Estrogen therapy venous thromboembolism with

Raloxifene is well tolerated overall. Hot flushes occur more frequently in women recently finishing menopause or discontinuing estrogen therapy (ET). Endometrial bleeding occurs rarely. Raloxifene is contraindicated in women with an active or past history of venous thromboembolism. Therapy should be stopped if a patient anticipates extended immobility. 

Cardiovascular disorders Estrogen and estrogen/progestin therapy have been associated with an increased risk of cardiovascular events (eg, Ml and stroke, venous thrombosis, PE [venous thromboembolism]). Manage risk factors for cardiovascular disease appropriately. 

There is other evidence that transdermal estrogen replacement therapy has relatively little effect on hemostasis. In a case control study, 155 consecutive patients with a first documented episode of idiopathic venous thromboembolism, 92 of whom had had a pulmonary embolism and 63 a deep venous thrombosis, were compared with 381 healthy matched controls (88). Overall, 32 (21%) of the cases and 27 (7%) of the controls were current users of oral estrogen replacement therapy, whereas 30 (19%) cases and 93 (24%) controls were current users of transdermal estrogen replacement therapy. After adjustment for potential confounding variables, the odds ratios for venous thromboembolism in current users of oral and transdermal estrogen replacement therapy compared with non-users were 3.5 (95% Cl = 1.8, 6.8) and 0.9 (0.5, 1.6) respectively. Estimated risk for venous thromboembolism in current users of oral estrogen replacement therapy compared with transdermal users was 4.0 (1.9, 8.3). 

Scarabin PY, Oger E, Plu-Bureau G.EStrogen and THromboEmbolism Risk Study Group. Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet 2003 362(9382) 428-32. 

MORE" 7705 postmenopausal women with osteoporosis Raloxifene 60 or 120 mg/ day or placebo 76% lower risk of estrogen receptor-positive breast cancer after 4 years of raloxifene therapy Raloxifene can cause or exacerbate hot flushes. Also, it increases the risk of venous thromboembolism by about 2-fold. 

I Administration. Overall, raloxifene therapy is well tolerated, but hot flushes occasionally cause women to discontinue therapy (see Table 88-6). Raloxifene use is associated with a threefold increased risk of venous thromboembolism, similar to the increased risk seen in women taking estrogens. Raloxifene is contraindicated for those with active thromboembolic disease. Therapy should be stopped if a patient anticipates a signiflcant period (several hours or more) of immobility. Raloxifene does not induce endometrial bleeding. 

---