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Published in: BMC Hematology 1/2016

Open Access 01-12-2016 | Research article

Hospitalization for pulmonary embolism associated with antecedent testosterone or estrogen therapy in patients found to have familial and acquired thrombophilia

Authors: Marloe Prince, Charles J. Glueck, Parth Shah, Ashwin Kumar, Michael Goldenberg, Matan Rothschild, Nasim Motayar, Vybhav Jetty, Kevin Lee, Ping Wang

Published in: BMC Hematology | Issue 1/2016

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Abstract

Background

In patients hospitalized over a 4 year period for pulmonary embolism (PE), we assessed relationships of testosterone (TT) and estrogen therapy (ET) anteceding PE in patients found to have familial-acquired thrombophilia.

Methods

From 2011 through 2014, 347 patients were hospitalized in Cincinnati Mercy Hospitals with PE. Retrospective chart review was used to identify patients receiving TT or ET before PE; coagulation studies were done prospectively if necessary.

Results

Preceding hospitalization for PE, 8 of 154 men (5 %) used TT, and 24 of 193 women (12 %) used ET. The median number of months from the initiation of TT or ET to development of PE was 7 months in men and 18 months in women. Of the 6 men having coagulation measures, all had ≥ 1 thrombophilia, and of the 18 women having measures of coagulation, 16 had ≥ 1 thrombophilia. The sensitivity of a previous history of thrombosis to predict PE was low, 25 % (2/8 men), 4 % (1/24 women).

