ABSTRACT
The role of gender in the causation of first and recurrent venous thromboembolism
(VTE) is uncertain. The use of hormonal therapy and pregnancy has been associated
with VTE in women. Epidemiological studies have described a higher incidence of first
VTE in women of childbearing age. Nevertheless, no consistent differences in the overall
incidence of VTE between males and females have been found. Recent studies have shown
that women exhibit a lower risk of recurrent VTE than men, although these data were
not confirmed in other studies that evaluated only women with idiopathic VTE. This
article reviews the role of gender as a risk factor for first and recurrent VTE.
KEYWORDS
Venous thromboembolism - gender - ethnicity
REFERENCES
- 1
Silverstein M D, Heit J A, Mohr D N, Petterson T M, O'Fallon W M, Melton III L J.
Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year
population-based study.
Arch Intern Med.
1998;
158
(6)
585-593
- 2
Kyrle P A, Eichinger S.
Deep vein thrombosis.
Lancet.
2005;
365
(9465)
1163-1174
- 3
Anderson Jr F A, Wheeler H B, Goldberg R J et al..
A population-based perspective of the hospital incidence and case-fatality rates of
deep vein thrombosis and pulmonary embolism. The Worcester DVT Study.
Arch Intern Med.
1991;
151
(5)
933-938
- 4
Nordström M, Lindblad B, Bergqvist D, Kjellström T.
A prospective study of the incidence of deep-vein thrombosis within a defined urban
population.
J Intern Med.
1992;
232
(2)
155-160
- 5
Prandoni P, Lensing A W, Cogo A et al..
The long-term clinical course of acute deep venous thrombosis.
Ann Intern Med.
1996;
125
(1)
1-7
- 6
Heit J A, Mohr D N, Silverstein M D, Petterson T M, O'Fallon W M, Melton III L J.
Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based
cohort study.
Arch Intern Med.
2000;
160
(6)
761-768
- 7
Heit J A, Melton III L J, Lohse C M et al..
Incidence of venous thromboembolism in hospitalized patients vs community residents.
Mayo Clin Proc.
2001;
76
(11)
1102-1110
- 8
Spencer F A, Emery C, Lessard D et al..
The Worcester Venous Thromboembolism study: a population-based study of the clinical
epidemiology of venous thromboembolism.
J Gen Intern Med.
2006;
21
(7)
722-727
- 9
White R H, Zhou H, Romano P S.
Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among
ethnic groups in California.
Ann Intern Med.
1998;
128
(9)
737-740
- 10
White R H, Zhou H, Murin S, Harvey D.
Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse
population in California in 1996.
Thromb Haemost.
2005;
93
(2)
298-305
- 11
Sakon M, Maehara Y, Yoshikawa H, Akaza H.
Incidence of venous thromboembolism following major abdominal surgery: a multi-center,
prospective epidemiological study in Japan.
J Thromb Haemost.
2006;
4
(3)
581-586
- 12
Samama M M.
An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients:
the Sirius study.
Arch Intern Med.
2000;
160
(22)
3415-3420
- 13
Danilenko-Dixon D R, Heit J A, Silverstein M D et al..
Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post
partum: a population-based, case-control study.
Am J Obstet Gynecol.
2001;
184
(2)
104-110
- 14
Gomes M P, Deitcher S R.
Risk of venous thromboembolic disease associated with hormonal contraceptives and
hormone replacement therapy: a clinical review.
Arch Intern Med.
2004;
164
(18)
1965-1976
- 15
Rosendaal F R.
Risk factors for venous thrombotic disease.
Thromb Haemost.
1999;
82
(2)
610-619
- 16
Kemmeren J M, Algra A, Grobbee D E.
Third generation oral contraceptives and risk of venous thrombosis: meta-analysis.
BMJ.
2001;
323
(7305)
131-134
- 17
Grady D, Wenger N K, Herrington D et al..
Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The
Heart and Estrogen/progestin Replacement Study.
Ann Intern Med.
2000;
132
(9)
689-696
- 18
Smith N L, Heckbert S R, Lemaitre R N et al..
Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis.
JAMA.
2004;
292
(13)
1581-1587
- 19
Kawase K, Okazaki S, Toyoda K et al..
