VTE recurrence risks in women with hormone exposure at the time of index VTE
| Reference . | Study type . | Recurrence rates of hormone VTE . | Groups compared (for HR, RR, or IRR) . | HR, RR, or IRR (95% CI) . |
|---|---|---|---|---|
| Heit et al 2000 (45) | Retrospective cohort | N/R for ♀ separately | COC- VTE ♀* vs all VTE | HR 0.3 (0.12-0.73) |
| HRT-related VTE vs all VTE | HR 0.7 (0.31-1.59) | |||
| Kyrle et al 2004 (46) | Prospective cohort | OC-VTE ♀: 5.9% at 5 y | OC- VTE vs idiopathic-VTE ♀ | RR 0.8 (0.1-4.0) |
| Non-OC ♀: 4.3% at 5 y | HRT-VTE vs idiopathic-VTE ♀ | RR 1.6 (0.4-6.0) | ||
| Baglin et al 2004 (47) | Prospective cohort | Estrogen-VTE: 8.7% at 2 y | Estrogen ♀ vs ♀ with other risk factors | HR 1.181 (0.35-4.03) |
| Other ♀: 8.7% at 2 y | ||||
| Cushman et al 2006 (56) | Data from PREVENT RCT | Hormone-VTE: 5% at 3 y | 1.Hormone-VTE vs idiopathic | 1.aHR 0.54 (0.19-1.54) |
| Other ♀: 15% at 3 y | 2.OC-VTE vs idiopathic | 2.aHR 0.43 (0.07-2.46) | ||
| 3.HRT-VTE vs idiopathic | 3.aHR 0.62 (0.2-1.91) | |||
| Rodger et al 2008 (42) | Prospective cohort | N/R | 1.OC-VTE vs non-OC-VTE ♀ | 1.RR 0.37 (0.11-1.21) |
| 2. HRT-VTE vs non-HRT-VTE ♀ | 2.RR 2.19 (0.86-5.55) | |||
| Le Gal et al 2010 (28) | Data from prospective cohort study | COC-VTE: 1.7% pa | 1.COC-VTE v snon-COC VTE ♀ | 1.aHR 0.6 (0.1-2.8) |
| HRT-VTE: 10% pa | 2.HRT-VTE vs non-HRT VTE ♀ | 2.aHR 1.8 (0.6-5.2) (adjusted for age) | ||
| Non-COC-VTE ♀ 5% pa | ||||
| High HERDOO2 OC-VTE 4% pa | ||||
| Douketis et al 2011 (49) | Patient-level meta-analysis | N/R | 1. Hormone-VTE vs unprovoked VTE ♀ | 1. HR 0.5 (0.3-0.8) |
| 2. OC-VTE vs unprovoked ♀ | 2. HR 0.39 (0.16-0.91) | |||
| 3. HRT-VTE vs unprovoked ♀ | 3. HR 0.76 (0.39-1.49) | |||
| Tosetto et al 2012 (20) | Individual patient data (prospective studies) | N/R | Hormone-VTE vs non-hormone-VTE ♀ | HR N/R (β coefficient −1.08; P = .002†) |
| Le Moigne et al 2013 (57) | Prospective single-center cohort | COC-VTE: IR 17.9/1000/y | COC-VTE vs non-COC VTE ♀ | IRR 0.7 (0.2-2.4) |
| Non-COC: 17.6/1000/y | ||||
| Eischer et al 2014 (58) | Prospective cohort (all women) | Estrogen-VTE: 6% at 5 y | 1.EC-VTE vs non-EC VTE ♀ | 1.RR 0.3 (0.1-0.5) |
| Non estrogen ♀: 17% at 5 y | 2.HRT-VTE vs non-HRT VTE ♀ | 2.RR 0.7 (0.3-1.5) | ||
| Ljungqvist et al 2014 (59) | Prospective follow-up of case control study | Estrogen-VTE: 2% pa | Hormone-VTE vs unprovoked ♀ | HR 0.57 (0.36-0.9) |
| Non estrogen ♀: 3.2% pa | aHR 0.7 (0.43-1.20) | |||
| Kearon et al 2015 (29) | Prospective clinical management | Non-estrogen ♀: 5.4% PPY | Men, nonestrogen ♀, estrogen ♀ | N/R (P = .001 for the 3–group comparison) |
| Estrogen ♀: 0.0% PPY | ||||
| All had persistent negative D-dimer at end of AC and off AC | ||||
| Rodger et al 2017 (18) | Prospective clinical management | Low HERDOO2 stopping AC; <50 y: | N/R | N/R |
| Estrogen-VTE: 1.4%/100 PY | ||||
| Nonestrogen ♀: 3.1%/100 PY | ||||
| Kiconco et al 2017 (60) | Retrospective population-based cohort study | Hormone-VTE: 37/1000 PY | 1.Hormone-VTE vs unprovoked ♀ | 1. aHR 0.72 (0.58-0.88) |
| Non hormone ♀: 51/1000 PY | 2. OC-VTE vs unprovoked ♀ | 2. aHR 0.71 (0.52-0.96) | ||
| 3. HRT-VTE vs unprovoked ♀ | 3. aHR 0.71 (0.53-0.95) |
| Reference . | Study type . | Recurrence rates of hormone VTE . | Groups compared (for HR, RR, or IRR) . | HR, RR, or IRR (95% CI) . |
|---|---|---|---|---|
| Heit et al 2000 (45) | Retrospective cohort | N/R for ♀ separately | COC- VTE ♀* vs all VTE | HR 0.3 (0.12-0.73) |
| HRT-related VTE vs all VTE | HR 0.7 (0.31-1.59) | |||
| Kyrle et al 2004 (46) | Prospective cohort | OC-VTE ♀: 5.9% at 5 y | OC- VTE vs idiopathic-VTE ♀ | RR 0.8 (0.1-4.0) |
