Secondary prevention
Patients taking hormonal therapies should avoid prothrombogenic states such as obesity, smoking, or inactivity.
Hormone therapy may increase cardiovascular and thromboembolic risk, particularly for trangender women taking feminising hormone therapy. The risk of pulmonary embolism and other thromboembolic events appears to be particularly high during the first year of hormone treatment.[61]
Note that traditional cardiovascular and thromboembolic risk calculators do not take into account the use of current or past hormones. Factors to consider when estimating cardiovascular and thromboembolic risk include the dose, length and age of onset of hormone therapy.[4] As a general guide, when estimating long-term cardiovascular risk, it may be appropriate to use birth-assigned sex for those who have transitioned in later life, and to use a patient’s affirmed gender for those who have been taking hormone therapy since adolescence/young adulthood.[62]
Data to guide optimal cardiovascular and thromboembolic prevention strategies for transgender people is currently lacking.[61] For those with non-modifiable risk factors which may increase the risk of thromboembolic disease: for example, a known history of thrombophilia, a past history of thrombosis, or a strong family history of thromboembolism, offering an anticoagulant in addition to treatment with transdermal oestrogen may decrease the risk of thromboembolism, based on very limited data.[4]
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