ABSTRACT
BACKGROUND: The risk of recurrence after a venous thromboembolism (VTE) related to estrogen-containing contraceptives is a key driver to guide anticoagulant treatment decisions. OBJECTIVE: To estimate the incidence rate of recurrent VTE after discontinuation of anticoagulant treatment in women with a first episode of VTE related to estrogen-containing contraceptives. METHODS: Embase, MEDLINE, and the CENTRAL were searched from 1 January 2008 to 27 May 2021 for prospective and retrospective studies reporting on recurrence after a first VTE related to estrogen-containing contraceptives. Risk of bias was assessed using QUIPS tool. Recurrence rates per 100 patient-years were pooled using Knapp-Hartung random-effects meta-analysis. Incidence rates were reported separately based on study follow-up duration (≤1 year, 1-5 years, and >5 years) and for several subgroups. RESULTS: A total of 4,120 studies were identified, of which 14 were included. The pooled recurrence rate was 1.57 (95%-CI: 1.10-2.23; I2 = 82%) per 100 patient-years. Recurrence rates per 100 patient-years were 2.73 (95%-CI: 0.00-3643; I2 = 80%) for studies with ≤1 year follow-up, 1.35 (95%-CI: 0.68-2.68; I2 = 44%) for studies with 1-5 years follow-up, and 1.42 (95%-CI: 0.84-2.42; I2 = 78%) for studies with >5 years follow-up. CONCLUSION: Among women with VTE associated with estrogen-containing contraceptives, the risk of recurrence after stopping anticoagulation is low, which favors short-term anticoagulation. Large prospective studies on VTE recurrence rates and risk factors after stopping short-term anticoagulants are needed.
Subject(s)
Venous Thromboembolism , Anticoagulants/adverse effects , Contraceptives, Oral, Hormonal/adverse effects , Estrogens/adverse effects , Female , Humans , Male , Prospective Studies , Recurrence , Retrospective Studies , Risk Factors , Venous Thromboembolism/chemically induced , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiologyABSTRACT
A 74-year-old woman was referred to the dermatologist because of erythema on the chest which had not improved with topical corticosteroids. She had a medical history of papillary thyroid carcinoma. Pathologic assessment of two skin biopsies revealed cutaneous metastases from thyroid carcinoma.
Subject(s)
Erythema/diagnosis , Skin Neoplasms/diagnosis , Thyroid Cancer, Papillary/pathology , Thyroid Neoplasms/pathology , Aged , Erythema/etiology , Female , Humans , Skin Neoplasms/pathology , Skin Neoplasms/secondaryABSTRACT
BACKGROUND: The prevalence of lanolin contact allergy in dermatitis patients varies from 1.2% to 6.9%. Different lanolin derivatives are used in patch testing. OBJECTIVES: To determine which combination of lanolin derivatives is most effective in patch testing for the diagnosis of lanolin contact allergy. METHODS: A retrospective analysis of patients patch tested between 2016 and 2017 was performed. Patients were eligible if they had been tested with lanolin alcohol 30% pet., Amerchol L101 50% pet., and a supplementary series containing other lanolin derivatives. Lanolin alcohol and Amerchol L101 were tested in duplicate. RESULTS: Of 594 patients, 28.6% (95% confidence interval [CI]: 25.1%-32.3%) had a positive patch test reaction to at least one lanolin derivative. Reactions to lanolin alcohol (14.7%, 95%CI: 11.3%-18.2%) and Amerchol L101 (15.0%, 95%CI: 11.5%-18.5%) were common in the routinely tested series. Reactions to other test preparations were significantly less frequent (P < 0.05). The addition of Amerchol L101 to lanolin alcohol significantly increased the number of positive cases (odds ratio 1.79, P < 0.001). CONCLUSIONS: The combination of lanolin alcohol and Amerchol L101 is effective in patch testing for the diagnosis of lanolin contact allergy. Routinely testing with other lanolin derivatives may not be worthwhile, as it detects only a few additional patients.
