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Review
. 2024 Dec 6;2024(1):664-671.
doi: 10.1182/hematology.2024000593.

Hormone-related thrombosis: duration of anticoagulation, risk of recurrence, and the role of hypercoagulability testing

Luuk J J Scheres  1   2 , Saskia Middeldorp  1
Affiliations
Review

Hormone-related thrombosis: duration of anticoagulation, risk of recurrence, and the role of hypercoagulability testing

Luuk J J Scheres et al. Hematology Am Soc Hematol Educ Program. .

Abstract

Hormone-related venous thromboembolism (VTE) is common and entails scenarios in which VTE occurs during exposure to exogenous or endogenous female sex hormones, typically estrogen and progestogen. For the management of hormone-related VTE, it is important to realize that many patients use these hormones for a vital purpose often strongly related to the patient's well-being and quality of life. In this review we discuss clinical cases of VTE related to hormonal contraceptive use and pregnancy to illustrate key considerations for clinical practice. We cover practice points for primary VTE treatment and detail the evidence on the risk of recurrent VTE and bleeding in this population. The potential value of thrombophilia testing is described, including "who, why, when, what, and how." We also discuss key aspects of shared decision-making for anticoagulant duration, including a reduced-dose anticoagulant strategy in hormone-related VTE.

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Conflict of interest statement

Luuk J. J. Scheres: no competing financial interests to declare.

Saskia Middeldorp: Consultancy fees from Abbvie, Alveron, Astra Zeneca, Bayer (markets Rivaroxaban which is a Factor Xa inhibitor mentioned in the article), Hemab, Norgine, Sanofi and Viatris and Research funding from Synaspe.

Figures

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Graphical abstract
See this image and copyright information in PMC

References

    1. Bistervels IM, Scheres LJJ, Hamulyák EN, Middeldorp S.. Sex matters: practice 5P's when treating young women with venous thromboembolism. J Thromb Haemost. 2019;17(9):1417-1429. - PMC - PubMed
    1. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJM, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ. 13 August 2009;339(2):b2921. - PMC - PubMed
    1. Scheres LJJ, Bistervels IM, Middeldorp S.. Everything the clinician needs to know about evidence-based anticoagulation in pregnancy. Blood Rev. January 2019;33:82-97. - PubMed
    1. Ortel TL, Neumann I, Ageno W, et al.. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693-4738. - PMC - PubMed
    1. Samuelson Bannow B, McLintock C, James P.. Menstruation, anticoagulation, and contraception: VTE and uterine bleeding. Res Pract Thromb Haemost. 2021;5(5):e12570. - PMC - PubMed