Laurie Barclay, MD
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Aug. 7, 2003 — Transdermal estrogen therapy is not associated with an increased risk of venous thromboembolism (VTE), according to the results of a multicenter, case-control study published in the Aug. 9 issue of The Lancet.
“Oral but not transdermal estrogen replacement therapy (ERT) is associated with a risk of VTE in postmenopausal women,” lead author Pierre Yves Scarabin, from INSERM in Paris, France, says in a news release. “These data suggest that transdermal ERT might be safer than oral ERT with respect to thrombotic risk.”
From 1999 through 2002, the investigators recruited 155 women with a first documented episode of idiopathic VTE, including 92 with pulmonary embolism and 63 with deep venous thrombosis, and compared them with 381 controls matched for center, age, and time of recruitment.
At enrollment, 21% of women with VTE and 7% of controls were current users of oral ERT, whereas 19% of women with VTE and 24% of controls were current users of transdermal ERT. After adjustment for potential confounding variables, women using oral ERT were more than three times more likely to develop VTE than were transdermal ERT users (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8 – 6.8) and nonusers of ERT (OR, 3.5; 95% CI, 1.8 – 6.8).
Study limitations include the bias inherent in observational studies and potential confounding by differential prescription of oral or transdermal ERT according to known risk factors.
“Our findings could be important in assessment of the risk-benefit profile of ERT,” the authors write. “The effects of transdermal ERT on health outcomes should be assessed in randomized trials.”
INSERM, FRM, Besins International, Sanofi, Aventis, and Servier Institute helped support this study.