Open Access
CC BY-NC-ND 4.0 · Thromb Haemost 2025; 125(04): 385-394
DOI: 10.1055/a-2407-9498
Stroke, Systemic or Venous Thromboembolism

Unravelling the Causal Relationship between Endometriosis and the Risk for Developing Venous Thromboembolism: A Pooled Analysis

1   Berlin Center for Epidemiology and Health Research, Berlin, Germany
4   Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
,
Igor Milhoranca
1   Berlin Center for Epidemiology and Health Research, Berlin, Germany
,
Sylvia Mechsner
2   Department of Gynaecology, Charité – Universitätsmedizin Berlin, Endometriosis Centre Charité, Berlin, Germany
,
Anna Sara Oberg
3   Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
,
Tobias Kurth
4   Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
,
Klaas Heinemann
1   Berlin Center for Epidemiology and Health Research, Berlin, Germany
› Institutsangaben


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Abstract

Objective

To investigate the effect of endometriosis on venous thromboembolism (VTE) in oral contraceptive (OC) users. Pooled analysis on a harmonized dataset compromising international patient-centric cohort studies: INAS-VIPOS, INAS-SCORE, and INAS-FOCUS. Eleven European countries, the United States, and Canada. Individuals being newly prescribed an OC with or without an endometriosis and no VTE history.

Methods

Detailed information was captured using self-administered questionnaires at baseline and every 6 to 12 months thereafter. Self-reported VTEs were medically validated and reviewed by an independent adjudication committee. Incidence rates (IRs) were calculated per 10,000 woman-years. The association of endometriosis on VTE was determined in a time-to-event analysis, calculating crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) using stabilized inverse probability of treatment weighting (IPTW).

Results

A total of 22,072 women had an endometriosis diagnosis, and 91,056 women did not. Women with endometriosis contributed 78,751 woman-years during which 41 VTE events occurred (IR: 5.2/10,000, 95% CI: 3.7–7.1) compared to 127 VTEs during 310,501 woman-years in women without endometriosis (IR: 4.1/10,000, 95% CI: 3.4–4.9). The hazard ratio of VTE in women with endometriosis was 1.79 (95% CI: 1.24–2.57) using stabilized IPTW controlling for age, body mass index, smoking, education, age at menarche, and family history of VTE. Subgroup and sensitivity analyses showed similar results.

Conclusion

These results highlight the importance of considering endometriosis as a potential factor contributing to VTE in women using OC; however, further research on the relationship between endometriosis and VTE is warranted.

Authors' Contribution

All authors contributed to the conceptualization and writing (review and editing) of this research; P.D.C., A.S.O., and T.K. contributed to the methodology of the study. P.D.C. contributed to data curation, writing (original draft), and visualization; P.D.C. and I.M. contributed to software, formal analysis, and validation. All authors take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Supplementary Material



Publikationsverlauf

Eingereicht: 24. März 2024

Angenommen: 20. August 2024

Accepted Manuscript online:
02. September 2024

Artikel online veröffentlicht:
18. September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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