Rapid activation of haemostasis after hormonal emergency contraception

Marianne van Rooijen; Angela Silveira; Stella Thomassen; Lars-Olof Hansson; Jan Rosing; Anders Hamsten; Katarina Bremme

doi:10.1160/TH06-09-0540

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2007; 97(01): 15-20
DOI: 10.1160/TH06-09-0540

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Rapid activation of haemostasis after hormonal emergency contraception

Marianne van Rooijen

¹Department of Woman and Child Health, Division of Obstetrics and Gynecology

,

Angela Silveira

²Department of Medicine, Atherosclerosis Research Unit, King Gustaf V Research Institute, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

,

Stella Thomassen

³Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands and

,

Lars-Olof Hansson

⁴Department of Clinical Chemistry and Pharmacology, University Hospital, Uppsala, Sweden

,

Jan Rosing

³Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands and

,

Anders Hamsten

²Department of Medicine, Atherosclerosis Research Unit, King Gustaf V Research Institute, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

,

Katarina Bremme

¹Department of Woman and Child Health, Division of Obstetrics and Gynecology

› Author Affiliations

Abstract

Summary

Hormonal emergency contraception (EC) is a well established contraceptive method, recommended to all women, although the effects on haemostais are not fully evaluated. The aim of this study was to evaluate whether exposure to EC has effects on well established cardiovascular risk factors, and also to examine whether differences exist between two EC treatments. In a prospective randomized cross over design 11 women used two different EC methods, one with estrogen and levonorgestrel (EE-EC) and one with levonorgestrel only (LNG-EC). Plasma concentrations of haemostatic factors (APC resistance, antithrombin, fibrinogen, prothrombin fragment 1+2, free protein S, factor VII and PAI-1), sex-hormone-binding globulin (SHBG), the apolipoprotein (apo)B/apoA1 ratio and C-reactive protein (CRP) were followed frequently during the following 48 h A rapid haemostatic activation was induced with both treatments, although more pronounced with EE-EC. Already two hours after EC, the plasma concentrations of haemostatic parameters and SHBG were significantly different from baseline concentrations. An ETP-based APC-resistance method showed increased APC resistance with EE-EC and decreased APC resistance with LNG-EC. The ApoB/ApoA1 ratio was affected in a favourable direction with EE-EC.CRP increased slightly regardless of treatment. Even a very short exposure to exogenous sex hormones causes prompt effects on hepatic protein synthesis and the coagulation system. This must be taken into consideration whenever exogenous steroid hormones are administered, especially to individuals with a genetic predisposition to thrombosis or transiently disturbed haemostasis.

Keywords

APC resistance - estrogen - levonorgestrel - SHBG

Full Text

References

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