和过去使用（VTE 发生前 24 个月以上）。
我们确定了 5066 例病例和 10127 名年龄匹配的对照组。在完全调整的分析中，阴道雌激素与复发性 VTE 无关，当前使用的风险比为 0.75（p=0.07），既往使用的风险比为 0.83（p=0.13），过去使用的风险比为 1.24（p=0.06）。
既往有 VTE 病史的女性使用阴道用雌二醇片与复发性 VTE 发生率增加无关。我们的研究表明，阴道用雌二醇治疗不太可能增加既往有 VTE 病史的女性复发性 VTE 的风险。
