Venous Thromboembolism in Women with Breast and Gynaecological Cancers: What Do We Know and What Should We Do?

High Risk of Pregnancy Related Venous Thromboembolism in Women with a Hereditary Deficiency of Antithrombin, Protein C or Protein S in Concomitance of Other Thrombophilic Defects: A Retrospective Cohort Study.

Objective To assess the risk of venous thromboembolism in women using hormone replacement therapy by study design, characteristics of the therapy and venous thromboembolism, and clinical background.Design Systematic review and...

Objective To determine the effect of sex on the risk of recurrent venous thromboembolism in all patients and in patients with venous thromboembolism that was unprovoked or provoked (by non-hormonal...

Risk of pregnancy‐associated recurrent venous thromboembolism in women with a history of venous thrombosis

Efficacy of Dabigatran Etexilate in a Murine Model of Cancer Associated Thrombosis

Objective:Women without versus those with vertebral fracture may have different benefits and risks during raloxifene treatment. Our objective was to compare the effects of raloxifene to decrease risk for vertebral fracture and invasive breast cancer with its effect to increase risk for venous thromboembolism in postmenopausal women without or with baseline vertebral fracture.Research design and methods:The Multiple Outcomes of Raloxifene Evaluation trial included postmenopausal women with osteoporosis randomized to placebo, raloxifene 60 mg/day, or raloxifene 120 mg/day for 4 years. The protocol specified subgroups based on whether or not patients had a vertebral fracture at baseline. Absolute differences between placebo and raloxifene 60 mg/day (the approved dose) for endpoints in these groups were defined as the incidence in the raloxifene group minus the incidence in the placebo group.Results:Raloxifene decreased the incidence of vertebral fracture and invasive breast cancer while increasing the incidence of venous thromboembolism. All treatment by vertebral fracture status interaction p-values were greater than 0.13, indicating that the effect of raloxifene on these outcomes was not significantly different between patients without versus those with vertebral fractures. In women without baseline vertebral fracture, absolute risk differences between the raloxifene and placebo group included vertebral fracture −2.83%, invasive breast cancer −1.21%, and venous thromboembolism +0.28%. In women with baseline vertebral fracture, absolute risk differences between raloxifene and placebo group included vertebral fracture −8.21%, invasive breast cancer −0.75% and venous thromboembolism +0.91%. The analysis had limited power to test whether raloxifene had a significantly different effect on venous thromboembolism in women without versus those with a vertebral fracture.Conclusions:In women without and in those with vertebral fractures at baseline, the effects of raloxifene to decrease vertebral fracture and invasive breast cancer were greater than its effects to increase venous thromboembolism.

The risk of venous thromboembolism (VTE) in women taking combined oral contraceptives (COCs) is attributed to changes in coagulation and fibrinolysis. Their impact may be greater in women with preexistent thrombophilic defects. We assessed the effects of COCs on absolute VTE risk in women with single or multiple thrombophilic defects in a retrospective family cohort study. Female relatives of probands with VTE and hereditary deficiencies of protein S, protein C, or antithrombin were tested for known thrombophilic defects, including the index deficiency. Absolute incidences of VTE were compared in deficient vs nondeficient women, in deficient and nondeficient women who ever or never used COCs, and in deficient and nondeficient women with 0, 1, or more than 1 other thrombophilic defect during exposure to COCs. Of 222 women, 135 (61%) ever used COCs. Overall, annual incidences of VTE were 1.64% and 0.18% in deficient and nondeficient women, respectively; the adjusted relative risk was 11.9 (95% confidence interval, 3.9-36.2). The risk was comparable in deficient ever and never users (1.73% vs 1.54%). Annual incidences during actual COC use were 4.62% in deficient women and 0.48% in nondeficient women; the relative risk was 9.7 (95% confidence interval, 3.0-42.4). The incidence increased by concomitant thrombophilic defects, from 3.49% to 12.00% in deficient women and from 0% to 3.13% in nondeficient women. Women with hereditary deficiencies of protein S, protein C, or antithrombin are at high risk of VTE during use of COCs, particularly when other thrombophilic defects are present. They have VTE at a younger age, but the overall risk is not increased by COCs.

