Contraception-Related Venous Thromboembolism in Adolescents

Abstract

Venous thromboembolism (VTE) is a rare but serious complication of combined hormonal contraception. While the absolute risk of VTE is low in adolescents, thrombotic events in contraception users younger than the age of 20 years account for 5 to 10% of total contraception-related VTE events in population studies, because of the high frequency of contraception use in adolescents. An increased risk of VTE exists not only with oral contraceptives, but also the contraceptive patch and vaginal ring. Most adolescents who experience contraception-related VTE have additional transient or inherited thrombotic risk factors at the time of VTE. Although the presence of inherited thrombophilia impacts the risk of contraception-related VTE, thrombophilia screening before contraception prescribing should be targeted only to high-risk populations. Pediatric institutions, caregivers, and young women need to be aware of the risk of VTE with estrogen-containing contraception, and maintain a high index of suspicion for this complication in women using these agents.

Keywords

deep vein thrombosis - pulmonary embolism - inherited thrombophilia - adolescents

• References

• 1 Tans G, Bouma BN, Büller HR, Rosing J. Changes of hemostatic variables during oral contraceptive use. Semin Vasc Med 2003; 3 (1) 61-68
• 2 Urisman A, Leard LE, Nathan M , et al. Rapidly progressive pulmonary venoocclusive disease in young women taking oral contraceptives. J Heart Lung Transplant 2012; 31 (9) 1031-1036
• 3 Sass AE, Neufeld EJ. Risk factors for thromboembolism in teens: when should I test?. Curr Opin Pediatr 2002; 14 (4) 370-378
• 4 Lidegaard O, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ 2009; 339: b2890
• 5 Lidegaard O, Nielsen LH, Skovlund CW, Løkkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ 2012; 344: e2990
• 6 Lidegaard O, Nielsen LH, Skovlund CW, Skjeldestad FE, Løkkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. BMJ 2011; 343: d6423
• 7 Jick SS, Kaye JA, Russmann S, Jick H. Risk of nonfatal venous thromboembolism with oral contraceptives containing norgestimate or desogestrel compared with oral contraceptives containing levonorgestrel. Contraception 2006; 73 (6) 566-570
• 8 Rott H. Hormonal contraception in thrombophilic adolescents: risk of thrombosis and recommendations. Hamostaseologie 2012; 32 (1) 15-21
• 9 Gomes MP, Deitcher SR. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review. Arch Intern Med 2004; 164 (18) 1965-1976
• 10 van den Heuvel MW, van Bragt AJ, Alnabawy AK, Kaptein MC. Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception 2005; 72 (3) 168-174
• 11 Jick SS, Kaye JA, Russmann S, Jick H. Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception 2006; 73 (3) 223-228
• 12 Lippi G, Favaloro EJ, Meschi T, Mattiuzzi C, Borghi L, Cervellin G. E-cigarettes and cardiovascular risk: beyond science and mysticism. Semin Thromb Hemost 2014; 40 (1) 60-65
• 13 Sitruk-Ware R, Plu-Bureau G, Menard J , et al. Effects of oral and transvaginal ethinyl estradiol on hemostatic factors and hepatic proteins in a randomized, crossover study. J Clin Endocrinol Metab 2007; 92 (6) 2074-2079
• 14 Agostino H, Di Meglio G. Low-dose oral contraceptives in adolescents: how low can you go?. J Pediatr Adolesc Gynecol 2010; 23 (4) 195-201
• 15 Verhaeghe J. Clinical practice: Contraception in adolescents. Eur J Pediatr 2012; 171 (6) 895-899
• 16 Dulícek P, Malý J, Pecka M, Beránek M, Cermáková E, Malý R. Venous thromboembolism in young female while on oral contraceptives: high frequency of inherited thrombophilia and analysis of thrombotic events in 400 Czech women. Clin Appl Thromb Hemost 2009; 15 (5) 567-573
• 17 Dinger J, Assmann A, Möhner S, Minh TD. Risk of venous thromboembolism and the use of dienogest- and drospirenone-containing oral contraceptives: results from a German case-control study. J Fam Plann Reprod Health Care 2010; 36 (3) 123-129
• 18 Pillai P, Bonny AE, O'Brien SH. Contraception-related venous thromboembolism in a pediatric institution. J Pediatr Adolesc Gynecol 2013; 26 (3) 186-188
• 19 Samková A, Lejhancová K, Hak J, Lukes A. Venous thromboembolism in adolescents. Acta Med (Hradec Kralove) 2012; 55 (2) 78-82
• 20 Bank I, Libourel EJ, Middeldorp S , et al. Elevated levels of FVIII:C within families are associated with an increased risk for venous and arterial thrombosis. J Thromb Haemost 2005; 3 (1) 79-84
• 21 Kraaijenhagen RA, in't Anker PS, Koopman MM , et al. High plasma concentration of factor VIIIc is a major risk factor for venous thromboembolism. Thromb Haemost 2000; 83 (1) 5-9
• 22 van Vlijmen EF, Veeger NJ, Middeldorp S , et al. Thrombotic risk during oral contraceptive use and pregnancy in women with factor V Leiden or prothrombin mutation: a rational approach to contraception. Blood 2011; 118 (8) 2055-2061 , quiz 2375
• 23 Middeldorp S, Meinardi JR, Koopman MM , et al. A prospective study of asymptomatic carriers of the factor V Leiden mutation to determine the incidence of venous thromboembolism. Ann Intern Med 2001; 135 (5) 322-327
• 24 Wu O, Greer IA. Is screening for thrombophilia cost-effective?. Curr Opin Hematol 2007; 14 (5) 500-503
• 25 Creinin MD, Lisman R, Strickler RC. Screening for factor V Leiden mutation before prescribing combination oral contraceptives. Fertil Steril 1999; 72 (4) 646-651
• 26 Dietrich JE, Hertweck SP. Thrombophilias in adolescents: the past, present and future. Curr Opin Obstet Gynecol 2008; 20 (5) 470-474
• 27 van Hylckama Vlieg A, Helmerhorst FM, Rosendaal FR. The risk of deep venous thrombosis associated with injectable depot-medroxyprogesterone acetate contraceptives or a levonorgestrel intrauterine device. Arterioscler Thromb Vasc Biol 2010; 30 (11) 2297-2300
• 28 World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 4th ed. In: Geneva, Switzerland: World Health Organization; 2009
• 29 Chroustova D, Kubinyi J, Jansa P, Veprekova L, Trnka J. V/P scan in diagnosis and follow-up of pulmonary embolism in 15-25-year-old females in relation to hormonal contraception use. Nucl Med Rev Cent East Eur 2011; 14 (2) 63-67