論文No1062
Association Between Testosterone Replacement Therapy and the Incidence of DVT and Pulmonary Embolism:
A Retrospective Cohort Study of the Veterans Administration Database
Rishi Sharma, MD, MHSA; Olurinde A. Oni, MBBS, MPH; Guoqing Chen, MD, PhD; Mukut Sharma, PhD; Buddhadeb Dawn, MD; Ram Sharma, PhD; Deepak Parashara, MD; Virginia J. Savin, MD; Rajat S. Barua, MD, PhD; Kamal Gupta, MD
Chest. 2016;150(3):563-571. doi:10.1016/j.chest.2016.05.007
＜背景＞
テストステロン補充療法（TRT）はこの１０年間で数倍に増加している。
TRTに伴うDVTや肺塞栓(PE)の増加の可能性に関心が集まっている。
しかしTRTとDVT/PEの関連を調べた研究はほとんどない。
我々は血清テストステロン(sTT)低値に対してTRTが処方された男性のDVT,PEの頻度を調べた。
＜方法＞
これはVeterans Affairs Informatics and Computing Infrastructureから得られたデータの後ろ向きコホート研究である。
TRTを受け正常なsTTの患者(Gp1)、TRTを受けたがsTTが低い患者(Gp2)、TRTを受けなかった患者(Gp3)のDVT/PEの頻度を比較した。
既往にDVT/PEがある、がん、過凝固状態、慢性的に抗凝固療法をうけている人は除外した。
＜結果＞
最終的に71407名がベースラインでsTTが低かった。
このうち、10854名はTRTを受けず（Gp3）、60553名がTRTを受けていた。
38362名がsTT正常となり(Gp1)、22191名がsTTが低いままだった(Gp2)。
DVT/PEの頻度はGp1,Gp2,Gp3でそれぞれ0.5%, 0.4%, 0.5%であった。
単変量、多変量などでもDVT/FEのない生存にグループ間の差はなかった。
＜感想＞
この大規模後ろ向き研究ではsTTが低い群にTRTをしてもしなくても、
DVT/PEの率に差は出なかったようです。
Background Testosterone replacement therapy (TRT) prescriptions have increased several-fold in the last decade. There have been concerns regarding a possible increased incidence of DVT and pulmonary embolism (PE) with TRT. Few data support the association between TRT and DVT/PE. We evaluated the incidence of DVT and PE in men who were prescribed TRT for low serum total testosterone (sTT) levels.
Methods This is a retrospective cohort study, conducted using data obtained from the Veterans Affairs Informatics and Computing Infrastructure. We compared the incidence of DVT/PE between those who received TRT and subsequently had normal on-treatment sTT levels (Gp1), those who received TRT but continued to have low on-treatment sTT (Gp2), and those who did not receive TRT (Gp3). Those with prior history of DVT/PE, cancer, hypercoagulable state, and chronic anticoagulation were excluded.
Results The final cohort consisted of 71,407 subjects with low baseline sTT. Of these, 10,854 did not receive TRT (Gp3) and 60,553 received TRT. Of those who received TRT, 38,362 achieved normal sTT (Gp1) while 22,191 continued to have low sTT (Gp2). The incidence of DVT/PE was 0.5%, 0.4%, and 0.4% in Gp1, Gp2, and Gp3, respectively. Univariate, multivariate, and stabilized inverse probability of treatment weights analyses showed no statistically significant difference in DVT/PE-free survival between the various groups.
Conclusions This study did not detect a significant association between testosterone replacement therapy and risk of DVT/PE in adult men with low sTT who were at low to moderate baseline risk of DVT/PE.