Risk of recurrent venous thromboembolism after a first oestrogen-associated episode

Grégoire Le Gal; Michael J. Kovacs; Marc Carrier; Kimberley Do; Susan R. Kahn; Philip S. Wells; David A. Anderson; Isabelle Chagnon; Susan Solymoss; Mark Crowther; Marc Righini; Karine Lacut; Richard H. White; Linda Vickars; Marc Rodger

doi:10.1160/TH09-10-0685

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 104(03): 498-503
DOI: 10.1160/TH09-10-0685

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Risk of recurrent venous thromboembolism after a first oestrogen-associated episode

Data from the REVERSE cohort study

Grégoire Le Gal

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

²Department of Internal Medicine and Chest Diseases and EA 3878, Brest University Hospital, Brest, France

,

Michael J. Kovacs

³Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada

,

Marc Carrier

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

⁴Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada

,

Kimberley Do

⁴Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada

,

Susan R. Kahn

⁵Department of Medicine, McGill University, Montreal, Canada

⁶Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada

,

Philip S. Wells

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

⁴Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada

,

David A. Anderson

⁷Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

,

Isabelle Chagnon

⁸Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada

,

Susan Solymoss

⁵Department of Medicine, McGill University, Montreal, Canada

,

Mark Crowther

⁹Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

,

Marc Righini

¹⁰Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland

,

Karine Lacut

²Department of Internal Medicine and Chest Diseases and EA 3878, Brest University Hospital, Brest, France

,

Richard H. White

¹¹Department of Medicine, UC Davis School of Medicine, Sacramento, California, USA

,

Linda Vickars

¹²Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Marc Rodger

¹Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

⁴Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada

› Author Affiliations

Abstract

Summary

The use of exogenous oestrogen in women with otherwise unprovoked venous thromboembolism (VTE) could be considered sufficient explanation to classify VTE as provoked if the risk of recurrent VTE after 3–6 months of anticoagulant treatment is similar to the risk of recurrent VTE observed after a surgery or prolonged immobilisation. Our objective was to assess the risk of recurrent VTE in women after a first unprovoked episode on oestrogen. The REVERSE study is a cohort study of patients with a first unprovoked VTE treated with anticoagulant treatment for 5–7 months. The risk of recurrent VTE during follow-up was compared between women users and non users of oestrogen at the time of index VTE. Among the 646 patients included, 314 were women, of them 67 were current users of oestrogen at the time of their VTE: 49 were on oral contraceptives and 18 on post-menopausal hormone replacement therapy (HRT). No significant association was found between oestrogen exposure, either oral contraceptives or HRT, and a lower risk of recurrent VTE after adjustment for age, or analysis restricted to women in the same age range as oestrogen contraceptives and HRT users, respectively. The risk of recurrent VTE is low in women after a first otherwise unprovoked oestrogen-associated VTE. However, this risk is not significantly lower than in women whose VTE was not related to oestrogen use.

Keywords

Venous thromboembolism - recurrence - cohort study - oestrogens

Full Text

References

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