PDF(Pubmed)
Abstract：
Background: Venous thromboembolism (VTE) is a rare side effect of hormonal therapy in transgender persons. Prothrombotic genetic variants can increase this risk. For this reason, previous VTE and/or genetic thrombophilia may be considered by some as contraindications to hormonal treatment. Aim: To formulate directions for clinical practice about the indications for thrombophilia screening and when to consider combination therapy of therapeutic anticoagulation and hormonal treatment as a safe alternative to withholding hormonal treatment. Methods: We conducted a literature search and describe a case series. All adult patients with gender dysphoria and a known prothrombotic genetic variant or history of VTE were invited by letter to participate in this study. Results: In our center, thrombophilia screening before start of hormonal treatment was restricted to those with a personal or family history of VTE. Sixteen individuals with a history of VTE and/or an underlying prothrombogenic condition were described. The time of follow up varied from 4 months to 20 years. Seven trans women had a positive thrombophilia screening (2 Factor V Leiden (FVL), 1 FVL + anticardiolipin antibodies, 1 FVL + high Factor VIII coagulant activity, 1 protein C deficiency, 1 prothrombin mutation, 1 positive lupus anticoagulant). Three trans women experienced an unprovoked VTE after start of hormonal therapy of which one lead to a positive thrombophilia screening. One VTE event in a trans woman was assumed to be provoked by surgery. Five trans men were identified with a prothrombogenic mutation (3 FVL, 1 protein C deficiency, 1 prothrombin mutation). One trans man, with a negative thrombophilia screen, experienced multiple provoked VTE events before start of hormonal therapy. Conclusion: Based on our literature review and case series we offer guidance when confronted with patients with previous VTE and/or genetic thrombophilia requesting hormonal interventions.
摘要：
背景：静脉血栓栓塞症（VTE）是变性人激素治疗的罕见副作用。血栓前遗传变异会增加这种风险。出于这个原因,既往VTE和/或遗传性血栓形成倾向可能被一些人视为激素治疗的禁忌症.目的：制定有关血栓性疾病筛查适应症的临床实践指导，以及何时考虑将治疗性抗凝和激素治疗联合治疗作为拒绝激素治疗的安全替代方案。方法：我们进行了文献检索并描述了一个案例系列。所有患有性别烦躁不安且已知血栓前遗传变异或VTE病史的成年患者均被邀请参加本研究。结果：在我们中心，激素治疗开始前的血栓形成筛查仅限于有VTE个人或家族史的患者.描述了16名具有VTE病史和/或潜在的血栓形成前疾病的个体。随访时间从4个月到20年不等。7名跨性别女性的血栓性筛查呈阳性（2因子V莱顿（FVL），1FVL+抗心磷脂抗体，1FVL+高因子VIII凝血活性，1蛋白C缺乏，1凝血酶原突变，1阳性狼疮抗凝药）。三名跨性别妇女在开始激素治疗后经历了无缘无故的VTE，其中一名导致血栓性筛查阳性。跨性别妇女的一次VTE事件被认为是由手术引起的。5名跨性别男性被鉴定为血栓形成前突变（3FVL，1蛋白C缺乏，1个凝血酶原突变）。一个跨性别者，血栓性筛查阴性,在开始激素治疗之前经历了多次引起的VTE事件。结论：根据我们的文献综述和病例系列，我们在面对先前患有VTE和/或遗传性血栓形成倾向的患者需要激素干预时提供指导。
