A 20-year-old assigned female at birth (AFAB) transmasculine individual was evaluated
to undergo gender-affirming mastectomy. He was on oral ethynodiol-ethinyl estradiol
(a combination oral contraceptive), testosterone cypionate injections, oral paroxetine,
and oral trazodone. The patient's preoperative body mass index (BMI) was 40 kg/m2. His preoperative Caprini score was 4. He was deemed an appropriate operative candidate
and underwent gender-affirming mastectomy as an outpatient surgery. Eight days postoperatively,
he presented with acute chest and back pain with dyspnea. He was found to have bilateral
pulmonary emboli on computed tomography angiography (CTA). The patient later recalled
that other family members experienced prior thrombotic events; therefore, the patient's
true preoperative Caprini score was 7. His thrombophilia workup was negative. The
patient received a 6-month course of anticoagulation. Additionally, cessation of the
oral contraceptive and alternative menstrual suppression management and contraceptive
options were discussed with the patient. He ultimately chose to have an etonogestrel
implant placed.
Keywords
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References
- Venous thromboembolism risk and thromboprophylaxis assessment in surgical patients based on Caprini risk assessment model.Risk Manag. Healthc. Policy. 2020; 13: 2545-2552https://doi.org/10.2147/RMHP.S272852
- A call for consideration of gender identity in venous thromboembolism risk assessment.Ann. Surg. 2021; 274: e191-e192https://doi.org/10.1097/SLA.0000000000004654
- Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy.J. Blood Med. 2019; 10: 209-216https://doi.org/10.2147/JBM.S166780
- Risk for venous thromboembolism in transgender patients undergoing cross-sex hormone treatment: a systematic review.J. Sex. Med. 2021; 18: 1280-1291https://doi.org/10.1016/j.jsxm.2021.04.006
- Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk score.Plast. Reconstr. Surg. 2012; 130: 343-353https://doi.org/10.1097/PRS.0b013e3182589e49
- Testosterone therapy and venous thromboembolism: a systematic review and meta-analysis.Thromb. Res. 2018; 172: 94-103https://doi.org/10.1016/j.thromres.2018.10.023
- Effect of gender-affirming hormone use on coagulation profiles in transmen and transwomen.J. Thromb. Haemost. 2021; 19: 1029-1037https://doi.org/10.1111/jth.15256
- Cross-sex hormones and acute cardiovascular events in transgender persons.Ann. Intern. Med. 2018; 169: 205-213https://doi.org/10.7326/M17-2785
- Association of surgical risk with exogenous hormone use in transgender patients: a systematic review.JAMA Surg. 2019; 154: 159-169https://doi.org/10.1001/jamasurg.2018.4598
- Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience.J. Plast. Reconstr. Aesthet. Surg. 2012; 65: 711-719https://doi.org/10.1016/j.bjps.2011.11.053
. IK Berrahou A Grimes AM Autry M. Hawkins Management of Menstruation in Transgender and Gender Nonbinary Adolescents. Clinical Obstetrics and Gynecology.:10.1097/GRF.0000000000000710. doi:10.1097/GRF.0000000000000710.
- Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review.Arch. Intern. Med. 2004; 164: 1965-1976https://doi.org/10.1001/archinte.164.18.1965
- Venous thromboembolism following elective aesthetic plastic surgery: a longitudinal prospective study in 1254 patients.Plast. Surg. Int. 2014; 2014565793https://doi.org/10.1155/2014/565793
- Association between progestin-only contraceptive use and cardiometabolic outcomes: a systematic review and meta-analysis.Eur. J. Prev. Cardiol. 2018; 25: 1042-1052https://doi.org/10.1177/2047487318774847
- Progestin-only contraception and thromboembolism: a systematic review.Contraception. 2016; 94: 678-700https://doi.org/10.1016/j.contraception.2016.04.014
- Testosterone therapy, thrombophilia, venous thromboembolism, and thrombotic events.J. Clin. Med. 2018; 8: E11https://doi.org/10.3390/jcm8010011
- Risk of recurrent venous thromboembolism on progestin-only contraception: a cohort study.Haematologica. 2016; 101: e12-e14https://doi.org/10.3324/haematol.2015.134882
- Optimal management of hormonal contraceptives after an episode of venous thromboembolism.Thromb. Res. 2019; 181: S1-S5https://doi.org/10.1016/S0049-3848(19)30357-3
- Effect of cross-sex hormone therapy on venous thromboembolism risk in male-to-female gender-affirming surgery.Ann. Plast. Surg. 2021; 86: 109-114https://doi.org/10.1097/SAP.0000000000002300
Article info
Publication history
Published online: December 21, 2022
Accepted:
December 13,
2022
Received in revised form:
December 4,
2022
Received:
October 6,
2022
Identification
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