激素的使用和静脉血栓栓塞的风险
Venina Isabel Poço Viana Leme de Barros1, André Luiz Malavasi Longo de Oliveira1, Denis Jose do Nascimento2
1Clínica Obstétrica Hospital das Clínicas Universidade de São Paulo São PauloSP Brasil Clínica Obstétrica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
概括
长效可逆避孕药 (LARC) 不会增加静脉血栓栓塞 (VTE) 的风险. 然而,与非使用者相比,组合激素避孕药 (如贴片,戒指和一些口服药) 显著增加了静脉突发症的风险.
科学领域:
- 药理学和血栓形成的原因
- 生殖健康和内分泌学
背景情况:
- 激素避孕药 (HC) 和激素治疗 (HT) 广泛用于避孕和更年期症状管理.
- 了解不同激素配方与静脉血栓栓塞 (VTE) 风险之间的关联对于患者的安全至关重要.
研究的目的:
- 综合当前关于与各种荷尔蒙避孕方法和荷尔蒙治疗相关的VTE风险的证据.
主要方法:
- 综述流行病学研究和临床数据,分析不同激素药物的使用者VTE风险.
- 在各种避孕配方和激素治疗方案中对VTE发病率的比较分析.
主要成果:
- 长效可逆避孕药 (LARCs) 与孕激素并没有增加VTE风险.
- 只有孕激素的药丸也没有增加VTE风险.
- 通过皮肤贴片和联合口服避孕药 (COCs) 增加了大约八倍的静脉瘤风险;阴道环增加了6.5倍的风险.
- 与含有levonorgestrel或norgestimate的口服避孕药相比,与含有desogestrel,gestodene或drospirenone的口服避孕药相比,VTE风险有一半.
- 跨性别者和绝经后妇女的激素治疗 (HT) 会增加静脉瘤风险,而肥胖和年龄等因素会进一步增加风险.
- 结合性雌激素-孕激素治疗比雌激素单一治疗具有更高的VTE风险.
结论:
- 选择荷尔蒙避孕药和荷尔蒙治疗配方显著影响VTE风险.
- LARCs和仅含孕激素的药丸与较低的VTE风险概况有关.
- 仔细的患者选择和咨询是必不可少的,考虑到个体风险因素和使用的特定激素剂.
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