Sex difference in the prevalence of deep-vein thrombosis in Japanese patients with
acute intracerebral hemorrhage.
Cerebrovasc Dis.
2009;
27
(4)
313-319
- 20
Cushman M, Tsai A, Heckbert S R et al..
Incidence rates, case fatality, and recurrence rates of deep vein thrombosis and pulmonary
embolus: the Longitudinal Investigation of Thromboembolism Etiology (LITE) [abstract].
Thromb Haemost.
2001;
86
(Suppl 1)
OC2349
- 21
Kniffin Jr W D, Baron J A, Barrett J, Birkmeyer J D, Anderson Jr F A.
The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the
elderly.
Arch Intern Med.
1994;
154
(8)
861-866
- 22
Andreou E R, Koru-Sengul T, Linkins L, Bates S M, Ginsberg J S, Kearon C.
Differences in clinical presentation of deep vein thrombosis in men and women.
J Thromb Haemost.
2008;
6
(10)
1713-1719
- 23
Bauersachs R M, Riess H, Hach-Wunderle V et al..
Impact of gender on the clinical presentation and diagnosis of deep-vein thrombosis.
Thromb Haemost.
2010;
103
(4)
710-717
- 24
Robert-Ebadi H, Le Gal G, Carrier M et al..
Differences in clinical presentation of pulmonary embolism in women and men.
J Thromb Haemost.
2010;
8
(4)
693-698
- 25
Tormene D, Barbar S, Perlati M, Brandolin B, Simioni P.
Sex-related type of venous thromboembolism in patients with and without thrombophilia.
Thromb Haemost.
2009;
102
(1)
177-178
- 26
Heit J A, Mohr D N, Silverstein M D, Petterson T M, O'Fallon W M, Melton III L J.
Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based
cohort study.
Arch Intern Med.
2000;
160
(6)
761-768
- 27
Kyrle P A, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S.
The risk of recurrent venous thromboembolism in men and women.
N Engl J Med.
2004;
350
(25)
2558-2563
- 28
Baglin T, Luddington R, Brown K, Baglin C.
High risk of recurrent venous thromboembolism in men.
J Thromb Haemost.
2004;
2
(12)
2152-2155
- 29
Agnelli G, Becattini C, Prandoni P.
Recurrent venous thromboembolism in men and women.
N Engl J Med.
2004;
351
(19)
2015-2018; author reply 2015–2018
- 30
Prandoni P, Noventa F, Ghirarduzzi A et al..
The risk of recurrent venous thromboembolism after discontinuing anticoagulation in
patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective
cohort study in 1,626 patients.
Haematologica.
2007;
92
(2)
199-205
- 31
Cushman M, Glynn R J, Goldhaber S Z et al..
Hormonal factors and risk of recurrent venous thrombosis: the prevention of recurrent
venous thromboembolism trial.
J Thromb Haemost.
2006;
4
(10)
2199-2203
- 32
Eriksson H, Lundström T, Wåhlander K, Clason S B, Schulman S. THRIVE III Investigators
.
Prognostic factors for recurrence of venous thromboembolism (VTE) or bleeding during
long-term secondary prevention of VTE with ximelagatran.
Thromb Haemost.
2005;
94
(3)
522-527
- 33
McRae S, Tran H, Schulman S, Ginsberg J, Kearon C.
Effect of patient's sex on risk of recurrent venous thromboembolism: a meta-analysis.
Lancet.
2006;
368
(9533)
371-378
- 34
Eichinger S, Heinze G, Jandeck L M, Kyrle P A.
Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or
pulmonary embolism: the Vienna prediction model.
Circulation.
2010;
121
(14)
1630-1636
- 35
Lijfering W M, Veeger N J, Middeldorp S et al..
A lower risk of recurrent venous thrombosis in women compared with men is explained
by sex-specific risk factors at time of first venous thrombosis in thrombophilic families.
Blood.
2009;
114
(10)
2031-2036
Daniela TormeneM.D. Ph.D.
Department of Cardiologic, Thoracic and Vascular Sciences, Thromboembolism Unit, University
of Padua
Via Giustiniani 2, 35128 Padua, Italy
Email: daniela.tormene@unipd.it
