Female hormone therapy tied to intracranial haemorrhage risk in patients with cerebral cavernous malformations

Consecutive patients with cerebral cavernous malformation were included. A comparison of the association between female hormone therapy use and ICH occurrence duet to the CCM was drawn during five years of prospective follow-up. An additional systematic review was performed from inception to November 2, 2021, to identify studies and assess their intracranial haemorrhage incidence rate ratio according to the use of female hormone therapy.

The study revealed the following findings:

• Of 722 female patients aged ten years or older at cerebral cavernous malformation diagnosis, 137 used female hormone therapy at any point during follow-up.
• Female hormone therapy use (adjusted for age, mode of presentation, and CCM location) was associated with an increased risk of subsequent intracranial haemorrhage (33·6% versus 15·6% adjusted hazard ratio 1·56).
• Use of oral contraceptives in female patients aged 10-44 years adjusted for the same factors was associated with a higher risk of subsequent intracranial haemorrhage (adjusted hazard ratio 2·00).
• The systematic literature search showed no studies reporting on the effect of female hormone therapy on the risk of intracranial haemorrhage during follow-up.

The study provides Class III evidence that female hormone therapy raised the risk of intracranial haemorrhage in patients with CCM.

"Further studies evaluating clinical factors raising the risk of thrombosis may be useful to determine which patients may be most susceptible to intracranial haemorrhage," the researchers concluded.

Reference:

Female Hormone Therapy and Risk of Intracranial Hemorrhage From Cerebral Cavernous Malformations: A Multicenter Observational Cohort Study Susanna M Zuurbier, Alejandro N Santos, Kelly D Flemming, Börge Schmidt, Ramazan Jabbarli, Giuseppe Lanzino, Ulrich Sure, Philipp Dammann Neurology Feb 2023, 10.1212/WNL.0000000000206888; DOI: 10.1212/WNL.0000000000206888