The effect of the levonorgestrel-releasing intrauterine system on the resistance to activated protein C (APC)

Huib A. A. M. van Vliet; Svetlana N. Tchaikovski; Frits R. Rosendaal; Jan Rosing; Frans M. Helmerhorst

doi:10.1160/TH08-09-0621

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 101(04): 691-695
DOI: 10.1160/TH08-09-0621

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

The effect of the levonorgestrel-releasing intrauterine system on the resistance to activated protein C (APC)

Huib A. A. M. van Vliet

¹Department of Gynaecology and Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands

,

Svetlana N. Tchaikovski

²Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands

,

Frits R. Rosendaal

³Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands

⁴Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

,

Jan Rosing

²Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands

,

Frans M. Helmerhorst

¹Department of Gynaecology and Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands

⁴Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

› Author Affiliations

Abstract

Summary

Exogenously administered estrogens and progestogens as during combined oral contraceptive use increase the risk of venous thrombosis. The thrombin generation-based APC resistance assay is a global coagulation test that enables quantification of the net prothrombotic effect of combined oral contraceptives and that predicts the risk of thrombosis. The thrombotic risk of the levonorgestrel-releasing intrauterine system is unknown. It was the objective of this study to evaluate the thrombotic risk by comparing the APC resistance before and after insertion of a levonorgestrel-releasing or a copper-containing intrauterine device. We measured normalized APC-sensitivity ratios (nAPCsr) before and three months after insertion of the levonorgestrelintrauterine system in 56 women and the copper-intrauterine device in 18 women. In women without hormonal contraceptive use or a pregnancy in the three months before collection of the baseline samples, nAPCsr were lower three months after insertion of the levonorgestrel-intrauterine system than at baseline (difference –0.29; 95% CI –0.04 to –0.53) and hardly changed after insertion of the copper-intrauterine device (difference -0.11; 95% CI –1.03 to 0.82). In women who switched from a combined oral contraceptive to the levonorgestrel-system the difference was more pronounced (-1.48; 95% CI –0.85 to –2.11). In this study we observed that the levonorgestrel-intrauterine system decreases the resistance to APC which indicates that the levonorgestrel-intrauterine system does not have a prothrombotic effect.

Keywords

Intrauterine device - activated protein C resistance - venous thrombosis - hemostasis

Full Text

References

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