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Thromb Haemost 2005; 94(01): 17-25
DOI: 10.1160/TH04-11-0759
Review Article
Schattauer GmbH

Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism: a systematic review

The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study
Olivia Wu
1   Division of Developmental Medicine, University of Glasgow, Scotland
,
Lindsay Robertson
1   Division of Developmental Medicine, University of Glasgow, Scotland
,
Peter Langhorne
2   Division of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
,
Sara Twaddle
3   Scottish Intercollegiate Guidelines Network, Edinburgh, Scotland
,
Gordon D. O. Lowe
2   Division of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
3   Scottish Intercollegiate Guidelines Network, Edinburgh, Scotland
,
Peter Clark
4   Ninewells Hospital, Dundee, Scotland
,
Mike Greaves
5   Department of Medicine and Therapeutics, University of Aberdeen, Scotland
,
Isobel D. Walker
2   Division of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
,
Ivan Brenkel
6   Fife Acute Hospital NHS Trust, Scotland
,
Lesley Regan
7   Department of Obstetrics and Gynaecology, Imperial College School of Medicine, London, UK
,
Ian A. Greer
1   Division of Developmental Medicine, University of Glasgow, Scotland
› Author Affiliations
Further Information

Publication History

Received 24 November 2004

Accepted after resubmission 13 April 2005

Publication Date:
05 December 2017 (online)

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Summary

Combined oral contraceptives, oral hormone replacement therapy and thrombophilias are recognised risk factors for venous thromboembolism in women. The objective of this study was to assess the risk of thromboembolism among women with thrombophilia who are taking oral contraceptives or hormone replacement therapy, conducting a systematic review and metaanalysis. Of 201 studies identified, only nine met the inclusion criteria. Seven studies included pre-menopausal women on oral contraceptives and two studies included peri-menopausal women on hormone replacement therapy. For oral contraceptive use, significant associations of the risk of venous thromboembolism were found in women with factor V Leiden (OR 15.62; 95%CI 8.66 to 28.15); deficiencies of antithrombin (OR 12.60; 95%CI 1.37 to 115.79), protein C (OR 6.33; 95%CI 1.68 to 23.87), or protein S (OR 4.88; 95%CI 1.39 to 17.10), elevated levels of factor VIIIc (OR 8.80; 95%CI 4.13 to 18.75); and factor V Leiden and prothrombin G20210A (OR 7.85; 95%CI 1.65 to 37.41). For hormone replacement therapy, a significant association was found in women with factor V Leiden (OR 13.16; 95%CI 4.28 to 40.47).Although limited by the small number of studies, the findings of this study support the presence of interaction between thrombophilia and venous thromboembolism among women taking oral contraceptives. However, further studies are required to establish with greater confidence the associations of these, and other, thrombophilias with venous thromboembolism among hormone users.

Keywords

Venous thromboembolism - oral contraceptives - hormone replacement therapy - thrombophilia
 

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