Transdermal HRT safer than pills in terms of VTE risk

  • Vinogradova Y & al.
  • BMJ
  • 9 Jan 2019

  • curated by Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • Analysis of 2 nested case-control studies suggests that oral hormone replacement therapy (HRT) is associated with increased risk for venous thromboembolism (VTE), whereas transdermal HRT is not.

Why this matters

  • This study suggests that despite the greater popularity of oral HRT formulations, transdermal formulations are safer in terms of VTE risk.

Key results

  • Overall exposure to HRT was associated with increased VTE risk (aOR, 1.43; 95% CI, 1.38-1.48) compared with no exposure.
  • Oral HRT was associated with increased VTE risk (aOR, 1.58; 95% CI, 1.52-1.64) compared with no exposure.
    • aOR, 1.40 (95% CI, 1.32-1.48) for estrogen-only preparations.
    • aOR, 1.73 (95% CI, 1.65-1.81) for combined preparations.
    • Estradiol had lower VTE risk compared with conjugated equine estrogen for estrogen-only preparations (aOR, 0.85; 95% CI, 0.76-0.95) and combined preparations (aOR, 0.83; 95% CI, 0.76-0.91).
  • Transdermal HRT was not associated with increased VTE risk (aOR, 0.93; 95% CI, 0.87-1.01) compared with no exposure.

Study design

  • 80,396 women aged 40-79 years who experienced VTE and 391,494 matched control patients were analyzed.
    • 5795 women who experienced VTE and 21,670 women who did not experience VTE had been exposed to HRT within 90 days before the index date.
  • Funding: None.

Limitations

  • Observational study.

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