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Hormonal replacement therapy and venous thrombosis

Nalini Mahajan, Padmaja Naidu, Shalu Gupta, Kumkum Rani
Deep venous thrombosis (DVT) has been reported extensively following ovarian hyperstimulation syndrome during in-vitro fertilization (IVF). Pregnancy per se increases the risk of DVT due to a hypercoagulable state. The long-term use of hormone replacement therapy (HRT) is another critical factor associated with DVT in women. However, an association between the short-term use of HRT in oocyte donation (OD) cycles and DVT has not yet been reported. We present a case of 43-year-old woman who developed DVT after IVF-OD...
July 2015: Journal of Human Reproductive Sciences
Charles J Glueck, Joel Friedman, Ahsan Hafeez, Atif Hassan, Ping Wang
Our hypothesis was that testosterone therapy (TT) interacts with previously undiagnosed thrombophilia-hypofibrinolysis, leading to hospitalization for deep venous thrombosis (DVT)-pulmonary emboli (PE). We determined the prevalence of DVT-PE associated with TT 147 men hospitalized in the last 12 months for DVT-PE. Of the 147 men, 2 (1.4%) had TT before and at the time of their DVT-PE. Neither had risk factors for thrombosis. Neither smoked. Case #1 (intramuscular T 50mg/week) had 2 PE, 6 and 24 months after starting TT...
April 2015: Medical Hypotheses
Jiri Horacek, Jaroslav Maly, Ioannis Svilias, Lukas Smolej, Jitka Cepkova, Jaroslav Vizda, Petr Sadilek, Ilona Fatorova, Pavel Zak
OBJECTIVE: With increasing free thyroxine levels, a gradually rising risk of venous thromboembolism has been described in case-control studies. However, reports on the influence of thyroid hormones on haemostasis, while suggesting a hypercoagulable state in thyrotoxicosis, have often been inconclusive. This study evaluates multiple markers of haemostasis and fibrinolysis in a paired design, making it more sensitive to changes in thyroid hormone levels. DESIGN: We analysed multiple variables in patients who shifted from severe hypothyroidism to mild hyperthyroidism during thyroid cancer treatment...
May 2015: European Journal of Endocrinology
A R Folsom, W Tang, N S Roetker, A V Kshirsagar, V K Derebail, P L Lutsey, R Naik, J S Pankow, M L Grove, S Basu, N S Key, M Cushman
BACKGROUND: Sickle cell trait may increase risk of venous thromboembolism, but this is not fully established. OBJECTIVES: We sought to determine the association of sickle cell trait with deep vein thrombosis and pulmonary embolism. METHODS: Middle-aged African Americans participating in a prospective, population-based cohort investigation, the Atherosclerosis Risk in Communities Study, were followed from 1987 through 2011 for incident hospitalized pulmonary embolism (n = 111) or isolated deep vein thrombosis (n = 138), verified by physician review of medical records...
January 2015: Journal of Thrombosis and Haemostasis: JTH
Ida Martinelli, Valerio De Stefano, Alessandra Carobbio, Maria L Randi, Claudia Santarossa, Alessandro Rambaldi, Maria C Finazzi, Francisco Cervantes, Eduardo Arellano-Rodrigo, Serena Rupoli, Lucia Canafoglia, Alessia Tieghi, Luca Facchini, Silvia Betti, Alessandro M Vannucchi, Lisa Pieri, Rossella Cacciola, Emma Cacciola, Agostino Cortelezzi, Alessandra Iurlo, Enrico M Pogliani, Elena M Elli, Antonio Spadea, Tiziano Barbui
To investigate the characteristics and clinical course of cerebral vein thrombosis (CVT) in patients with myeloproliferative neoplasms (MPN) we compared 48 patients with MPN and CVT (group MPN-CVT) to 87 with MPN and other venous thrombosis (group MPN-VT) and 178 with MPN and no thrombosis (group MPN-NoT) matched by sex, age at diagnosis of MPN (±5 years) and type of MPN. The study population was identified among 5,500 patients with MPN, from January 1982 to June 2013. Thrombophilia abnormalities were significantly more prevalent in the MPN-CVT and MPN-VT than in MPN-NoT group (P = 0...
November 2014: American Journal of Hematology
A R Folsom, N S Roetker, W D Rosamond, S R Heckbert, S Basu, M Cushman, P L Lutsey
BACKGROUND: Some evidence suggests that an inadequate vitamin D level may increase the risk for atherosclerotic cardiovascular disease. Whether a low vitamin D level plays a role in venous thromboembolism (VTE), that is, venous thrombosis and pulmonary embolism, is largely unexplored. OBJECTIVES: We tested prospectively, in the Atherosclerosis Risk in Communities (ARIC) cohort, whether the serum level of 25-hydroxyvitamin D (25[OH]D) is inversely associated with VTE incidence, and whether it partly explains the African American excess of VTE in the ARIC Study...
