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Recurrence Rates for Women with Estrogen-Associated Venous Thromboembolism
Classification of estrogen-associated venous thromboembolism (VTE) is controversial — some consider estrogen to be a provoking risk factor, whereas others consider these events to be unprovoked. This classification is important, as duration of anticoagulation is heavily influenced by context: patients with provoked events are treated with finite duration of anticoagulation, whereas those with unprovoked events may be candidates for longer-term anticoagulation. Prior studies of recurrence rates after discontinuation of anticoagulation in women with oral contraceptive–associated events have been limited by sample size, patient heterogeneity, and inconsistent results. To address this, researchers conducted a systematic review to estimate the incidence rate for recurrent VTE after discontinuation of anticoagulation in women with a first VTE related to estrogen use.
In a literature search from 2008 to 2021, the researchers identified studies that enrolled patients who had a mean age of <50 years, a first symptomatic VTE related to use of estrogen-containing contraceptives, and completion of at least 3 months of anticoagulation, and that documented follow up and reported recurrences. Fourteen studies (11 prospective cohort, 3 retrospective cohort) were included in the analysis. With a mean or median follow-up time ranging from 0.7 to 9.5 years, the pooled recurrence rate was 1.57 per 100 patient-years.
This systematic review reports a relatively low risk for VTE recurrence following anticoagulant discontinuation among women with estrogen-associated VTE. The rate reported here is below the typical threshold of 3%, above which longer-term anticoagulation may be justified. The authors acknowledge limitations, noting heterogeneity across studies. In addition, no randomized control trials were identified, and the analysis could not identify whether recurrence rates would differ based on estrogen formulation, which could impact generalizability of the findings. However, this systematic review supports the recommendation from the American Society of Hematology regarding shorter-term anticoagulation for women with oral contraceptive-associated VTE.
Wiegers HMG et al.
Title: Risk of recurrence in women with venous thromboembolism related to estrogen-containing contraceptives: Systematic review and meta-analysis.
Source: J Thromb Haemost 2022 May ; [e-pub]. (Abstract/FREE Full Text)