Estrogen and thrombosis: A bench to bedside review

Area of Science:

• Reproductive Endocrinology
• Hematology
• Thrombosis Research

Background:

• Estrogen is clinically used for contraception and hormone replacement therapy.
• Estrogen is a known risk factor for arterial and venous thrombosis.
• The precise molecular mechanisms underlying estrogen-induced prothrombotic effects remain unclear.

Purpose of the Study:

• To review current evidence on managing high-estrogen states in women at high risk for thrombosis.
• To discuss emerging data on unique populations, such as transgender women.
• To highlight the need for further research into the pathophysiology and risk stratification of hormone-related thrombosis.

Main Methods:

• Literature review of recent evidence on estrogen and thrombosis.
• Analysis of clinical presentations and risk factors.
• Discussion of management strategies and future research directions.

Main Results:

• Estrogen increases the risk of both arterial and venous thrombosis, with venous thromboembolism (VTE) being the most common presentation.
• Thromboses can occur in deep leg veins or pulmonary vessels, often within months of estrogen initiation.
• Estrogen is also linked to unusual site thromboses and arterial thrombosis.

Conclusions:

• Women at high risk of thrombosis require careful evaluation and counseling regarding estrogen use for contraception, menopausal hormone therapy, and other indications.
• Understanding the pathophysiology and developing better risk stratification techniques are crucial for personalized recommendations.
• Further studies are essential to elucidate hormone-related thrombosis mechanisms and improve patient management.