September 2014: Journal of Thrombosis and Haemostasis: JTH
R A Lobo
With an increasing world population of postmenopausal women, providers of health care need to focus on improving the quality of life as well as the longevity of women. This review emphasizes the importance of health care for postmenopausal women, particularly the role of menopausal hormonal therapy (MHT), from the perspective of where we have been, where we are now, and where we can expect to be in the future. Use of MHT increased dramatically in the 1980s and then fell very abruptly in the early 2000s with the publications of various randomized hormonal trials, including the Women's Health Initiative (WHI)...
December 2014: Climacteric: the Journal of the International Menopause Society
Pierre-Yves Scarabin
Venous thromboembolism (VTE) is a major harmful effect of hormone therapy (HT) among postmenopausal women. A large variety of HT can be used with significant differences in adverse effects. There is evidence that the VTE risk among HT users depends on the route of estrogen administration. Oral but not transdermal estrogens dose-dependently increase the VTE risk. This difference is supported by biological data. Whereas oral estrogens increase thrombin generation and induce resistance to activated protein C, transdermal estrogens have minimal effect on hemostasis...
2014: Frontiers of Hormone Research
Yanjie Wang, Xin Yang, Xiaodong Li, Xiaojing He, Yang Zhao
OBJECTIVE: Obstetrician-gynecologists' (ob-gyns) knowledge of the benefits and risks of-and attitude toward-menopausal hormone therapy (HT) have evolved since the publication of the Heart and Estrogen/progestin Replacement Study and the Women's Health Initiative. The survey investigated Chinese ob-gyns' perception and personal use of-and attitude toward-HT. METHODS: A total of 2,000 self-administered questionnaires were sent to female ob-gyns who attended gynecological endocrinology workshops in 15 provinces and cities in China from February to May 2013...
November 2014: Menopause: the Journal of the North American Menopause Society
Joann E Manson
Menopausal hormone therapy (HT) has complex biologic effects but continues to have an important clinical role in the management of vasomotor and other menopausal symptoms. The rational use of menopausal HT requires balancing the potential benefits and risks of treatment. Findings from the Women's Health Initiative (WHI) and other randomized clinical trials have helped to clarify the benefits and risks of HT and have provided insights to improve decision making. Several clinical characteristics have utility in identifying women for whom benefits of HT are likely to outweigh the risks...
April 2014: Fertility and Sterility
Nancy C Greep, David S Liebeskind, Rubine Gevorgyan, Tam Truong, Bennett Cua, Chi-Hong Tseng, David W Dodick, Bart M Demaerschalk, David E Thaler, Jonathan M Tobis
BACKGROUND: Postmenopausal hormone therapy (HT) increases the risk of venous thrombosis and ischemic stroke. OBJECTIVES: We postulated that HT might increase the risk of ischemic stroke by promoting venous clots that travel to the brain through a right to left shunt (RLS). METHODS: A total of 2,389 records were studied. After eliminating the premenopausal patients, and those with TIAs and non-ischemic strokes, the medical records of 1846 postmenopausal women hospitalized at four institutions for ischemic stroke were reviewed to identify those who had undergone an adequate study to assess for RLS...
September 1, 2014: Catheterization and Cardiovascular Interventions
Beatrice A Golomb, Virginia T Chan, Julie O Denenberg, Sabrina Koperski, Michael H Criqui
OBJECTIVE: To examine the interrelations among, and risk marker associations for, superficial and deep venous events-superficial venous thrombosis (SVT), deep venous thrombosis (DVT) and pulmonary embolism (PE). DESIGN: Cross-sectional analysis. SETTING: San Diego, California, USA. PARTICIPANTS: 2404 men and women aged 40-79 years from four ethnic groups: non-Hispanic White, Hispanic, African-American and Asian. The study sample was drawn from current and former staff and employees of the University of California, San Diego and their spouses/significant others...
2014: BMJ Open
M Blondon, A van Hylckama Vlieg, K L Wiggins, L B Harrington, B McKnight, K M Rice, F R Rosendaal, S R Heckbert, B M Psaty, N L Smith
BACKGROUND: The risk of venous thrombosis (VT) associated with oral hormone therapy (HT) may differ by type of estrogen compound. OBJECTIVE: To compare the thrombotic profile of women using oral conjugated equine estrogens (CEE) with that of women using oral estradiol (E2). METHODS: In postmenopausal, female, health maintenance organization (HMO) members with no history of VT, we measured thrombin generation, levels of factor VII activity, antithrombin activity and total protein S antigen...
