Venous Thromboembolism and Women's Health

The document from October 18, 2018, reviews the risks and management of venous thromboembolism (VTE) in women, emphasizing the increased risk due to hormonal contraception, pregnancy, hormone replacement therapy (HRT), and certain cancers like breast and gynecological malignancies. It notes that VTE incidence is five times higher in women with reproductive risk factors and 2- to 4-fold higher with HRT. The review also discusses the challenges in treating VTE during pregnancy and breastfeeding, with low molecular weight heparin (LMWH) being the preferred treatment during pregnancy and several options considered safe during breastfeeding. It highlights the need for risk assessment in women starting contraception or HRT and the importance of thromboprophylaxis, which can reduce VTE risk by up to 60% following cancer surgery. The document also addresses the management of hormonal therapy after a VTE diagnosis, the use of risk stratification tools like HERDOO2 to guide the duration of anticoagulation therapy, and the impact of anticoagulants on bleeding risks and alopecia. It concludes that more research is needed to optimize treatment strategies for women, especially regarding the safety of direct oral anticoagulants (DOACs) in pregnancy and the management of abnormal uterine bleeding (AUB) and alopecia as side effects of anticoagulation therapy.