系统性雌激素治疗和血栓形成:在急性护理环境中呼吁个性化临床决策
Valentina Restrepo1, Kelsey Martin1, Layla Van Doren1
1Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Clinical therapeutics
|October 23, 2024
概括
系统性雌激素疗法 (SETs) 是至关重要的,但会增加静脉血栓栓塞 (VTE) 的风险. 突然停止SET可以伤害患者;个性化的方法对于安全,公平的护理至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 血管医学 血管医学
- 健康 公平 卫生 公平
背景情况:
- 系统性雌激素疗法 (SET) 对生殖健康,更年期管理和性别肯定激素疗法 (GAHT) 是必不可少的.
- SETs与静脉血栓塞栓症 (VTE) 的风险增加有关,使急性护理管理复杂化.
- 目前的做法往往涉及在急性VTE事件期间停止SETs,可能导致不良健康结果.
研究的目的:
- 检查在急性护理环境中出现与激素相关的VTE的患者中SET的管理.
- 挑战SET的常规停用,并倡导个性化患者护理.
- 突出需要量身定制的方法,特别是对于边缘化的患者群体.
主要方法:
- 关于SET和VTE管理的当前临床实践的审查.
- 分析与突然停止SET相关的不良影响.
- 强调以患者为中心的护理和共享决策.
主要成果:
- 停止使用SET可以使严重月经出血 (HMB) 恶化,导致意外怀孕,加剧更年期症状,并引起心理困扰.
- 突发性停止会对患者的生活质量和抗凝治疗的坚持产生负面影响,增加静脉瘤复发的风险.
- 一个适合所有人的方法来停止SET是有害的.
结论:
- 以患者为中心的方法,考虑个体需求和SET使用的原因,优于广泛的停药.
- 共享决策和个性化护理对于确保安全,公平和肯定医疗保健至关重要,特别是对于 cisgender 女性,跨性别女性和 HMB 个体.
- 需要进一步的研究,特别是在经历了GAHT的跨性别女性的VTE方面.
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