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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
1   Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
2   Department of Internal Medicine and Chest Diseases and EA 3878, Brest University Hospital, Brest, France
,
Michael J. Kovacs
3   Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
,
Marc Carrier
1   Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
4   Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada
,
Kimberley Do
4   Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada
,
Susan R. Kahn
5   Department of Medicine, McGill University, Montreal, Canada
6   Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
,
Philip S. Wells
1   Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
4   Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada
,
David A. Anderson
7   Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
,
Isabelle Chagnon
8   Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada
,
Susan Solymoss
5   Department of Medicine, McGill University, Montreal, Canada
,
Mark Crowther
9   Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
,
Marc Righini
10   Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
,
Karine Lacut
2   Department of Internal Medicine and Chest Diseases and EA 3878, Brest University Hospital, Brest, France
,
Richard H. White
11   Department of Medicine, UC Davis School of Medicine, Sacramento, California, USA
,
Linda Vickars
12   Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Marc Rodger
1   Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
4   Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ottawa, Ontario, Canada
› Author Affiliations Financial support:The REVERSE study was funded by the Canadian Institutes of Health Research (grant no. MOP 64319) and bioMérieux (through an unrestricted research grant). Dr. Grégoire Le Gal was the recipient of a University of Ottawa International Fellowship. Dr. Marc Carrier is a recipient of a Canadian Institute for Health Research Fellowship. Dr. Marc Rodger is a Heart and Stroke Foundation of Canada Career Scientist and has received support from the Ontario Ministry of Research and Innovation. Dr. Susan Kahn is a recipient of a Clinical Investigator Award from the Fonds de la Recherche en Santé du Québec. Dr. Phil Wells is a recipient of Canada Research Chair. Dr. Mark Crowther holds a Career Investigator Award from the Heart and Stroke Foundation.
Further Information

Publication History

Received: 03 October 2009

Accepted after major revision: 15 April 2010

Publication Date:
23 November 2017 (online)

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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