Download PDF
Hamostaseologie 2009; 29(02): 193-196
DOI: 10.1055/s-0037-1617024
Original Article
Schattauer GmbH

Contraception and thrombophilia

Kontrazeption bei Thrombophilie
H. Rott
1   Ambulanz für Gerinnungsstörung/Hämophilie, MVZ Labor Duisburg, Germany
,
A. Kruempel
2   Abteilung für Hämatologie und Onkologie , Universtitäts-Kinderklinik Münster, Germany
,
G. Kappert
1   Ambulanz für Gerinnungsstörung/Hämophilie, MVZ Labor Duisburg, Germany
,
U. Nowak-Göttl
2   Abteilung für Hämatologie und Onkologie , Universtitäts-Kinderklinik Münster, Germany
,
S. Halimeh
1   Ambulanz für Gerinnungsstörung/Hämophilie, MVZ Labor Duisburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
29 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

The risk of thromboembolic events (TE) is increased by acquired or inherited thrombo -philias (IT). We know that some hormonal contraceptives also increase the risk of thrombosis, thus, the use of such contraceptives are discussed as contraindications in women with IT. TEs are infrequent events in children and adolescents and in the majority of cases are associated with secondary complications from underlying chronic illness. Although adolescents are not typically considered to be at high-risk for TE, this cohort is frequently using hormonal contraception, leading to an increased risk in cases with unknown IT. The risk of TE with pregnancy alone is higher than associated with combined hormonal contra -ception. Progestin-only methods have not been found to increase the risk of TE with only moderate changes of coagulation proteins compared to normal reference values. Conclusion: Thrombophilic women are good candidates for progestin-only contraceptive methods.

Zusammenfassung

Das Risiko thromboembolischer Erkrankungen (TE) ist erhöht im Rahmen erworbener oder hereditärer Thrombophilien. Die Anwen-dung hormoneller Kontrazeptiva erhöht eben-falls das Thromboembolierisiko. Sie werden daher als Kontraindikation bei thrombophilen Frauen angesehen. TEs sind im Kindes- und Jugendalter eher selten und meist mit chronischen Erkrankungen oder anderen typischen Risikosituationen assoziiert. Jugendliche gehören also eher zur Niedrig-RisikoGruppe für TE. Doch sie verwenden häufig hormonelle Kontrazeptiva. Das Risiko einer TE durch Schwangerschaft ist höher als das bei Einnahme der üblichen kombinierten hormonellen Kontrazeptiva (KOK). Rein Gestagenhaltige Kontrazeptiva scheinen das Risiko von TE nicht zu erhöhen bei nur moderaten Änderungen der Hämostase. Schlussfolgerung: Rein Gestagen-haltige Kontrazeptiva sind eine gute Alternative für thrombophile Frauen.