| Non-OC ♀: 4.3% at 5 y | HRT-VTE vs idiopathic-VTE ♀ | RR 1.6 (0.4-6.0) | ||
| Baglin et al 2004 (47) | Prospective cohort | Estrogen-VTE: 8.7% at 2 y | Estrogen ♀ vs ♀ with other risk factors | HR 1.181 (0.35-4.03) |
| Other ♀: 8.7% at 2 y | ||||
| Cushman et al 2006 (56) | Data from PREVENT RCT | Hormone-VTE: 5% at 3 y | 1.Hormone-VTE vs idiopathic | 1.aHR 0.54 (0.19-1.54) |
| Other ♀: 15% at 3 y | 2.OC-VTE vs idiopathic | 2.aHR 0.43 (0.07-2.46) | ||
| 3.HRT-VTE vs idiopathic | 3.aHR 0.62 (0.2-1.91) | |||
| Rodger et al 2008 (42) | Prospective cohort | N/R | 1.OC-VTE vs non-OC-VTE ♀ | 1.RR 0.37 (0.11-1.21) |
| 2. HRT-VTE vs non-HRT-VTE ♀ | 2.RR 2.19 (0.86-5.55) | |||
| Le Gal et al 2010 (28) | Data from prospective cohort study | COC-VTE: 1.7% pa | 1.COC-VTE v snon-COC VTE ♀ | 1.aHR 0.6 (0.1-2.8) |
| HRT-VTE: 10% pa | 2.HRT-VTE vs non-HRT VTE ♀ | 2.aHR 1.8 (0.6-5.2) (adjusted for age) | ||
| Non-COC-VTE ♀ 5% pa | ||||
| High HERDOO2 OC-VTE 4% pa | ||||
| Douketis et al 2011 (49) | Patient-level meta-analysis | N/R | 1. Hormone-VTE vs unprovoked VTE ♀ | 1. HR 0.5 (0.3-0.8) |
| 2. OC-VTE vs unprovoked ♀ | 2. HR 0.39 (0.16-0.91) | |||
| 3. HRT-VTE vs unprovoked ♀ | 3. HR 0.76 (0.39-1.49) | |||
| Tosetto et al 2012 (20) | Individual patient data (prospective studies) | N/R | Hormone-VTE vs non-hormone-VTE ♀ | HR N/R (β coefficient −1.08; P = .002†) |
| Le Moigne et al 2013 (57) | Prospective single-center cohort | COC-VTE: IR 17.9/1000/y | COC-VTE vs non-COC VTE ♀ | IRR 0.7 (0.2-2.4) |
| Non-COC: 17.6/1000/y | ||||
| Eischer et al 2014 (58) | Prospective cohort (all women) | Estrogen-VTE: 6% at 5 y | 1.EC-VTE vs non-EC VTE ♀ | 1.RR 0.3 (0.1-0.5) |
| Non estrogen ♀: 17% at 5 y | 2.HRT-VTE vs non-HRT VTE ♀ | 2.RR 0.7 (0.3-1.5) | ||
| Ljungqvist et al 2014 (59) | Prospective follow-up of case control study | Estrogen-VTE: 2% pa | Hormone-VTE vs unprovoked ♀ | HR 0.57 (0.36-0.9) |
| Non estrogen ♀: 3.2% pa | aHR 0.7 (0.43-1.20) | |||
| Kearon et al 2015 (29) | Prospective clinical management | Non-estrogen ♀: 5.4% PPY | Men, nonestrogen ♀, estrogen ♀ | N/R (P = .001 for the 3–group comparison) |
| Estrogen ♀: 0.0% PPY | ||||
| All had persistent negative D-dimer at end of AC and off AC | ||||
| Rodger et al 2017 (18) | Prospective clinical management | Low HERDOO2 stopping AC; <50 y: | N/R | N/R |
| Estrogen-VTE: 1.4%/100 PY | ||||
| Nonestrogen ♀: 3.1%/100 PY | ||||
| Kiconco et al 2017 (60) | Retrospective population-based cohort study | Hormone-VTE: 37/1000 PY | 1.Hormone-VTE vs unprovoked ♀ | 1. aHR 0.72 (0.58-0.88) |
| Non hormone ♀: 51/1000 PY | 2. OC-VTE vs unprovoked ♀ | 2. aHR 0.71 (0.52-0.96) | ||
| 3. HRT-VTE vs unprovoked ♀ | 3. aHR 0.71 (0.53-0.95) |
Low HERDOO2 risk: ≤1 HERDOO2 criteria (hyperpigmentation, edema, or redness in either leg; D-dimer level ≥ 250 μg/L; obesity with body mass index ≥ 30 kg/m2; or older age, ≥ 65 years).
AC, anticoagulation; aHR, adjusted hazard ratio; CHC, combined hormonal contraceptives; COC, combined oral contraceptive; EC, estrogen contraceptives (including nonoral formulations); FVL, factor V Leiden polymorphism; Gen, generation; HC, hormonal contraceptive; HR, hazard ratio; HRT, hormone replacement therapy; IR, incidence rate; IRR, incidence rate ratio; N/R, not reported; N/S, not specified; OC, oral contraceptives; pa, per annum; PP, postpartum; PPY, per patient year; PY, person year; RR, risk ratio.
COC-VTE: initial VTE occurring in the context of COC.
Recurrence risk modeled using multivariable Cox regression; β coefficient and P value after backward elimination is reported.