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Hormonal replacement therapy(HRT) and pulmonary embolism

Stavros Apostolakis, Renee M Sullivan, Brian Olshansky, Gregory Y H Lip
BACKGROUND AND PURPOSE: Hormone replacement therapy (HRT) use has been related to thromboembolism, but whether HRT increases adverse outcomes in females with atrial fibrillation is uncertain. METHODS: We used the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial data set that included 1594 women (39.3% of the population, mean age 71±8), of whom 376 (23.6%) were taking HRT at baseline. The primary end point, a composite of all-cause death, stroke, systemic/pulmonary embolism, and myocardial infarction, and secondary outcomes (ie, each individual end point) and major bleeding, were considered...
October 2014: Stroke; a Journal of Cerebral Circulation
Andrew Eisenberger, Carolyn Westhoff
Hormone replacement therapy (HRT) for post-menopausal women is known to promote venous thromboembolism (VTE), i.e., deep venous thrombosis and pulmonary embolism, though the absolute risk for a given patient is very small. The risk of VTE appears to be greatest soon after the initiation of HRT and returns to the baseline level of risk of non-HRT users after discontinuation. There is inconsistent data about whether estrogen-only or combined estrogen-progestin HRT are associated with similar VTE risk. Retrospective analyses suggest that transdermal HRT is not as prothrombotic as oral HRT, though this has not been evaluated in randomized clinical trials...
July 2014: Journal of Steroid Biochemistry and Molecular Biology
(no author information available yet)
BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed by the European Society of Human Reproduction and Embryology Workshop Group. RESULTS VTE is a multifactorial disease with a baseline annual incidence around 50 per 100 000 at 25 years and 120 per 100 000 at age 50...
September 2013: Human Reproduction Update
Mary Sano, Diane Jacobs, Howard Andrews, Karen Bell, Neill Graff-Radford, John Lucas, Peter Rabins, Karen Bolla, Wei-Yan Tsai, Peter Cross, Karen Andrews, Rosann Costa, Xiaodong Luo
BACKGROUND: Observational studies and small clinical trials suggested that hormone replacement therapy (HRT) decreases risk of cognitive loss and Alzheimer's disease (AD) in postmenopausal women and may have value in primary prevention. PURPOSE: A clinical trial was designed to determine if HRT delays AD or memory loss. This report describes the rationale and original design of the trial and details extensive modifications that were required to respond to unanticipated findings that emerged from other studies during the course of the trial...
2008: Clinical Trials: Journal of the Society for Clinical Trials
Gillian M Sare, Laura J Gray, Philip M W Bath
AIMS: Randomized controlled trials (RCTs) have shown that the risk of stroke and venous thromboembolism (VTE) is increased with hormone replacement therapy (HRT); the effect on coronary heart disease (CHD) remains unclear. METHODS AND RESULTS: RCTs of HRT were identified. Event rates for cerebrovascular disease [stroke, TIA (transient ischaemic attack)], CHD (myocardial infarction, unstable angina, sudden cardiac death), and VTE (pulmonary embolism, deep vein thrombosis) were analysed...
August 2008: European Heart Journal
George Mastorakos, Evangelos Gr Sakkas, Antonios M Xydakis, George Creatsas
Recently, the use of hormone replacement therapy (HRT) at menopause has become a matter of debate. Its utility has been questioned after the publication of the results of the Women's Health Initiative (WHI) studies. This trial was divided in two arms of which the first examined the use of combined HRT (continuous estrogens plus progestins) and the second the use of estrogens alone in menopausal women. The first arm was terminated prematurely at 5.2 years because the number of cases of coronary heart disease (CHD), strokes, venous thromboembolic disease, and breast cancer were more in women receiving HRT than in women receiving placebo, if the nominal confidence intervals (CIs) were taken into account...
