Risk of venous thromboembolic disease in women A qualitative systematic review.
OBJECTIVE
To review the scientific evidence on the risk and prevention of venous thromboembolic disease (VTD) associated with specific clinical factors in women.


METHODS
Qualitative systematic review.


METHODS
MEDLINE, Cochrane library, clinical practice guidelines, and referenced articles from these sources.


RESULTS
Gender is not an independent risk factor of VTD. Absolute risks associated with each circumstance (per 1000 women-year) were: pregnancy, 1.23; puerperium, 3.2; pregnancy in thrombophilic, 40; pregnancy and background of previous VTD, 110; use of third generation contraceptives, 0.3; postcoital pill, no risk; hormone replacement therapy, 0.2-5.9; tamoxifen, 3.6-12; and raloxifene, 9.5. The quality of the evidence on risk was classified as good or excellent. Evidence on prevention was scarce. Screening for thrombophilia prior to the prescription of contraceptives is not cost-effective as a strategy for prophylaxis. Use of low molecular weight heparin (LMWH) in high-risk pregnancies is supported by medium quality studies.


CONCLUSIONS
There is good quality evidence on the magnitude of VTD risk associated with specific clinical factors in women. No studies on the utility of preventive measures have been performed for most of these circumstances. There is no evidence about the risk associated with the combination of several risk factors.
Romero
Alberto
A
Internal Medicine Department, Hospital Universitario de Valme, Carretera de Cádiz, s/n, Seville, Spain.
Alonso
Carlos
C
Rincón
Manuel
M
Medrano
Javier
J
Santos
Jose-Manuel
JM
Calderón
Enrique
E
Marín
Ignacio
I
González
Miguel-Angel
MA
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D003276:Contraceptives, Oral / Q000009:adverse effects; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008593:Menopause; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D003276:Contraceptives, Oral