1. Venous Thromboembolic Disease
John C. Stevenson
Martin Birkhäuser
Alfred O. Mueck

2. Venous Thromboembolic Disease
1. Risk factors, absolute risks
2. MHT – WHI, RCTs
3. MHT – Observational Studies
4. Tibolone, SERMs
5. Experimental Research Thrombophilia, Screening?
6. VTE Management
Guidelines, Consensus Statement

3. Venous Thromboembolic Disease
1. Risk factors, absolute risks
2. MHT – WHI, RCTs
3. MHT – Observational Studies
4. Tibolone, SERMs
5. Experimental Research Thrombophilia, Screening?
6. VTE Management
Guidelines, Consensus Statement

4. Risk factors for Venous Thromboembolism
Age
Obesity
Malignancy
Immobilization
History/family history
Thrombophilia
(Varicose veins)
Smoking
Oral MHT, specific SERMS
Others (e.g. corticoids, intestinal inflammation etc.)
Risk factors, all important (varicosis only if severe), may be additive and synergistic. Smoking risk factor also for venous thromboembolism!

5. Venous Thromboembolism
Risk of VTE in postmenopausal women: 1 per 10,000 patient-years
2–3 non-fatal VTE per year for every 10,000 women given HRT
Deaths from VTE: 1 per 1,000,000 patient-years
absolute excessive risk very low!

6. MHT and thromboembolic risk: Excessive absolute risk
A peroral MHT increases moderately the thromboembolic risk, higher risk in presence of hereditary or acquired thrombophilia, and during the first year after initiation of MHT
(Age 50–59: 2 additional cases/year per 10,000 women)
Low-dose transdermal MHT seems not to increase the thromboembolic risk
excessive absolute risk low, exception high risk of thrombophilia (see section“thrombophilia“)