June 2014: Journal of Thrombosis and Haemostasis: JTH
Elizabeth A Scoville, Gauree G Konijeti, Deanna D Nguyen, Jenny Sauk, Vijay Yajnik, Ashwin N Ananthakrishnan
BACKGROUND: Inflammatory bowel disease (IBD) is a well-known risk factor for venous thromboembolism (VTE). Existing guidelines for thromboprophylaxis in hospitalized patients do not extend to other clinical scenarios that may also be associated with VTE risk. Our aim was to estimate the fraction of VTE events in patients with IBD that could be prevented. METHODS: A retrospective analysis assessed all patients with IBD diagnosed with VTE at a single academic medical center from 2002 to 2012...
April 2014: Inflammatory Bowel Diseases
Olga V Glinskii, Virginia H Huxley, Vladimir V Glinskii, Leona J Rubin, Vladislav V Glinsky
In postmenopausal women, estrogen (E2) deficiencies are frequently associated with higher risk of intracranial hemorrhage, increased incidence of stroke, cerebral aneurysm, and decline in cognitive abilities. In younger postpartum women and those using oral contraceptives, perturbations in E2 are associated with higher risk of cerebral venous thrombosis. A number of serious intracranial pathologic conditions linked to E2 deficiencies, such as dural sinus thrombosis, dural fistulae, non-parenchymal intracranial hemorrhages, migraines, and spontaneous cerebrospinal fluid leaks, involve the vessels not of the brain itself, but of the outer fibrous membrane of the brain, the dura mater (DM)...
2013: PloS One
M Gambacciani
Hypoestrogenism is the primary etiologic factor for osteoporosis and related fractures, as well as for a number of clinical symptoms that can reduce the quality of life in postmenopausal women. Alternative to classical hormone replacement therapy (HRT) are needed for women that cannot or don't want to be treated with hormones. Selective estrogen receptor modulators (SERMs) are compounds that lack the steroid structure of estrogens, but interact with estrogen receptors (ERs) as agonists or antagonists depending on the target tissue...
December 2013: Minerva Ginecologica
H N Holmegard, B G Nordestgaard, P Schnohr, A Tybjaerg-Hansen, M Benn
BACKGROUND: Use of oral contraceptives with estrogen and hormone replacement therapy with estrogen or testosterone are associated with increased risk of venous thromboembolism (VTE). However, whether endogenous estradiol and testosterone concentrations are also associated with risk of VTE is unknown. OBJECTIVE: We tested the hypothesis that elevated endogenous total estradiol and total testosterone concentrations are associated with increased risk of VTE in the general population...
2014: Journal of Thrombosis and Haemostasis: JTH
D G Watt, O Shapter, D Mittapalli, W G Murray
Hormone replacement therapy increases risk of deep venous thrombosis (DVT) mainly in the extremities and lungs. There are reports of mesenteric ischemia secondary to oral contraceptive pills but no reports on hormone replacement therapy and mesenteric thrombosis. The authors present a case of a 44-year-old obese (BMI 32) woman, on long-term hormone replacement therapy, presented with thrombosis of portal, splenic and superior mesenteric veins. She underwent surgical resection of ischemic bowel and planned re-look laparotomies with further resections and jejuno-ileal anastomosis at final laparotomy...
November 2013: Scottish Medical Journal
Rachel E J Roach, Willem M Lijfering, Astrid van Hylckama Vlieg, Frans M Helmerhorst, Frits R Rosendaal, Suzanne C Cannegieter
Superficial vein thrombosis (SVT) increases the risk of venous thrombosis fourfold to sixfold. As most individuals with SVT do not develop venous thrombosis, additional risk factors may explain the risk of developing a venous thrombosis. In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis study, we assessed the risk of venous thrombosis in individuals with previous SVT and a mild thrombotic risk factor (smoking or overweight/obesity), a strong risk factor (surgery, hospitalization, plaster cast immobilization, or malignancy), or a reproductive factor in women (oral contraception, postmenopausal hormone therapy, or pregnancy/puerperium)...
December 19, 2013: Blood
Rachel E J Roach, Willem M Lijfering, Frits R Rosendaal, Suzanne C Cannegieter, Saskia le Cessie
BACKGROUND: The risk of recurrent venous thrombosis is 2-fold higher in men than in women. In contrast, no such sex difference in the risk of first venous thrombosis has been reported. We hypothesized that, for a first event, a risk difference between the sexes is masked by female exposure to reproductive factors (oral contraception, pregnancy/puerperium, and postmenopausal hormone therapy). METHODS AND RESULTS: From the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA) study, a population-based case-control study on risk factors for venous thrombosis, 2915 patients with a first venous thrombosis and their partners as control subjects were included...
January 7, 2014: Circulation
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