December 2006: Annals of the New York Academy of Sciences
O Wu, L Robertson, S Twaddle, G D O Lowe, P Clark, M Greaves, I D Walker, P Langhorne, I Brenkel, L Regan, I Greer
OBJECTIVES: To assess the risk of clinical complications associated with thrombophilia in three high-risk patient groups: women using oral oestrogen preparations, women during pregnancy and patients undergoing major orthopaedic surgery. To assess the effectiveness of prophylactic treatments in preventing venous thromboembolism (VTE) and adverse pregnancy outcomes in women with thrombophilia during pregnancy and VTE in patients with thrombophilia, undergoing major orthopaedic surgery. To evaluate the relative cost-effectiveness of universal and selective VTE history-based screening for thrombophilia compared with no screening in the three high-risk patient groups...
April 2006: Health Technology Assessment: HTA
Olivia Wu
BACKGROUND: Women taking hormone replacement therapy (HRT) have a 2- to 5-fold increased risk of venous thrombosis compared with nonusers. Increasingly, evidence has suggested that the size of the risk increase varies according to related factors, such as the type of estrogen used, the mode of delivery, and the presence of other predisposing factors. OBJECTIVE: The aim of this study was to examine the current literature to assess the varying risk of venous thrombosis among women taking HRT...
2005: Gender Medicine
Tomoko Adachi, Shoichi Sakamoto
Japanese women are unaccustomed to taking hormone therapies such as oral contraceptives (OCs) and hormone replacement therapy (HRT); therefore, there are few studies associated with hormone treatment in Japan. This study focused on evaluating thromboembolism during hormone therapy in Japanese women. In February 2002, we mailed questionnaires regarding the monthly average number of patients who had received prescriptions for OCs and HRT, and the incidence of arterial and venous thromboemboli during hormone therapy for the last 10 years...
June 2005: Seminars in Thrombosis and Hemostasis
Jennifer J Hillman, Ilene H Zuckerman, Euni Lee
BACKGROUND: Observational studies suggest that hormone replacement therapy (HRT) reduces women's risk of cardiovascular disease (CVD). However the Women's Health Initiative (WHI) HRT arm was stopped early because of increased risk of CVD, stroke, pulmonary embolism, and breast cancer. Evaluating HRT-prescribing patterns in relation to the release of the WHI will help determine if these study results have influenced the use of HRT. METHODS: This is a descriptive time series analysis to primarily evaluate utilization trends of HRT in women > or =50 years enrolled in the Pennsylvania Medicaid Program...
November 2004: Journal of Women's Health
Ming-Dao Chen, Ying Yang
In July 2002, the Women's Heath Initiative (WHI) clinical trial, designed to clarify the risks and benefits of combination hormone replacement therapy (HRT) to the postmenopausal women declared that interim safety review after an average follow-up of 5.2 years found that a combination of estrogen and progestin frequently prescribed to postmenopausal women in USA increased the risk of invasive breast cancer, heart disease, stroke, and pulmonary embolism while reduced bone fractures and colorectal cancer. The overall risks of HRT outweigh the benefits, which provides an opportunity for traditional Chinese medicine (TCM) going abroad...
May 2003: Zhong Xi Yi Jie He Xue Bao, Journal of Chinese Integrative Medicine
B Uebelhart, D Frey, D Uebelhart
Based on the most recent studies, it clearly appears that long-term hormone replacement therapy (HRT) prevents fractures but does not improve established coronary artery disease. In addition, HRT leads to a small increase in breast cancer incidence and to a decrease in colorectal cancer incidence. HRT increases the incidence of venous thrombosis, pulmonary embolisms and strokes. As a consequence, HRT can no longer be recommended for primary or secondary prevention of cardiovascular diseases. In addition, it was also demonstrated that HRT was not able to improve cognitive functions and prevent dementia...
December 2003: Zeitschrift Für Rheumatologie
F H Loh
The publication of the Women's Health Initiative (WHI) Study results in July 2002 has changed the understanding of the use of hormone replacement therapy (HRT) in the postmenopausal woman, and challenged many of the accepted dogmas culled from decades of observational studies. The results of the WHI demonstrated a small but significant increased risk of coronary heart disease, strokes, pulmonary embolism and breast cancer amongst women who used continuous combined HRT. Conversely, there was a decreased risk of colonic cancer and osteoporotic fractures...