The scientific works of recent years have clearly demonstrated the importance of considering various clinical problems from the perspective of the gender approach, since the pathogenesis of diseases and the metabolism of medications are much different in women and men. This article provides an overview of current scientific literature on etiology and factors predisposing to the development of venous thromboembolism (VTE) in women. The spectrum of factors predisposing to VTE is extremely wide – besides such well known factors as immobilization, oncopathology, estrogen-containing medications, there are many less known influences, but nevertheless capable of playing a critical role for VTE such as the intake of certain non-hormonal drugs. Particular attention is paid to the latest research and key positions of the consensus documents of leading professional societies on the prevention of VTE in users of combined hormonal contraceptives and menopausal hormone therapy, as well as the association of such widespread pathologies as metabolic syndrome and polycystic ovary syndrome with VTE.In recent years, there has been a reassessment of certain risk factors for VTE, the role of hereditary and acquired forms of thrombophilia as the cause of complications of pregnancy or factor influencing management of gynecological disorders significantly increased.In women in such clinical situations as family planning counseling, preconception councelling, planning of operative treatment and hospitalization, menopausal replacement therapy, glucocorticoids and certain non-hormonal drugs prescription comprehensive assessment of the combination of VTE risk factors helps prevent the development of this dangerous pathology by correcting the management plan and applying modern anticoagulants.The purpose of the article is to present new theoretical positions that help physicians understand the causes of venous thrombosis and evaluate the risks of gynecological patients in office and inhospital settings.

Venous thromboembolism after induced abortion: a population-based, propensity-score-matched cohort study in Canada

Overweight and obesity rates have increased in recent decades, particularly among the younger population. The long-term consequences of obesity with respect to early venous thromboembolism (VTE) in women have not been established. The aim was to investigate the association between body mass index (BMI) in early pregnancy as a proxy for non-pregnant weight and long-term post-pregnancy risk of VTE in women. This registry-based prospective cohort study analysed data from the Swedish Medical Birth Registry, linked to the National Patient and the National Cause of Death Registries for information on post-pregnancy long-term risk of VTE. Cox proportional hazards model were used to determine the association between BMI at baseline and VTE events during follow-up starting 1 year after baseline. The mean age at registration was 27.5 (standard deviation, 4.9) years. During a median follow-up duration of 12 years (interquartile range, 6–21 years) starting 1 year after the first antenatal visit, 1765 and 2549 women had a deep vein thrombosis and/or pulmonary embolism. The risk of VTE linearly increased with increasing BMI. Compared to women with 20 ≤ BMI < 22.5 kg/m2, women with high normal weight, i.e. with a BMI of 22.5–25.0 kg/m2, had an adjusted hazard ratio (HR) of 1.30 (95% confidence interval [CI] 1.19–1.41), whereas those with a BMI of 30–35 kg/m2 and ≥ 35 kg/m2 (severe obesity) had an adjusted HR of 2.35 (95% CI 2.04–2.70) and 3.47 (95% CI 2.82–4.25, respectively. Using BMI in early pregnancy as a proxy for pre-pregnancy or non-pregnant BMI in young women, we found a significantly increased risk of post-pregnancy long-term risk of VTE even in those with high normal BMI, compared with lean women, whereas those with severe obesity had a markedly high risk.

Improving Hematology Clinic Access for Patients with Cancer-Associated Thrombosis

Practice and Correlates of Cancer Associated Thrombosis: The Impact of Socioeconomic Status

Source Citation Sweetland S, Green J, Liu B, et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ. 2009;339:b4583. 19959589

PO-40 - Real-life use of non-vitamin k antagonist oral anticoagulants in patients with cancer associated venous thromboembolism: data from a prospective cohort

Significance of venous thromboembolism in women with uterine carcinosarcoma