ABSTRACT
Background: The thrombotic risk associated with SARS-CoV- 2 (COVID-19) is well documented, although there is limited information on how additional prothrombotic risk factors impact persons who contract COVID-19. Certain estrogen containing contraceptives and hormone replacement therapies are also well known to increase the risk of thrombosis. It is unknown if the risks of these agents and concurrent COVID-19 infection are additive. Aim(s): To investigate the relationship between COVID-19 infection and concurrent exogenous estrogen on the rate of thrombotic events. Method(s): A retrospective analysis including all adult female patients diagnosed with COVID-19 between January 2020-2022 at our center also treated with hormone therapy. Female patients on hormone replacement therapy (HRT) for post-menopausal symptoms were included in this analysis. HRT was defined as any treatment consisting of an estrogen analog with or without a progesterone. Thrombotic events were defined as any venous thromboembolism (VTE), cerebrovascular accident (CVA), myocardia infarction (MI), or any arterial clot/embolic event. Events were included if they were recorded as current SNOMED/ICD codes in the same encounter as the diagnosis of COVID-19. Inpatients and outpatients were included in the analysis. Result(s): 92 patients were identified who were diagnosed with COVID-19 while on hormone therapy at the time of diagnosis. 18 of the patients were hospitalized. Mean age was 42 years and 59 years for all patients and hospitalized patients, respectively. The most common estrogen therapies were norethindrone-estradiol (38%) and conjugated estrogen (14.1%). There were 3 (3.2%) total thrombotic events which all occurred in hospitalized patients. 2 patients experienced VTE while 1 patient experienced a cerebrovascular event with arterial clot. Conclusion(s): This retrospective study demonstrates a low rate of thrombosis in patients treated with exogenous estrogen and with COVID-19. The rate of thrombosis in the outpatient setting was low while thrombotic events occurred in hospitalized older patients. Further studies are warranted to explore this association.