Venous Thromboembolism: Gender Effects and Gender-Specific Risk Factors for Women

This chapter discusses the symptoms, epidemiology, and risk factors of venous thromboembolism (VTE). It focuses on gender-specific risk factors for VTE among women, as well as on special considerations in the diagnostic and therapeutic approaches to VTE in the pregnant patients. The incidence of VTE increases markedly with increasing age. The incidence of VTE does not appear to vary significantly by gender, as evidenced by a lack of consistency in the magnitude and even direction of effect of gender in a variety of epidemiologic studies of varying designs. The main influence of gender upon VTE is the relationship between female gender and several well-recognized clinical risk factors for VTE-Oral contraceptives (OCs) use, hormone replacement therapy (HRT), estrogen receptor modulator therapy, and pregnancy. The fact that women of childbearing age do not appear to have a substantially greater incidence of VTE compared with age-matched men may reflect an offsetting of these female-specific risk factors by other risk factors that are more common in men, such as trauma. Hormonal therapies are associated with a 2- to 3-fold increase in VTE incidence. The pregnancy state is associated with a 3- to 5-fold increase in VTE risk, and thromboembolism is a major cause of peripartum death.