Conclusions

Of 154 men hospitalized for PE, 8 (5 %) used TT, and of 193 women, 24 (12 %) used ET. Our data suggests that PE is an important complication of TT in men and ET in women, in part reflecting an interaction between familial and acquired thrombophilia and exogenous hormone use.
Literature
1.
go back to reference Glueck CJ, Goldenberg N, Budhani S, Lotner D, Abuchaibe C, Gowda M, et al. Thrombotic events after starting exogenous testosterone in men with previously undiagnosed familial thrombophilia. Transl Res. 2011;158:225–34.CrossRefPubMed Glueck CJ, Goldenberg N, Budhani S, Lotner D, Abuchaibe C, Gowda M, et al. Thrombotic events after starting exogenous testosterone in men with previously undiagnosed familial thrombophilia. Transl Res. 2011;158:225–34.CrossRefPubMed
2.
go back to reference Glueck CJ, Wang P. Testosterone therapy, thrombosis, thrombophilia, cardiovascular events. Metabolism. 2014;63:989–94.CrossRefPubMed Glueck CJ, Wang P. Testosterone therapy, thrombosis, thrombophilia, cardiovascular events. Metabolism. 2014;63:989–94.CrossRefPubMed
3.
go back to reference Glueck CJ, Richardson-Royer C, Schultz R, Burger T, Bowe D, Padda J, et al. Testosterone therapy, thrombophilia-hypofibrinolysis, and hospitalization for deep venous thrombosis-pulmonary embolus: an exploratory, hypothesis-generating study. Clin Appl Thromb Hemost. 2014;20:244–9.CrossRefPubMed Glueck CJ, Richardson-Royer C, Schultz R, Burger T, Bowe D, Padda J, et al. Testosterone therapy, thrombophilia-hypofibrinolysis, and hospitalization for deep venous thrombosis-pulmonary embolus: an exploratory, hypothesis-generating study. Clin Appl Thromb Hemost. 2014;20:244–9.CrossRefPubMed
4.
go back to reference Freedman J, Glueck CJ, Prince M, Riaz R, Wang P. Testosterone, thrombophilia, thrombosis. Transl Res. 2015;165:537–48.CrossRefPubMed Freedman J, Glueck CJ, Prince M, Riaz R, Wang P. Testosterone, thrombophilia, thrombosis. Transl Res. 2015;165:537–48.CrossRefPubMed
5.
go back to reference Glueck CJ, Friedman J, Hafeez A, Hassan A, Wang P. Testosterone therapy, thrombophilia, and hospitalization for deep venous thrombosis-pulmonary embolus, an exploratory, hypothesis-generating study. Med Hypotheses. 2015;84:341–3.CrossRefPubMed Glueck CJ, Friedman J, Hafeez A, Hassan A, Wang P. Testosterone therapy, thrombophilia, and hospitalization for deep venous thrombosis-pulmonary embolus, an exploratory, hypothesis-generating study. Med Hypotheses. 2015;84:341–3.CrossRefPubMed
6.
go back to reference Glueck CJ, Bowe D, Valdez A, Wang P. Thrombosis in three postmenopausal women receiving testosterone therapy for low libido. Womens Health (Lond Engl). 2013;9:405–10.CrossRef Glueck CJ, Bowe D, Valdez A, Wang P. Thrombosis in three postmenopausal women receiving testosterone therapy for low libido. Womens Health (Lond Engl). 2013;9:405–10.CrossRef
7.
go back to reference Glueck CJ, Richardson-Royer C, Schultz R, Burger T, Labitue F, Riaz MK, et al. Testosterone, thrombophilia, and thrombosis. Clin Appl Thromb Hemost. 2014;20:22–30.CrossRefPubMed Glueck CJ, Richardson-Royer C, Schultz R, Burger T, Labitue F, Riaz MK, et al. Testosterone, thrombophilia, and thrombosis. Clin Appl Thromb Hemost. 2014;20:22–30.CrossRefPubMed
8.
go back to reference Glueck CJ, Prince M, Patel N, Patel J, Shah P, Mehta N, et al. Thrombophilia in 67 Patients With Thrombotic Events After Starting Testosterone Therapy. Clin Appl Thromb Hemost. 2015. Glueck CJ, Prince M, Patel N, Patel J, Shah P, Mehta N, et al. Thrombophilia in 67 Patients With Thrombotic Events After Starting Testosterone Therapy. Clin Appl Thromb Hemost. 2015.
9.
go back to reference Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107:I22–30.PubMed Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107:I22–30.PubMed
11.
go back to reference Bertoletti L, Quenet S, Laporte S, Sahuquillo JC, Conget F, Pedrajas JM, et al. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry. Respir Res. 2013;14:75.CrossRefPubMedPubMedCentral Bertoletti L, Quenet S, Laporte S, Sahuquillo JC, Conget F, Pedrajas JM, et al. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry. Respir Res. 2013;14:75.CrossRefPubMedPubMedCentral
12.
go back to reference Lidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009;339:b2890.CrossRefPubMedPubMedCentral Lidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009;339:b2890.CrossRefPubMedPubMedCentral
