Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study

Michel K. Barsoum, John A. Heit, Aneel Arjun Ashrani, Cynthia L. Leibson, Tanya M. Petterson, Kent R Bailey

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Introduction: Because the risk of venous thromboembolism (VTE) associated with progestin is uncertain, we tested oral contraceptives, estrogen and progestin as independent VTE risk factors. Materials and Methods: Using longitudinal, population-based Rochester Epidemiology Project resources, we identified all Olmsted County, MN women with objectively-diagnosed incident VTE over the 13-year period, 1988-2000 (n = 726) and one to two Olmsted County women per case matched on age, event year and duration of prior medical history (n = 830), and reviewed their complete medical history in the community for previously-identified VTE risk factors (i.e., hospitalization with or without surgery, nursing home confinement, trauma/fracture, leg paresis, active cancer, varicose veins and pregnancy/postpartum), and oral contraceptive, oral estrogen, and oral or injectable progestin exposure. Using conditional logistic regression we tested these hormone exposures as VTE risk factors, both unadjusted and after adjusting for previously-identified VTE risk factors. Results: In unadjusted models, oral contraceptives, progestin alone, and estrogen plus progestin were significantly associated with VTE. Individually adjusting for body mass index (BMI) and previously-identified VTE risk factors, these effects remained essentially unchanged except that progestin alone was not associated with VTE after adjusting for active cancer. Considering only case-control pairs without active cancer, progestin alone was positively but non-significantly associated with VTE (OR = 2.49; p = 0.16). Adjusting for BMI and previously-identified VTE risk factors including active cancer, oral contraceptives, estrogen alone, and progestin with or without estrogen were significantly associated with VTE. Conclusions: Oral contraceptives, estrogen alone, estrogen plus progestin, and progestin with or without estrogen are independent VTE risk factors.

Original languageEnglish (US)
Pages (from-to)373-378
Number of pages6
JournalThrombosis Research
Volume126
Issue number5
DOIs
StatePublished - Nov 2010

Fingerprint

Venous Thromboembolism
Progestins
Case-Control Studies
Estrogens
Population
Oral Contraceptives
Body Mass Index
Neoplasms
Mouth Neoplasms
Varicose Veins
Paresis
Nursing Homes
Postpartum Period
Leg
Epidemiology
Hospitalization
Logistic Models

Keywords

  • Deep vein thrombosis
  • Epidemiology
  • Progestin
  • Pulmonary embolism
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study. / Barsoum, Michel K.; Heit, John A.; Ashrani, Aneel Arjun; Leibson, Cynthia L.; Petterson, Tanya M.; Bailey, Kent R.

In: Thrombosis Research, Vol. 126, No. 5, 11.2010, p. 373-378.

Research output: Contribution to journalArticle

Barsoum, Michel K. ; Heit, John A. ; Ashrani, Aneel Arjun ; Leibson, Cynthia L. ; Petterson, Tanya M. ; Bailey, Kent R. / Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study. In: Thrombosis Research. 2010 ; Vol. 126, No. 5. pp. 373-378.
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T1 - Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study

AU - Barsoum, Michel K.

AU - Heit, John A.

AU - Ashrani, Aneel Arjun

AU - Leibson, Cynthia L.

AU - Petterson, Tanya M.

AU - Bailey, Kent R

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N2 - Introduction: Because the risk of venous thromboembolism (VTE) associated with progestin is uncertain, we tested oral contraceptives, estrogen and progestin as independent VTE risk factors. Materials and Methods: Using longitudinal, population-based Rochester Epidemiology Project resources, we identified all Olmsted County, MN women with objectively-diagnosed incident VTE over the 13-year period, 1988-2000 (n = 726) and one to two Olmsted County women per case matched on age, event year and duration of prior medical history (n = 830), and reviewed their complete medical history in the community for previously-identified VTE risk factors (i.e., hospitalization with or without surgery, nursing home confinement, trauma/fracture, leg paresis, active cancer, varicose veins and pregnancy/postpartum), and oral contraceptive, oral estrogen, and oral or injectable progestin exposure. Using conditional logistic regression we tested these hormone exposures as VTE risk factors, both unadjusted and after adjusting for previously-identified VTE risk factors. Results: In unadjusted models, oral contraceptives, progestin alone, and estrogen plus progestin were significantly associated with VTE. Individually adjusting for body mass index (BMI) and previously-identified VTE risk factors, these effects remained essentially unchanged except that progestin alone was not associated with VTE after adjusting for active cancer. Considering only case-control pairs without active cancer, progestin alone was positively but non-significantly associated with VTE (OR = 2.49; p = 0.16). Adjusting for BMI and previously-identified VTE risk factors including active cancer, oral contraceptives, estrogen alone, and progestin with or without estrogen were significantly associated with VTE. Conclusions: Oral contraceptives, estrogen alone, estrogen plus progestin, and progestin with or without estrogen are independent VTE risk factors.

AB - Introduction: Because the risk of venous thromboembolism (VTE) associated with progestin is uncertain, we tested oral contraceptives, estrogen and progestin as independent VTE risk factors. Materials and Methods: Using longitudinal, population-based Rochester Epidemiology Project resources, we identified all Olmsted County, MN women with objectively-diagnosed incident VTE over the 13-year period, 1988-2000 (n = 726) and one to two Olmsted County women per case matched on age, event year and duration of prior medical history (n = 830), and reviewed their complete medical history in the community for previously-identified VTE risk factors (i.e., hospitalization with or without surgery, nursing home confinement, trauma/fracture, leg paresis, active cancer, varicose veins and pregnancy/postpartum), and oral contraceptive, oral estrogen, and oral or injectable progestin exposure. Using conditional logistic regression we tested these hormone exposures as VTE risk factors, both unadjusted and after adjusting for previously-identified VTE risk factors. Results: In unadjusted models, oral contraceptives, progestin alone, and estrogen plus progestin were significantly associated with VTE. Individually adjusting for body mass index (BMI) and previously-identified VTE risk factors, these effects remained essentially unchanged except that progestin alone was not associated with VTE after adjusting for active cancer. Considering only case-control pairs without active cancer, progestin alone was positively but non-significantly associated with VTE (OR = 2.49; p = 0.16). Adjusting for BMI and previously-identified VTE risk factors including active cancer, oral contraceptives, estrogen alone, and progestin with or without estrogen were significantly associated with VTE. Conclusions: Oral contraceptives, estrogen alone, estrogen plus progestin, and progestin with or without estrogen are independent VTE risk factors.

KW - Deep vein thrombosis

KW - Epidemiology

KW - Progestin

KW - Pulmonary embolism

KW - Venous thromboembolism

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