Keywords

Thrombophilia - contraception - anti -coagulation - pregnancy

Schlüsselwörter

Thrombophilie - Kontrazeption - Antikoagulation - Schwangerschaft
 

  • References

  • 1 Barkfeldt J, Virkkunen A, Dieben T. The effects of two progestogen-only pills containing either desogestrel (75 μg/day) or levonorgestrel (30 μg/day) on lipid metabolism. Contraception 2001; 64: 295-299.
    CrossrefPubMedGoogle Scholar
  • 2 Bloemenkamp KW, Rosendaal FR, Helmerhorst FM. et al. Hemostatic effects of oral contraceptives in women who developed deep-vein thrombosis while using oral contraceptives. Thromb Haemost 1998; 80: 382-387.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Deutsche Ges. für Gynäkologie und Geburtshilfe e.V. Leitlinien 5/2008, Empfängnisverhütung.
    PubMed
  • 4 Dinger JC, Heinemann LA, Kühl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveil-lance Study on oral contraceptives based on 142,475 women-years of observation. Contraception 2007; 75: 344-354.
    CrossrefPubMedGoogle Scholar
  • 5 Douketis JD, Ginsberg JS, Holbrook A. et al. A reevaluation of the risk for venous thromboembolism with the use of oral contraceptives and hormone replacement therapy. Arch Intern Med 1997; 157: 1522-1530.
    CrossrefPubMedGoogle Scholar
  • 6 Endrikat J, Klipping C, Cronin M. et al. An open label, comparative study of the effects of a dose-reduced oral contraceptive containing 20 μg ethinyl -estradiol and 100 μg levonorgestrel on haemo -static, lipids, and carbohydrate metabolism variables. Contraception. 2002; 65: 215-221.
    PubMedGoogle Scholar
  • 7 Farmer RDT, Lawrenson RA, Thompson CR. et al. Population-based study of risk of venous thromboembolism associated with various oral contraceptives. Lancet 1997; 349: 83-88.
    CrossrefPubMedGoogle Scholar
  • 8 Fleischer K, van Vliet HA, Rosendaal FR. et al. Effects of the contraceptive patch, the vaginal ring and an oral contraceptive on APC resistance and SHBG: A cross-over study. Thromb Res 2009; 123: 429-435.
    CrossrefPubMedGoogle Scholar
  • 9 Gillum LA, Mamidipudi SK, Johnston SC. Ischemic stroke risk with oral contraceptives: a meta-analysis. JAMA 2000; 284: 72-78.
    CrossrefPubMedGoogle Scholar
  • 10 Gräser T. Sexual steroids and hemostasis. Hämostaseologie 2001; 21: 30-34.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Heinemann LA, Assmann A, DoMinh T, Garbe E. Oral progestogen-only contraceptives and cardioavascular risk: results from the Transnational Study on Oral Contraceptives and the Health of Young Women. Eur J Contracept Reprod Health Care 1999; 4: 67-73.
    CrossrefPubMedGoogle Scholar
  • 12 Hughes Q, Watson M, Cole V. et al. Upregulation of protein S by progestins. J Thromb Haemost 2007; 5: 2243-2249.
    CrossrefPubMedGoogle Scholar
  • 13 Jick S, Kaye JA, Li L, Jick H. Further results on the risk of nonfatal venous thromboembolism in users of the contraceptive transdermal patch compared to users of oral contraceptives containing norgesti-mate and 35 microg of ethinyl estradiol. Contraception 2007; 76: 4-7.
    CrossrefPubMedGoogle Scholar
  • 14 Jick H, Jick SS, Gurewich V. et al. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using OC. Lancet 1995; 346: 1589-1593.
    CrossrefPubMedGoogle Scholar
  • 15 Johnson JV, Lowell J, Badger GJ. et al. Effects of oral and transdermal hormonal contraception on vascular risk markers: a randomized controlled trial. Obstet Gynecol 2008; 111: 278-284.
    CrossrefPubMedGoogle Scholar
  • 16 Kemmeren JM, Algra A, Grobbee DE. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. Br Med J 2001; 323: 131-134.
    CrossrefPubMedGoogle Scholar
  • 17 Koster T, Small RA, Rosendaal FR, Helmerhorst FM. Oral contraceptives and venous thromboembolism: a quantitative discussion of the uncertainties. J Intern Med 1995; 238: 31-37.
    CrossrefPubMedGoogle Scholar
  • 18 Lewis MA, Spitzer WO, Heinemann LA. et al. Third generation oral contraceptives and risk of venous thromboembolic disorders; an international case-control study. Br Med J 1996; 312: 83-88.
    CrossrefPubMedGoogle Scholar