13.
go back to reference Lidegaard O, Nielsen LH, Skovlund CW, Skjeldestad FE, Lokkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001–9. BMJ. 2011;343:d6423.CrossRefPubMedPubMedCentral Lidegaard O, Nielsen LH, Skovlund CW, Skjeldestad FE, Lokkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001–9. BMJ. 2011;343:d6423.CrossRefPubMedPubMedCentral
14.
go back to reference Davey DA. Update: estrogen and estrogen plus progestin therapy in the care of women at and after the menopause. Womens Health (Lond Engl). 2012;8:169–89.CrossRef Davey DA. Update: estrogen and estrogen plus progestin therapy in the care of women at and after the menopause. Womens Health (Lond Engl). 2012;8:169–89.CrossRef
16.
go back to reference Xin-Guang C, Yong-Qiang Z, Shu-Jie W, Lian-Kai F, Hua-Cong C. Prevalence of the Factor V E666D Mutation and Its Correlation With Activated Protein C Resistance in the Chinese Population. Clin Appl Thromb Hemost. 2015;21:480–3.CrossRefPubMed Xin-Guang C, Yong-Qiang Z, Shu-Jie W, Lian-Kai F, Hua-Cong C. Prevalence of the Factor V E666D Mutation and Its Correlation With Activated Protein C Resistance in the Chinese Population. Clin Appl Thromb Hemost. 2015;21:480–3.CrossRefPubMed
17.
go back to reference Zavala-Hernandez C, Hernandez-Zamora E, Martinez-Murillo C, Majluf-Cruz A, Vela-Ojeda J, Garcia-Chavez J, et al. Risk Factors for Thrombosis Development in Mexican Patients. Ann Vasc Surg. 2015;29:1625–32.CrossRefPubMed Zavala-Hernandez C, Hernandez-Zamora E, Martinez-Murillo C, Majluf-Cruz A, Vela-Ojeda J, Garcia-Chavez J, et al. Risk Factors for Thrombosis Development in Mexican Patients. Ann Vasc Surg. 2015;29:1625–32.CrossRefPubMed
18.
go back to reference Siegerink B, Maino A, Algra A, Rosendaal FR. Hypercoagulability and the risk of myocardial infarction and ischemic stroke in young women. J Thromb Haemost. 2015;13:1568–75.CrossRefPubMed Siegerink B, Maino A, Algra A, Rosendaal FR. Hypercoagulability and the risk of myocardial infarction and ischemic stroke in young women. J Thromb Haemost. 2015;13:1568–75.CrossRefPubMed
19.
go back to reference Phillippe HM, Hornsby LB, Treadway S, Armstrong EM, Bellone JM. Inherited Thrombophilia. J Pharm Pract. 2014;27:227–33.CrossRefPubMed Phillippe HM, Hornsby LB, Treadway S, Armstrong EM, Bellone JM. Inherited Thrombophilia. J Pharm Pract. 2014;27:227–33.CrossRefPubMed
20.
go back to reference Glueck CJ, Bell H, Vadlamani L, Gupta A, Fontaine RN, Wang P, et al. Heritable thrombophilia and hypofibrinolysis. Possible causes of retinal vein occlusion. Arch Ophthalmol. 1999;117:43–9.CrossRefPubMed Glueck CJ, Bell H, Vadlamani L, Gupta A, Fontaine RN, Wang P, et al. Heritable thrombophilia and hypofibrinolysis. Possible causes of retinal vein occlusion. Arch Ophthalmol. 1999;117:43–9.CrossRefPubMed
21.
go back to reference Glueck CJ, Freiberg RA, Fontaine RN, Tracy T, Wang P. Hypofibrinolysis, thrombophilia, osteonecrosis. Clin Orthop Relat Res. 2001;19–33. Glueck CJ, Freiberg RA, Fontaine RN, Tracy T, Wang P. Hypofibrinolysis, thrombophilia, osteonecrosis. Clin Orthop Relat Res. 2001;19–33.
22.
go back to reference Glueck CJ, Wang P, Bell H, Rangaraj V, Goldenberg N. Associations of thrombophilia, hypofibrinolysis, and retinal vein occlusion. Clin Appl Thromb Hemost. 2005;11:375–89.CrossRefPubMed Glueck CJ, Wang P, Bell H, Rangaraj V, Goldenberg N. Associations of thrombophilia, hypofibrinolysis, and retinal vein occlusion. Clin Appl Thromb Hemost. 2005;11:375–89.CrossRefPubMed
23.
go back to reference Glueck CJ, Wang P. Ocular vascular thrombotic events: a diagnostic window to familial thrombophilia (compound factor V Leiden and prothrombin gene heterozygosity) and thrombosis. Clin Appl Thromb Hemost. 2009;15:12–8.CrossRefPubMed Glueck CJ, Wang P. Ocular vascular thrombotic events: a diagnostic window to familial thrombophilia (compound factor V Leiden and prothrombin gene heterozygosity) and thrombosis. Clin Appl Thromb Hemost. 2009;15:12–8.CrossRefPubMed
24.
