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review-article

Venous thromboembolism in women

Suman Rathbun

Non-invasive Vascular Laboratories, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA suman-rathbun{at}ouhsc.edu

Abstract

The risk of venous thromboembolism (VTE) varies throughout a woman's life and is associated primarily with underlying hormonal exposure. Alteration in hemostatic mechanisms, including resistance to activated protein C, may explain this altered risk. Initially, development of VTE with the use of contraception in young adulthood may reveal inherited thrombophilia. Pregnancy, and particularly the post-partum period, likely confer the greatest risk of VTE, but the absolute risk is small. Guidelines for prevention of VTE during pregnancy are based on personal or family history of VTE, and known inherited thrombophilia. Use of hormone replacement therapy later in life is associated with increased risk of VTE, and may be safest if given as an estrogen-only preparation to young postmenopausal women for less than 5 years. Universal screening for thrombophilia prior to pregnancy or initiating hormonal therapy is not recommended; however, selected testing in high-risk groups may be warranted. The lack of firm recommendations for the prevention of VTE in women highlights the need for future investigation aimed at identifying high-risk groups and evaluating the efficacy of prophylactic measures.

Key Words: contraception • hormone replacement therapy • pregnancy • venous thrombosis • women

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Vascular Medicine, Vol. 13, No. 3, 255-266 (2008)
DOI: 10.1177/1358863X07085404
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