Hormone-related thrombosis: duration of anticoagulation, risk of recurrence, and the role of hypercoagulability testing

Abstract

Hormone-related venous thromboembolism (VTE) is common and entails scenarios in which VTE occurs during exposure to exogenous or endogenous female sex hor mones, typically estrogen and progestogen. For the management of hormone-related VTE, it is important to realize that many patients use these hormones for a vital purpose often strongly related to the patient’s well-being and quality of life. In this review we discuss clinical cases of VTE related to hormonal contraceptive use and pregnancy to illustrate key considerations for clinical practice. We cover practice points for primary VTE treatment and detail the evidence on the risk of recurrent VTE and bleeding in this population. The potential value of thrombophilia testing is described, including “who, why, when, what, and how.” We also discuss key aspects of shared decision-making for anti coagulant duration, including a reduced-dose anticoagulant strategy in hormone-related VTE.