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Multicenter Study
. 2023 Nov;111(5):678-686.
doi: 10.1111/ejh.14061. Epub 2023 Jul 30.

Estrogen-based hormonal therapy and the risk of thrombosis in COVID-19 patients

Corinne LaVasseur  1 , Rick Mathews  2 , Jenny S H Wang  2 , Kylee Martens  3 , Hannah Stowe McMurry  3 , Shira Peress  1 , Jean Sabile  3 , Thomas Kartika  3 , Ileisa Oleson  1 , Jamie O Lo  4 , Thomas G DeLoughery  3 , Owen J T McCarty  2 , Joseph J Shatzel  1   3
Affiliations
Multicenter Study

Estrogen-based hormonal therapy and the risk of thrombosis in COVID-19 patients

Corinne LaVasseur et al. Eur J Haematol. 2023 Nov.

Abstract

Objective: Estrogen-containing contraceptives and hormone replacement therapy are used commonly, however, the risks of venous and arterial thrombosis imparted by such medications during COVID-19 infection or other similar viral infections remain undescribed.

Methods: To assess the risk of venous and arterial thrombosis in patients receiving oral estrogen-containing therapy (ECT) with COVID-19 as compared to those receiving non-estrogen-based hormonal therapy, we conducted a multicenter cohort study of 991 patients with confirmed COVID-19 infection, 466 receiving estrogen-containing hormonal therapy, and 525 receiving progestin-only or topical therapy.

Results: The use of estrogen-containing therapy was found to significantly increase the risk of venous thromboembolism (VTE) following COVID-19 diagnosis after controlling for age (HR 5.46 [95% CI 1.12-26.7, p = .036]). This risk was highest in patients over age 50, with 8.6% of patients receiving estrogen-containing therapy diagnosed with VTE compared to 0.9% of those receiving non-estrogen-based therapies (p = .026). The risk of arterial thrombosis was not significantly associated with oral estrogen use.

Conclusions: These results suggest that estrogen-containing therapy is associated with a significantly increased risk of VTE in COVID-19 patients, especially in older individuals. These findings may guide provider counseling and management of patients with COVID-19 on estrogen-containing therapy.

Keywords: COVID-19; contraception; estrogen; hormonal therapy; thrombosis.

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Figures

Figure 1:
Figure 1:
Inclusion/exclusion schema. CHC; combined hormonal contraceptives. HRT; hormone replacement therapy. IUD; progesterone intrauterine device.
Figure 2:
Figure 2:
Rate of venous thromboembolism by age in COVID-19 patients. VTE; venous thromboembolism.
See this image and copyright information in PMC

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