OC 44.3 - Postoperative venous thromboembolism in transgender patients receiving estrogen-based hormone therapy

Monday, June 24, 2024

15:15 – 15:30 ICT

Room: Ballroom B4

Presenting Author(s)

Ethan Oseas, MS

PhD Student
Oregon Health & Science University
Portland, Oregon, United States

Co-Author(s)

CL

Corinne Lavasseur

House Officer - Internal Medicine
Oregon Health & Science University
Portland, Oregon, United States
JA

Jacob Alex

House Officer - Internal Medicine
Oregon Health & Science University
Portland, Oregon, United States
SS

Sarah Svetec

House Officer - Internal Medicine
Oregon Health & Science University
Portland, Oregon, United States
JB

Jacob Berkowitz

House Officer - Internal Medicine
Oregon Health & Science University
Portland, Oregon, United States
Owen McCarty

Professor
Oregon Health & Science University
Portland, Oregon, United States
KN

Karina Nakayama

Assistant Professor
Oregon Health & Science University
Portland, Oregon, United States
JS

Joseph Shatzel

Associate Professor
Oregon Health & Science University
Portlan, Oregon, United States
CC

Cameron Chalker

Hematology & Oncology Fellow
Oregon Health & Science University
Portland, Oregon, United States

Background: The prothrombotic properties of estrogen are well-described; consequently, estrogen is often held in the perioperative period to decrease venous thromboembolism (VTE) risk. This practice particularly impacts transgender patients who are receiving feminizing hormone therapy (HT) as a component of gender-affirming care. Current World Professional Association for Transgender Health (WPATH) guidelines recommend continuing estrogen in the perioperative period; however, clinical practice varies due to the limited data on rates of thrombosis in this population.

Aims: To compare postoperative thromboses in transgender women who held vs. continued estrogen HT prior to gender-affirming vaginoplasty.

Methods: We identified and retrospectively reviewed the electronic medical records of transgender women who underwent vaginoplasty at our institution between June 2016 and December 2023.

Results: 180 patients were identified. Mean age at surgery was 41 years; mean BMI was 27.82; Four (2.2%) were active smokers. One (0.5%) reported prior VTE and three (1.6%) had a documented thrombophilia. All patients had been prescribed estrogen for >6 months. The route of estrogen administration was oral (PO) in 96 (53.5%), sublingual (SL) in 15 (8.3%), transdermal (TD) in 16 (8.8%), injected (IJ) in 52 (28.8%), and implanted pellet (IP) in one (0.5%). Estrogen HT was continued perioperatively in 52 cases (28.8%) and held for >2 weeks prior to vaginoplasty in 128 (71.1%). Of those who continued HT, 8 (15.3%) received estrogen PO, while 15 were SL (28.8%), 6 were TD (11.5%), 22 (42.3%) were IJ, and 1 (1.9%) was IP. All patients received VTE chemoprophylaxis with enoxaparin during their hospital stay. Zero patients experienced VTE within six months of surgery. Eight patients (4.4%) experienced bleeding requiring emergency department evaluation and three (1.7%) required a transfusion.

Conclusion(s): Postoperative VTE was nonexistent in our cohort irrespective of HT continuation. While analysis is ongoing, this preliminary data suggests estrogen HT can be safely continued in the perioperative period.