September 2003: Annals of the Academy of Medicine, Singapore
D Cibula, V Unzeitig, J Zivný
OBJECTIVE: Analysis of the issue of screening for Factor V Leiden mutation (FVL) in users of combined oral contraceptives (COC) or hormone replacement therapy (HRT). DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Charles University and General Faculty Hospital, Prague. METHODS: Review of published facts, analysis of possibilities to screen all users or to test risk groups in the current situation in the Czech Republic...
May 2003: Ceská Gynekologie
T Luukkainen
Several studies on hormone replacement therapy (HRT) in the USA have been published. They revealed that the risk of breast cancer is increased with HRT more than with estrogen alone (ERT). A progestin has been given with each dose of ERT, as was the case in the Women's Health Initiative (WHI) study. The results of studies in Europe show similar trends. The increased risk of breast cancer in the WHI study was significantly higher only in women who had used HRT for several years before entering the study. The study was non-blind in 3444 cases, i...
August 2003: Human Reproduction
Mary Armitage, Janet Nooney, Stephen Evans
Millions of women are treated with hormone replacement therapy (HRT) for relief of menopausal symptoms, including vasomotor flushes and sweats for which oestrogen is uniquely and highly effective. Others may continue longer-term treatment in the hope that HRT will help to prevent chronic disease. The preservation of bone mass with continuing oestrogen therapy and reduction of subsequent risk of fracture is well established. Observational studies of the metabolic and vascular effects of oestrogens have suggested a potential benefit in reducing the risk of vascular disease, but recently published randomized controlled trials demonstrate no evidence of benefit in women with established vascular disease or in apparently healthy women...
August 2003: Clinical Endocrinology
Svati H. Shah, Karen P. Alexander
Cardiovascular disease is the leading cause of death in women. In pooled analysis, observational studies have shown a 50% reduction in death and myocardial infarction among users of hormone replacement therapy (HRT) for the primary and secondary prevention of cardiovascular disease. The first randomized trial of HRT for secondary prevention of heart disease found no benefit to therapy (Heart and Estrogen/progestin Replacement Study ). Even after 6.8 years of follow-up, there was still no cardiovascular benefit from the use of HRT (HERS II)...
February 2003: Current Treatment Options in Cardiovascular Medicine
S Middeldorp, H R Büller, J P Vandenbroucke, F M Helmerhorst, F R Rosendaal
The views on the effects of postmenopausal hormone-replacement therapy (HRT) on cardiovascular disease have moved from one end of the spectrum to the other over the past decades. The presumed beneficial effects of HRT on arterial cardiovascular disease were based on observational findings and have led to the widespread use of these agents. However, recent large-scale randomised, placebo-controlled trials have demonstrated that HRT in women with a history of arterial diseases initially increases the risk of recurrent disease, while offering no benefit in the long term...
November 9, 2002: Nederlands Tijdschrift Voor Geneeskunde
Kwang Kon Koh
It has been speculated that hormone replacement therapy (HRT) containing relatively low dose of estrogen would be different from oral contraceptive pills in causing thromboembolism because activation of coagulation depends on the amount of estrogen. In contrast to this knowledge, activation of coagulation pathways has been detected in postmenopausal women treated with HRT in the observational and clinical studies. In this regard, recent studies have reported a 2 to approximately 4 fold risk of venous thromboembolism or pulmonary embolism in postmenopausal women receiving HRT than in non-users of estrogen...
August 2002: International Journal of Hematology
Paul G McDonough
In May 2002, the Women's Heath Initiative (WHI) clinical trial, designed to clarify the risks and benefits of combination hormone replacement therapy, came to a premature halt. An interim safety review after an average follow-up of 5.2 years found that a combination of estrogen and progestin often prescribed to postmenopausal women increased the risk of invasive breast cancer, heart disease, stroke, and pulmonary embolism. The combination hormone therapy reduced bone fractures and colorectal cancer, but not enough to outweigh the other risks...
November 2002: Fertility and Sterility
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