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Assessment of the risk for venous thromboembolism among users of hormone replacement therapy.

机译：激素替代疗法使用者中静脉血栓栓塞风险的评估。

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Although hormone replacement therapy (HRT) provides health benefits, concerns about harmful effects have been raised, including an increased risk of venous thromboembolism. The purpose of this review is to assess the risk for venous thromboembolism associated with HRT. Data searches involved the MEDLINE database from January 1982 to December 1997, and bibliographies of retrieved articles. Seven case-control studies and 1 prospective cohort study considering venous thromboembolism as the outcome of interest were selected and rated according to methodological criteria. Results of case-controls studies were pooled to determine an overall estimate. The pooled risk ratio (95% confidence interval) for venous thromboembolism among current users of HRT compared with non-users (never-users and past-users combined) was 2.1 (1.4 to 3.0) in the case-control studies (n = 7). Based on one prospective cohort study, the risk of primary pulmonary embolism associated with HRT was 2.1 (1.2 to 3.8). No association was found with past use of HRT. The risk of venous thromboembolism was higher within the first year of treatment. There was no strong evidence for a dose-response relationship with estrogen. No striking difference in risk of venous thromboembolism was observed between unopposed and opposed regimens. The small number of women using transdermal estrogen therapy precluded any firm conclusions about the impact of the route of estrogen administration. Current use of oral estrogen as HRT is associated with a 2- to 3-fold increased risk of venous thromboembolism. However, the absolute risk remains low, and these findings need to be weighed against the potential benefits of treatment. Whether transdermal estrogen therapy is safe with respect to venous thromboembolism has yet to be adequately investigated.
机译：尽管激素替代疗法（HRT）具有健康益处，但人们仍对有害影响表示担忧，包括增加静脉血栓栓塞的风险。这篇综述的目的是评估与HRT相关的静脉血栓栓塞的风险。数据搜索涉及1982年1月至1997年12月的MEDLINE数据库以及检索到的文献的书目。选择7例病例对照研究和1项以静脉血栓栓塞为关注结果的前瞻性队列研究，并根据方法学标准进行评分。汇总病例对照研究的结果，以确定总体估计值。在病例对照研究中，HRT的当前使用者与未使用者（从未使用者和过去使用者相加）相比，静脉血栓栓塞的合并风险比（95％置信区间）为2.1（1.4至3.0）（n = 7） ）。根据一项前瞻性队列研究，与HRT相关的原发性肺动脉栓塞的风险为2.1（1.2至3.8）。未发现与过去使用HRT相关。在治疗的第一年内，静脉血栓栓塞的风险较高。没有强有力的证据表明与雌激素的剂量反应关系。在非对立和对立治疗方案之间，未观察到静脉血栓栓塞风险的显着差异。少数使用经皮雌激素治疗的妇女排除了有关雌激素给药途径影响的任何可靠结论。当前使用口服雌激素作为HRT与静脉血栓栓塞的风险增加2至3倍有关。但是，绝对风险仍然很低，需要权衡这些发现与治疗的潜在益处。就静脉血栓栓塞而言，经皮雌激素疗法是否安全尚待充分研究。

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