Medication histories often record 'HRT' without the route, dose or regimen. For clot risk these details are the whole story: oral and transdermal oestrogen behave differently in the liver, and the difference matters when a woman presents with leg swelling, is going for surgery, or is being started on another prothrombotic drug.
- Record route (oral, patch, gel), oestrogen dose and whether a progestogen is continuous or cyclic
- Count oral oestrogen as a VTE risk factor in perioperative and Wells-type assessments
- Ask about HRT specifically — many women do not think of it as a medicine
- Include tibolone and vaginal oestrogen in the history, and note them separately
Why it matters
The route changes thrombotic risk enough to alter perioperative and diagnostic decisions.
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