Summary
Hormone replacement therapy has been associated with venous thromboembolism. Controversy
exists regarding the appropriate management of hormone replacement in the perioperative
setting and in other situations – such as acute illness – predisposing to acute venous
thromboembolism. We performed a case-control study to determine whether perioperative
hormone replacement is associated with venous thromboembolism following hip and knee
arthroplasty. 108 patients with postoperative venous thrombosis were matched by age,
date and type of surgery, and surgeon with 210 controls without thrombosis. Perioperative
hormone replacement use was no more prevalent in patients with postoperative thrombosis
than those without. Eighteen (16.7%) women with post-operative thrombosis had taken
perioperative hormone replacement compared to 49 (23.3%) of controls: odds ratio =
0.66; (95% CI 0.35–1.18; p=0.17). After multivariate analysis, the adjusted odds ratios
were similar. Variables predicting post-operative thrombosis included: prior venous
thromboembolism (OR = 2.3; p = 0.02), rheumatologic disease (OR = 2.2; p = 0.03),
and absence of pharmacologic antithrombotic prophylaxis (OR = 13.4; p = 0.005). Cases
and controls were otherwise similar. Users of hormone replacement were similar to
non-users except that they were less likely to have coronary disease (OR 0.34; p =
0.03) or prior thrombosis (OR = 0.28; p = 0.04), and were younger (median age 67 versus
74 years; p <0.0001). We found no association between perioperative hormone replacement
and post-operative thrombosis in patients undergoing major orthopaedic surgery. Routine
discontinuation of these medications preoperatively – and possibly in other situations
predisposing to thrombosis, such as acute medical illness – may be unnecessary in
patients receiving appropriate pharmacologic antithrombotic prophylaxis.
Keywords
Hormone replacement therapy - selective oestrogen receptor modulator - venous thromboembolism
- surgery - arthroplasty
