Waselenko J K, Nace M C, Alving B
Walter Reed Army Medical Center, Washington, DC, USA.
Semin Thromb Hemost. 1998;24 Suppl 1:33-9.
Women with inherited or acquired thrombophilia are at increased risk for venous thromboembolism (VTE) when they use oral contraceptives (OCs) of either the second or third generation. For women who are heterozygous for Factor V Leiden, the risk is probably 28 to 50 of 10,000 women-years compared to 2 to 5 of 10,000 years for those not known to have thrombophilia. The thrombotic risk is highest during the first year that OCs are used. Whether women with thrombophilia are at increased risk for VTE when they use hormone replacement therapy (HRT) has not been assessed in any study. For women without thrombophilia, the risk for VTE associated with HRT is probably 2 to 3 of 10,000 years. The benefits of HRT include reduced risk for myocardial infarction and Alzheimer's disease, and increased bone density. The physiological changes induced by HRT are not the same as those induced by OCs. Small studies have suggested that for women who have additional risks of thrombosis (i.e., perioperative setting, underlying systemic lupus erythematosus), HRT does not confer the same increased risk of thrombosis, as does the use of OCs. Until data are available to address the magnitude of any increase in thrombotic risk induced by HRT for women with thrombophilia, physicians probably serve their patients best by providing information about the benefits of HRT, emphasizing that the risk of VTE is unknown, and encouraging patients to take an active role in decisions about their healthcare.
患有遗传性或获得性血栓形成倾向的女性在使用第二代或第三代口服避孕药（OCs）时，发生静脉血栓栓塞（VTE）的风险会增加。对于携带因子V莱顿杂合子的女性，每10000妇女年的风险可能为28至50例，而对于那些未知有血栓形成倾向的女性，每10000妇女年的风险为2至5例。在使用OCs的第一年，血栓形成风险最高。目前尚无任何研究评估患有血栓形成倾向的女性在使用激素替代疗法（HRT）时发生VTE的风险是否增加。对于没有血栓形成倾向的女性，与HRT相关的VTE风险可能为每10000妇女年2至3例。HRT的益处包括降低心肌梗死和阿尔茨海默病的风险，以及增加骨密度。HRT引起的生理变化与OCs引起的不同。小型研究表明，对于有额外血栓形成风险的女性（即围手术期、潜在的系统性红斑狼疮），HRT不会像使用OCs那样带来相同程度的血栓形成风险增加。在有数据可用于解决HRT对患有血栓形成倾向的女性所诱导的血栓形成风险增加的程度之前，医生可能通过提供有关HRT益处的信息、强调VTE风险未知，并鼓励患者积极参与其医疗保健决策，从而为患者提供最佳服务。
