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Postmenopausal Hormone Therapy Increases Risk for Venous Thromboembolic Disease: The Heart and Estrogen/progestin Replacement Study

Deborah Grady, MD, MPH; Nanette K. Wenger, MD; David Herrington, MD, MHS; Steven Khan, MD; Curt Furberg, MD; Donald Hunninghake, MD; Eric Vittinghoff, PhD; Stephen Hulley, MD, MPH, Heart and Estrogen/progestin Replacement Study Research Group
[+] Article and Author Information

From the University of California, San Francisco, San Francisco, California; Emory University School of Medicine, Atlanta, Georgia; Wake Forest University School of Medicine, Winston-Salem, North Carolina; Cedars-Sinai Medical Center, Los Angeles, California; and University of Minnesota, Minneapolis, Minnesota.


Acknowledgments: The authors thank Josephine Fong for performing statistical analyses.

Grant Support: By Wyeth-Ayerst Laboratories.

Requests for Single Reprints: Deborah Grady, MD, MPH, University of California, San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Grady, Vittinghoff, and Hulley: University of California, San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105.

Dr. Wenger: Emory University School of Medicine, 69 Butler Street SE, Atlanta, GA 30303.

Drs. Herrington and Furberg: Wake Forest University School of Medicine, One Medical Center Boulevard, Winston-Salem, NC 27157-1066.

Dr. Khan: Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Suite 903, Los Angeles, CA 90048-4174.

Dr. Hunninghake: Heart Disease Prevention Clinic, Box 192, 151 Variety Club Heart and Research Center, 401 East River Parkway, Minneapolis, MN 55455.

Author Contributions: Conception and design: D. Grady, N.K. Wenger, S. Hulley.

Analysis and interpretation of the data: D. Grady, N.K. Wenger, D. Herrington, S. Khan, C. Furberg, D. Hunninghake, E. Vittinghoff, S. Hulley.

Drafting of the article: D. Grady.

Critical revision of the article for important intellectual content: D. Grady, N.K. Wenger, D. Herrington, S. Khan, C. Furberg, D. Hunninghake, S. Hulley.

Final approval of the article: D. Grady, N.K. Wenger, D. Herrington, S. Khan, C. Furberg, D. Hunninghake, E. Vittinghoff, S. Hulley.

Provision of study materials or patients: N.K. Wenger, D. Herrington, S. Khan, D. Hunninghake.

Statistical expertise: E. Vittinghoff, S. Hulley.

Obtaining of funding: D. Grady, C. Furberg, D. Hunninghake, S. Hulley.

Administrative, technical, or logistic support: D. Grady, S. Hulley.

Collection and assembly of data: D. Grady, S. Khan.


Ann Intern Med. 2000;132(9):689-696. doi:10.7326/0003-4819-132-9-200005020-00002
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Venous thromboembolism, including thrombosis of the deep veins of the legs and embolism to the pulmonary arteries, is a serious and potentially fatal event. Venous thromboembolism is uncommon in the general population, occurring in about 1 to 4 per 1000 adults annually (12). However, the risk is increased in persons with previous venous thromboembolism (3), recent surgical procedures (45), immobilization, fracture of a lower extremity (4, 67), cancer (4, 67), and inherited coagulation disorders (89).

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Figure.
Kaplan-Meier estimates of the cumulative incidence of venous thromboembolic events (top), deep venous thrombosis (middle), and pulmonary embolism (bottom).

The solid line represents the cumulative incidence of events among women assigned to hormone therapy, and the dashed line represents the cumulative incidence among women assigned to placebo. The number of women observed at each year of follow-up who remained free of an event is given in parentheses. Median follow-up was 4.1 years.

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Summary for Patients

Postmenopausal Hormone Replacement and the Risk for Blood Clots

The summary below is from the full report titled “Postmenopausal Hormone Therapy Increases Risk for Venous Thromboembolic Disease. The Heart and Estrogen/progestin Replacement Study.”. It is in the 2 May 2000 issue of Annals of Internal Medicine (volume 132, pages 689-696). The authors are D. Grady, N.K. Wenger, D. Herrington, S. Khan, C. Furberg, D. Hunninghake, E. Vittinghoff, and S. Hulley, for the Heart and Estrogen/progestin Replacement Study Research Group.

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