denotes an abstract that is clinically relevant.
denotes that this is a recommended PHD Trainee Session.
denotes that this is a ticketed session.Hematology Disease Topics & Pathways:
Bleeding and Clotting, Diversity, Equity, and Inclusion (DEI), Diseases, Treatment Considerations, Non-Biological therapies, Maternal Health
Description:
Venous thromboembolism is a common disease, with an incidence of one to three per 1000 individuals per year. Numerous risk factors are known, which can be divided into genetic and acquired. One of the most well‐known acquired risk factors is exposure to endogenous (i.e. pregnancy) and exogenous female hormones, including oral contraceptive use, hormone substitution therapy, and gender-affirming hormone therapy. Thrombosis specialists are frequently consulted about optimal hormonal therapy in individuals with an increased risk of venous thromboembolism, as well as optimal management of pregnancy-related venous thromboembolism.
Dr Leslie Skeith will cover contraceptive-related VTE risk by agent and by clinical scenario, including in patients with inherited thrombophilia, systemic lupus erythematosus with or without antiphospholipid antibodies or antiphospholipid syndrome, and sickle cell disease considering contraception. Relevant clinical practice guidelines are reviewed. A multidisciplinary approach to counselling is needed for patient-focused decision-making.
Dr Joseph Shatzel will explore the hematologic complications of gender-affirming therapy, with a particular focus on managing and mitigating the thrombotic risks linked to exogenous estrogen use. He will detail existing data on thrombotic risks reported in transgender individuals and provide insights from studies involving cisgender women and men who receive exogenous estrogen and testosterone, providing important contextual background. He will delve into strategies for addressing testosterone-induced erythrocytosis and iron deficiency in transgender individuals undergoing hormone therapy.
Dr Saskia Middeldorp will present clinical cases of VTE related to hormonal contraceptive use and pregnancy to illustrate key considerations for clinical practice. Practice points for primary VTE treatment and the evidence on the risk of recurrent VTE and bleeding in this population are detailed. The potential value of thrombophilia testing is described including the: “who, why, when, what and how”. We also discuss key aspects of shared decision making for anticoagulant duration, including a reduced dose anticoagulant strategy in hormone-related VTE.
Dr Leslie Skeith will cover contraceptive-related VTE risk by agent and by clinical scenario, including in patients with inherited thrombophilia, systemic lupus erythematosus with or without antiphospholipid antibodies or antiphospholipid syndrome, and sickle cell disease considering contraception. Relevant clinical practice guidelines are reviewed. A multidisciplinary approach to counselling is needed for patient-focused decision-making.
Dr Joseph Shatzel will explore the hematologic complications of gender-affirming therapy, with a particular focus on managing and mitigating the thrombotic risks linked to exogenous estrogen use. He will detail existing data on thrombotic risks reported in transgender individuals and provide insights from studies involving cisgender women and men who receive exogenous estrogen and testosterone, providing important contextual background. He will delve into strategies for addressing testosterone-induced erythrocytosis and iron deficiency in transgender individuals undergoing hormone therapy.
Dr Saskia Middeldorp will present clinical cases of VTE related to hormonal contraceptive use and pregnancy to illustrate key considerations for clinical practice. Practice points for primary VTE treatment and the evidence on the risk of recurrent VTE and bleeding in this population are detailed. The potential value of thrombophilia testing is described including the: “who, why, when, what and how”. We also discuss key aspects of shared decision making for anticoagulant duration, including a reduced dose anticoagulant strategy in hormone-related VTE.