PE and Stroke Risk for Transgender Patients

August 2, 2018

Written by Clay Smith

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Transfeminine* patients had nearly doubled risk for venous thromboembolism (VTE).  The risk tripled for VTE and doubled for stroke if taking hormone supplementation.

Why does this matter?
We know that estrogen-containing oral contraceptive use in women increased risk for VTE from this 2015 BMJ study and this 2011 BMJ study.  How does this impact transgender patients?

New PE and stroke risk considerations
This was a cohort study of 2842 transfeminine patients and 2118 transmasculine* patients compared with a matched cohort of 48686 cisgender men and 48775 cisgender women, followed for about 4 or more years for venous thromboembolism (VTE), ischemic stroke, and myocardial infarction (MI).  They found a nearly doubled risk of VTE among transfeminine patients: hazard ratio (HR) 1.9 (95%CI, 1.4–2.7).  Incidence of VTE, stroke, and MI were otherwise similar in the other groups.  There was an even greater risk of both VTE (HR 3.2) and stroke (HR 2.3) in transfeminine patients who were taking hormone therapy, predominantly estrogen.  Risk for stroke in such patients was nearly tenfold at >6 years of hormone treatment, HR 9.9 (95%CI, 3.0–33.1).  One of the weaknesses of the study is that they only had data on hormone treatment from within the Kaiser-Permanente Health System.  Patients could have obtained it elsewhere.  Use of cross-sex estrogen in transfeminine patients is a significant risk factor for VTE and stroke that we need to take into consideration as we care for these patients in the ED.

*“A person whose gender identity differs from a male sex designation at birth often is referred to as male-to-female, transfeminine, or trans woman.”  Transmasculine, or trans man, is the opposite.

Source
Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study.  Ann Intern Med. 2018 Jul 10. doi: 10.7326/M17-2785. [Epub ahead of print]
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Reviewed by Thomas Davis