  • 19 Lidegaard O, Edström B, Kreiner S. Oral contraception and venous thromboembolism: a case control study. Contraception 1998; 57: 291-301.
    CrossrefPubMedGoogle Scholar
  • 20 Lidegaard O, Edström B, Kreiner S. Oral contraceptives and venous thromboembolism: a five-year national case-control study. Contraception 2002; 65: 187-196.
    CrossrefPubMedGoogle Scholar
  • 21 Marcelo PV, Gomes MD, Steven R. et al. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormonal replacement therapy. Arch Intern Med 2004; 164: 1965-1976.
    CrossrefPubMedGoogle Scholar
  • 22 Morin-Papunen L, Martikainen H, McCarthy MI. et al. Comparison of metabolic and inflammatory outcomes in women who used oral contraceptives and the levonorgestrel-releasing intrauterine device in a general population. Am J Obstet Gynecol 2008; 199 529. e1-529.e10.
    PubMedGoogle Scholar
  • 23 Parkin L, Skegg DC, Wilson M. et al. Oral conraceptives and fatal pulmonary embolism. Lancet 2000; 355: 2133-2134.
    CrossrefPubMedGoogle Scholar
  • 24 Poulter NR, Chang CL, Farley TMM. et al. for the World Health Organization Collaborative Study of Cardiovascular disease and Steroid hormone contraception Investigators. Venous thromboembolic disease and combined oral contraceptives: results of an international multicenter case-control study. Lancet 1995; 346: 1575-1582.
    CrossrefPubMedGoogle Scholar
  • 25 Rott H, Kappert G, Halimeh S. Menorrhagia is common in patients on oral anticoagulation with vitamin-k-antagonist phenprocoumon. Hämostaseologie 2009; 29: A83.
    PubMedGoogle Scholar
  • 26 Royal College of Obstetricians and Gynaecologists (RCOG).. Venous thromboembolism and hormonal contraception. Guideline No. 40. London: RCOG; 2004: 13.
    Google Scholar
  • 27 Sartwell PE, Masi AT, Arthes FG. et al. Thromboembolism and oral contraceptives: an epidemiologic case–control study. Am J Epidemiol 1969; 90: 365-380.
    CrossrefPubMedGoogle Scholar
  • 28 Tans G, Curvers J, Middeldorp S. et al. A randomized cross-over study on the effects of levonorgestreland desogestrel-containing oral contraceptives on the anticoagulant pathways. Thromb Haemost 2000; 84: 15-21.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Van Rooijen M, Silveira A, Thomassen S. et al. Rapid activation of haemostasis after hormonal emergency contraception. Thromb Haemost 2007; 97: 15-20.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Van Vliet HA, Bertina RM, Dahm AE. et al. Different effects of oral contraceptives containing different progestogens on protein s and tissue factor pathway inhibitor. J Thromb Haemost 2008; 6: 346-351.
    CrossrefPubMedGoogle Scholar
  • 31 Van Vliet HA, Grimes DA, Helmerhorst FM, Schulz KF. Biphasic versusmonphasic oral contraceptives for contraception. The Cochrane Database of Systematic Reviews, Cochrane Library number: CD002032. In The Cochrane Library, Issue 2 2002
    PubMedGoogle Scholar
  • 32 Vasilakis C, Jick SS, Jick H. The risk of venous thromboembolism in users of postcoital contraceptive pills. Contraception 1999; 59: 79-83.
    CrossrefPubMedGoogle Scholar
  • 33 Vasilakis-Scaramozza C, Jick H. Risk of venous thromboembolism with cyproterone or levonorgestrel contraceptives. Lancet 2001; 358: 1427-1429.
    CrossrefPubMedGoogle Scholar
  • 34 Vieira CS, Ferriani RA, Garcia AA. et al. Use of the etonogestrel-releasing implant is associated with hypoactivation of the coagulation cascade. Hum Reprod 2007; 22: 2196-2201.
    CrossrefPubMedGoogle Scholar
  • 35 Winkler UH. A randomized controlled double-blind study of the effects on hemostasis of two progeston-only pills containing 75 μg desogestrel or 30 μg levonorgestrel. Contraception 1998; 57: 385-392.
    CrossrefPubMedGoogle Scholar
  • 36 World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception: Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives: Results of an international, multicenter, case-control study. Contraception 1998; 57: 315-324.
    CrossrefPubMedGoogle Scholar
  • 37 Wooltorton E. Diane-35 (Cyproterone acetate) safety concerns. CMAJ 2003; 168: 455.
    PubMedGoogle Scholar