1st January 2004
Royal College of Obstetricians and Gynaecologists - Medical Specialty Society
Summary,


GUIDELINE OBJECTIVE(S)

To enable physicians to assess thrombotic risk in patients undergoing or starting hormone replacement therapy

TARGET POPULATION

Women undergoing or considering hormone replacement therapy

INTERVENTIONS AND PRACTICES CONSIDERED

Assessment/Counseling

1. Personal and family history of venous thromboembolism (VTE) or risk factors for VTE
2. Counselling of women starting or continuing hormone replacement therapy (HRT) concerning risk of VTE
3. Thrombophilia screening (for women with a personal or family history of VTE)
   • Activated partial thromboplastin time and prothrombin time
   • Antithrombin activity
   • Protein C activity
   • Total and free protein S antigen
   • Modified activated protein C resistance (after predilution in factor V deficient plasma)
   • Factor V Leiden (optional if modified APC resistance abnormal)
   • Prothrombin 20210A variant
   • Lupus anticoagulant and anticardiolipin antibodies (immunoglobulins G and M)
4. Routine haematology and biochemistry
   • Full blood count including platelet count
   • Urea and electrolytes, liver function tests and urinalysis for protein

Management

1. Avoidance of oral HRT in women with personal or family history of VTE
2. Use of transdermal HRT in women with personal or family history of VTE
3. Discontinuation of HRT in women who develop a VTE
4. Consultation with a clinician with expertise in thrombosis and thrombophilia
5. Anticoagulation therapy in women after VTE who continue to use HRT
6. Thromboprophylaxis prior to surgery in women using HRT
   
   Universal screening of women for thrombophilic defects prior to or continuing the prescription of HRT was considered but not recommended.

MAJOR OUTCOMES CONSIDERED

Risk for and incidence of venous thromboembolism (VTE) associated with hormone replacement therapy