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A randomized cross-over study on the effects of levonorgestrel- and desogestrel-containing oral contraceptives on the anticoagulant pathways.
Thromb Haemost. 2000 Jul; 84(1):15-21.TH

Abstract

The use of oral contraceptives (OC) causes disturbances of the procoagulant, anticoagulant and fibrinolytic pathways of blood coagulation which may contribute to the increased risk of venous thrombosis associated with OC therapy. Here we report the results of a cycle-controlled randomized cross-over study, in which we determined the effects of so-called second and third generation OC's on a number of anticoagulant parameters. In this study, 28 non-OC using women were randomly prescribed either a second generation (150 microg levonorgestrel/30 microg ethinylestradiol) or a third generation OC (150 microg desogestrel/30 microg ethinylestradiol) and who switched to the other OC after a two month wash out period. The anticoagulant parameters determined were: antithrombin (AT), alpha2-macroglobulin (alpha2-M), alpha1-antitrypsin, protein C inhibitor (PCI), protein C, total and free protein S and activated protein C sensitivity ratios (APC-sr) measured with two functional APC resistance tests which quantify the effect of APC on either the activated partial thromboplastin time (aPTT) or on the endogenous thrombin potential (ETP). During the use of desogestrel-containing OC the plasma levels of alpha2-M, alpha1-antitrypsin, PCI and protein C significantly increased, whereas AT and protein S significantly decreased. Similar trends were observed with levonorgestrel-containing OC, although on this kind of OC the changes in AT, PCI and protein S (which was even slightly increased) did not reach significance. Compared with levonorgestrel, desogestrel-containing OC caused a significant decrease of total (p <0.005) as well as free protein S (p <0.0001) and more pronounced APC resistance in both the aPTT (p = 0.02) and ETP-based (p <0.0001) APC resistance tests. These observations indicate that the activity of the anticoagulant pathways in plasma from users of desogestrel-containing OC is more extensively impaired than in plasma from users of levonorgestrel-containing OC.

Authors+Show Affiliations

Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10928463

Citation

Tans, G, et al. "A Randomized Cross-over Study On the Effects of Levonorgestrel- and Desogestrel-containing Oral Contraceptives On the Anticoagulant Pathways." Thrombosis and Haemostasis, vol. 84, no. 1, 2000, pp. 15-21.
Tans G, Curvers J, Middeldorp S, et al. A randomized cross-over study on the effects of levonorgestrel- and desogestrel-containing oral contraceptives on the anticoagulant pathways. Thromb Haemost. 2000;84(1):15-21.
Tans, G., Curvers, J., Middeldorp, S., Thomassen, M. C., Meijers, J. C., Prins, M. H., Bouma, B. N., Büller, H. R., & Rosing, J. (2000). A randomized cross-over study on the effects of levonorgestrel- and desogestrel-containing oral contraceptives on the anticoagulant pathways. Thrombosis and Haemostasis, 84(1), 15-21.
Tans G, et al. A Randomized Cross-over Study On the Effects of Levonorgestrel- and Desogestrel-containing Oral Contraceptives On the Anticoagulant Pathways. Thromb Haemost. 2000;84(1):15-21. PubMed PMID: 10928463.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized cross-over study on the effects of levonorgestrel- and desogestrel-containing oral contraceptives on the anticoagulant pathways. AU - Tans,G, AU - Curvers,J, AU - Middeldorp,S, AU - Thomassen,M C, AU - Meijers,J C, AU - Prins,M H, AU - Bouma,B N, AU - Büller,H R, AU - Rosing,J, PY - 2000/8/6/pubmed PY - 2001/3/3/medline PY - 2000/8/6/entrez SP - 15 EP - 21 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 84 IS - 1 N2 - The use of oral contraceptives (OC) causes disturbances of the procoagulant, anticoagulant and fibrinolytic pathways of blood coagulation which may contribute to the increased risk of venous thrombosis associated with OC therapy. Here we report the results of a cycle-controlled randomized cross-over study, in which we determined the effects of so-called second and third generation OC's on a number of anticoagulant parameters. In this study, 28 non-OC using women were randomly prescribed either a second generation (150 microg levonorgestrel/30 microg ethinylestradiol) or a third generation OC (150 microg desogestrel/30 microg ethinylestradiol) and who switched to the other OC after a two month wash out period. The anticoagulant parameters determined were: antithrombin (AT), alpha2-macroglobulin (alpha2-M), alpha1-antitrypsin, protein C inhibitor (PCI), protein C, total and free protein S and activated protein C sensitivity ratios (APC-sr) measured with two functional APC resistance tests which quantify the effect of APC on either the activated partial thromboplastin time (aPTT) or on the endogenous thrombin potential (ETP). During the use of desogestrel-containing OC the plasma levels of alpha2-M, alpha1-antitrypsin, PCI and protein C significantly increased, whereas AT and protein S significantly decreased. Similar trends were observed with levonorgestrel-containing OC, although on this kind of OC the changes in AT, PCI and protein S (which was even slightly increased) did not reach significance. Compared with levonorgestrel, desogestrel-containing OC caused a significant decrease of total (p <0.005) as well as free protein S (p <0.0001) and more pronounced APC resistance in both the aPTT (p = 0.02) and ETP-based (p <0.0001) APC resistance tests. These observations indicate that the activity of the anticoagulant pathways in plasma from users of desogestrel-containing OC is more extensively impaired than in plasma from users of levonorgestrel-containing OC. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/10928463/A_randomized_cross_over_study_on_the_effects_of_levonorgestrel__and_desogestrel_containing_oral_contraceptives_on_the_anticoagulant_pathways_ L2 - https://antibodies.cancer.gov/detail/CPTC-SNCG-3 DB - PRIME DP - Unbound Medicine ER -