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Oral contraceptives and thrombotic disease: risk of venous thromboembolism.
Thromb Haemost. 1997 Jul; 78(1):327-33.TH

Abstract

Studies conducted in the first three decades after discovery of a link between venous thromboembolism and oral contraceptive users showed a relative risk of first thrombosis during oral contraceptive use of 2.9 (95% CI 0.5-17). In recent studies in which the sub-50 micrograms ethinyl estrodiol containing pills were investigated comparing current users with non-users, the RR is 3.8 for non-fatal deep VTE and 2.7 for superficial VTE, deep VTE and pulmonary embolism (PE) together and 2.1 for fatal VT and PE together. The association is attributed to the estrogenic component and not related to duration of pill use. The risk disappears once the pill has been stopped, and it is not elevated among past users. Smoking does not appear to be risk factor for VTE; obesity and varicose veins are, at the most, weak risk factors. Since a causal relationship between OC use and VTE is tempting, clues for unraveling the mechanism were sought in the hemostatic system. Studies of the coagulation system found changes in the activation of coagulation and fibrinolytic compartments, but within the normal range. An epidemiologic study showed that the risk of VTE among women using OCs is 30-fold increased by the presence of a mutation of factor V, called Factor V Leiden (5% prevalence in the Caucasian population). Selective screening for the mutated factor V should be limited to women with a personal or family history of VTE. Four epidemiologic studies showed a two-fold increase in risk of VTE with the use of OCs containing third-generation progestins (gestodene and desogestrel), relative to second-generations products (levonorgestrel). Biases cannot devaluate the conclusion that the increased risk of VTE in especially first-time and younger users of third-generation OCs is highly likely. The clinical consequence is therefore that second-generation OCs are the first choice in prescription to first-time users.

Authors+Show Affiliations

Department of Obstetrics, Gynecology and Reproductive Medicine, Leiden University, The Netherlands. helmerhorst@fullf2.MedFac.LeidenUniv.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

9198174

Citation

Helmerhorst, F M., et al. "Oral Contraceptives and Thrombotic Disease: Risk of Venous Thromboembolism." Thrombosis and Haemostasis, vol. 78, no. 1, 1997, pp. 327-33.
Helmerhorst FM, Bloemenkamp KW, Rosendaal FR, et al. Oral contraceptives and thrombotic disease: risk of venous thromboembolism. Thromb Haemost. 1997;78(1):327-33.
Helmerhorst, F. M., Bloemenkamp, K. W., Rosendaal, F. R., & Vandenbroucke, J. P. (1997). Oral contraceptives and thrombotic disease: risk of venous thromboembolism. Thrombosis and Haemostasis, 78(1), 327-33.
Helmerhorst FM, et al. Oral Contraceptives and Thrombotic Disease: Risk of Venous Thromboembolism. Thromb Haemost. 1997;78(1):327-33. PubMed PMID: 9198174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral contraceptives and thrombotic disease: risk of venous thromboembolism. AU - Helmerhorst,F M, AU - Bloemenkamp,K W, AU - Rosendaal,F R, AU - Vandenbroucke,J P, PY - 1997/7/1/pubmed PY - 1997/7/1/medline PY - 1997/7/1/entrez KW - Biology KW - Blood Coagulation Effects KW - Blood Proteins KW - Contraception KW - Contraceptive Agents KW - Contraceptive Agents, Female KW - Contraceptive Agents, Progestin KW - Contraceptive Methods KW - Desogestrel KW - Developed Countries KW - Diseases KW - Embolism KW - Epidemiology KW - Europe KW - Family Planning KW - Gestodene KW - Health KW - Hematological Effects KW - Hemic System KW - Levonorgestrel KW - Literature Review KW - Netherlands KW - Oral Contraceptives KW - Oral Contraceptives, Low-dose KW - Physiology KW - Public Health KW - Risk Factors KW - Thromboembolism KW - Vascular Diseases KW - Western Europe SP - 327 EP - 33 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 78 IS - 1 N2 - Studies conducted in the first three decades after discovery of a link between venous thromboembolism and oral contraceptive users showed a relative risk of first thrombosis during oral contraceptive use of 2.9 (95% CI 0.5-17). In recent studies in which the sub-50 micrograms ethinyl estrodiol containing pills were investigated comparing current users with non-users, the RR is 3.8 for non-fatal deep VTE and 2.7 for superficial VTE, deep VTE and pulmonary embolism (PE) together and 2.1 for fatal VT and PE together. The association is attributed to the estrogenic component and not related to duration of pill use. The risk disappears once the pill has been stopped, and it is not elevated among past users. Smoking does not appear to be risk factor for VTE; obesity and varicose veins are, at the most, weak risk factors. Since a causal relationship between OC use and VTE is tempting, clues for unraveling the mechanism were sought in the hemostatic system. Studies of the coagulation system found changes in the activation of coagulation and fibrinolytic compartments, but within the normal range. An epidemiologic study showed that the risk of VTE among women using OCs is 30-fold increased by the presence of a mutation of factor V, called Factor V Leiden (5% prevalence in the Caucasian population). Selective screening for the mutated factor V should be limited to women with a personal or family history of VTE. Four epidemiologic studies showed a two-fold increase in risk of VTE with the use of OCs containing third-generation progestins (gestodene and desogestrel), relative to second-generations products (levonorgestrel). Biases cannot devaluate the conclusion that the increased risk of VTE in especially first-time and younger users of third-generation OCs is highly likely. The clinical consequence is therefore that second-generation OCs are the first choice in prescription to first-time users. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/9198174/Oral_contraceptives_and_thrombotic_disease:_risk_of_venous_thromboembolism_ L2 - https://core.ac.uk/reader/15589849?utm_source=linkout DB - PRIME DP - Unbound Medicine ER -