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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Female hormone therapy and risk of intracranial haemorrhage from cerebral cavernous malformations – a multicentre observational cohort study

Weibliche Hormontherapie und Risiko einer intrakraniellen Blutung aus zerebralen kavernösen Malformationen: eine multizentrische Beobachtungskohortenstudie

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  • presenting/speaker Alejandro Nicolas Santos - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Susanna Zuurbier - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland; Amsterdam University Medical Center, Amsterdam, Deutschland
  • Kelly Flemming - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland; Amsterdam University Medical Center, Amsterdam, Deutschland; Mayo Clinic, Neurology, Rochester, NY, Vereinigte Staaten
  • Matthan Caan - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland; Amsterdam University Medical Center, Amsterdam, Deutschland; Mayo Clinic, Neurology, Rochester, NY, Vereinigte Staaten; Amsterdam University Medical Center, Amsterdam, Niederlande
  • Gabriel Rinkel - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland; Amsterdam University Medical Center, Amsterdam, Deutschland; Mayo Clinic, Neurology, Rochester, NY, Vereinigte Staaten; Amsterdam University Medical Center, Amsterdam, Niederlande
  • Yvo Roos - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland; Amsterdam University Medical Center, Amsterdam, Deutschland; Mayo Clinic, Neurology, Rochester, NY, Vereinigte Staaten; Amsterdam University Medical Center, Amsterdam, Niederlande
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Giuseppe Lanzino - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland; Mayo Clinic, Department of Neurosurgery, Rochester, NY, Vereinigte Staaten
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV015

doi: 10.3205/22dgnc016, urn:nbn:de:0183-22dgnc0163

Published: May 25, 2022

© 2022 Santos et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Female hormone therapy (oral contraception in women of reproductive age and hormone replacement therapy in postmenopausal women) are not withheld from patients with cerebral cavernous malformations, although the effects of these drugs on the risk of intracranial haemorrhage are unknown.

Methods: This multicentre observational cohort study included consecutive patients with a cerebral cavernous malformation. We compared the association between use of female hormone therapy and the occurrence of intracranial haemorrhage due to the cerebral cavernous malformation during up to 5 years of prospective follow-up in multivariable Cox proportional hazards regression. We searched OVID MEDLINE and EMBASE from inception to November 2, 2021 to identify comparative studies to calculate the intracranial haemorrhage incidence rate ratio according to female hormone.

Results: Of 722 women, aged 10 years or older at time of cerebral cavernous malformation diagnosis, 137 used female hormone therapy. Female hormone therapy use was associated with an increased risk of subsequent intracranial haemorrhage (46/137 [33.6%] versus 91/585 [15.6%], adjusted hazard ratio 1.58, 95% CI 1.10 to 2.27; p=0.012). Use of oral contraceptives in women aged 10-44 years was associated with a higher risk of subsequent intracranial haemorrhage (adjusted hazard ratio 2.05, 95% CI 1.29-3.26; p=0.002). Our systematic literature search showed no studies reporting on the effect of female hormone therapy on the risk of intracranial haemorrhage during follow-up.

Conclusion: Female hormone therapy use is associated with a higher risk of intracranial haemorrhage from cerebral cavernous malformations. These findings raise questions about the safety of female hormone therapy in clinical practice. Further studies evaluating the delivery, dose, and duration of hormone therapy as well as other clinical factors raising risk of thrombosis may be useful to determine which patients may be most susceptible to intracranial haemorrhage.