go back to reference Schenk JF, Stephan B, Zewinger S, Speer T, Pindur G. Comparison of the plasminogen activator inhibitor-1 4G/5G gene polymorphism in females with venous thromboembolism during pregnancy or spontaneous abortion. Clin Hemorheol Microcirc. 2008;39:329–32.PubMed Schenk JF, Stephan B, Zewinger S, Speer T, Pindur G. Comparison of the plasminogen activator inhibitor-1 4G/5G gene polymorphism in females with venous thromboembolism during pregnancy or spontaneous abortion. Clin Hemorheol Microcirc. 2008;39:329–32.PubMed
25.
go back to reference Jeon YJ, Kim YR, Lee BE, Choi YS, Kim JH, Shin JE, et al. Genetic association of five plasminogen activator inhibitor-1 (PAI-1) polymorphisms and idiopathic recurrent pregnancy loss in Korean women. Thromb Haemost. 2013;110:742–50.CrossRefPubMed Jeon YJ, Kim YR, Lee BE, Choi YS, Kim JH, Shin JE, et al. Genetic association of five plasminogen activator inhibitor-1 (PAI-1) polymorphisms and idiopathic recurrent pregnancy loss in Korean women. Thromb Haemost. 2013;110:742–50.CrossRefPubMed
26.
go back to reference Tyler ET. Oral contraception and venous thrombosis. JAMA. 1963;185:131–2.CrossRef Tyler ET. Oral contraception and venous thrombosis. JAMA. 1963;185:131–2.CrossRef
27.
go back to reference Perez Gutthann S, Garcia Rodriguez LA, Castellsague J, Duque Oliart A. Hormone replacement therapy and risk of venous thromboembolism: population based case–control study. BMJ. 1997;314:796–800.CrossRefPubMedPubMedCentral Perez Gutthann S, Garcia Rodriguez LA, Castellsague J, Duque Oliart A. Hormone replacement therapy and risk of venous thromboembolism: population based case–control study. BMJ. 1997;314:796–800.CrossRefPubMedPubMedCentral
28.
go back to reference Faiz AS, Khan I, Beckman MG, Bockenstedt P, Heit JA, Kulkarni R, et al. Characteristics and Risk Factors of Cancer Associated Venous Thromboembolism. Thromb Res. 2015;136:535–41.CrossRefPubMed Faiz AS, Khan I, Beckman MG, Bockenstedt P, Heit JA, Kulkarni R, et al. Characteristics and Risk Factors of Cancer Associated Venous Thromboembolism. Thromb Res. 2015;136:535–41.CrossRefPubMed
30.
go back to reference LaMori JC, Shoheiber O, Mody SH, Bookhart BK. Inpatient resource use and cost burden of deep vein thrombosis and pulmonary embolism in the United States. Clin Ther. 2015;37:62–70.CrossRefPubMed LaMori JC, Shoheiber O, Mody SH, Bookhart BK. Inpatient resource use and cost burden of deep vein thrombosis and pulmonary embolism in the United States. Clin Ther. 2015;37:62–70.CrossRefPubMed
31.
go back to reference Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34:2363–71.CrossRefPubMed Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34:2363–71.CrossRefPubMed
33.
go back to reference Wu O, Robertson L, Twaddle S, Lowe G, Clark P, Walker I, et al. Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness analysis. Br J Haematol. 2005;131:80–90.CrossRefPubMed Wu O, Robertson L, Twaddle S, Lowe G, Clark P, Walker I, et al. Screening for thrombophilia in high-risk situations: a meta-analysis and cost-effectiveness analysis. Br J Haematol. 2005;131:80–90.CrossRefPubMed
34.
go back to reference Wu O, Robertson L, Twaddle S, Lowe GD, Clark P, Greaves M, et al. Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study. Health Technol Assess. 2006;10:1–110.CrossRefPubMed Wu O, Robertson L, Twaddle S, Lowe GD, Clark P, Greaves M, et al. Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study. Health Technol Assess. 2006;10:1–110.CrossRefPubMed
35.
go back to reference Beral V, Banks E, Reeves G. Evidence from randomised trials on the long-term effects of hormone replacement therapy. Lancet. 2002;360:942–4.CrossRefPubMed Beral V, Banks E, Reeves G. Evidence from randomised trials on the long-term effects of hormone replacement therapy. Lancet. 2002;360:942–4.CrossRefPubMed
36.
go back to reference Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336:1227–31.CrossRefPubMedPubMedCentral Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336:1227–31.CrossRefPubMedPubMedCentral
Metadata
Title
Hospitalization for pulmonary embolism associated with antecedent testosterone or estrogen therapy in patients found to have familial and acquired thrombophilia
Authors
Marloe Prince
Charles J. Glueck
Parth Shah
Ashwin Kumar
Michael Goldenberg
Matan Rothschild
Nasim Motayar
Vybhav Jetty
Kevin Lee
Ping Wang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Hematology / Issue 1/2016
Electronic ISSN: 2052-1839
DOI
https://doi.org/10.1186/s12878-016-0045-9

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