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

Olivia Wu; Lindsay Robertson; Peter Langhorne; Sara Twaddle; Gordon D. O. Lowe; Peter Clark; Mike Greaves; Isobel D. Walker; Ivan Brenkel; Lesley Regan; Ian A. Greer

doi:10.1160/TH04-11-0759

Thrombosis and Haemostasis, Table of Contents

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

Authors

Olivia Wu

¹Division of Developmental Medicine, University of Glasgow, Scotland
Lindsay Robertson

¹Division of Developmental Medicine, University of Glasgow, Scotland
Peter Langhorne

²Division of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
Sara Twaddle

³Scottish Intercollegiate Guidelines Network, Edinburgh, Scotland
Gordon D. O. Lowe

²Division of Cardiovascular and Medical Sciences, University of Glasgow, Scotland

³Scottish Intercollegiate Guidelines Network, Edinburgh, Scotland
Peter Clark

⁴Ninewells Hospital, Dundee, Scotland
Mike Greaves

⁵Department of Medicine and Therapeutics, University of Aberdeen, Scotland
Isobel D. Walker

²Division of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
Ivan Brenkel

⁶Fife Acute Hospital NHS Trust, Scotland
Lesley Regan

⁷Department of Obstetrics and Gynaecology, Imperial College School of Medicine, London, UK
Ian A. Greer

¹Division of Developmental Medicine, University of Glasgow, Scotland

Abstract

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

Full Text

References

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