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Original Research: Pulmonary Vascular Disease |

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
Author and Funding Information

FUNDING/SUPPORT: The Kansas City Veterans Affairs Medical Center and the Midwest Biomedical Research Foundation (Kansas City, KS) supported this study. This study also received support from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development (VA BX001037 awarded to V. J. S.).

aDivision of Cardiovascular Research, Kansas City Veterans Affairs Medical Center, Kansas City, MO

bResearch Services, Kansas City Veterans Affairs Medical Center, Kansas City, MO

cResearch and Development, Kansas City Veterans Affairs Medical Center, Kansas City, MO

dDivision of Cardiovascular Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO

eDivision of Nephrology, Kansas City Veterans Affairs Medical Center, Kansas City, MO

fOffice of Scholarly, Academic, and Research Mentoring, University of Kansas Medical Center, Kansas City, KS

gDivision of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS

CORRESPONDENCE TO: Kamal Gupta, MD, Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):563-571. doi:10.1016/j.chest.2016.05.007
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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.

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