title: [Pulmonary embolism in patients using estrogen-progestagen contraceptives].
abstract: OBJECTIVE
  The risk of thromboembolism in patients taking estrogen-progestagen oral contraceptive drugs has apparently increased since the introduction of third-generation progestagens (desogestrel, gestodene). We examined the clinical features, risk factors and outcome of pulmonary embolism in this context.
  
  
  METHODS
  We reviewed 11 cases of thromboembolism in patients on oral contraception and hospitalized in emergency situations in 1995 and 1996 for pulmonary embolism in order to determine the gravity of the thromboembolic event, risk factors and type of drug used.
  
  
  RESULTS
  Early clinical signs had preceded the onset of embolism by 2 to 164 days. PaO2 was below 70 mmHg in 4 patients. Diagnosis was achieved with pulmonary scintigraphy (11 cases), spiral CT (3 cases) and angiopneumography (2 cases). Duplex Doppler visualized the phlebitis in 7 patients. Given heparin (with fibrinolysis in 3 cases) then anti-vitamin K, and after withdrawal of the oral contraceptive, outcome was favorable in all cases. There were no recurrences. The nature of the oral contraceptive varied. Five patients were taking third-generation progestagens. In two cases, embolism had occurred following a change from a second-generation to a third-generation progestagen. Family history of phlebitis and/or abnormal laboratory findings were observed in 6 patients: resistance to activated protein C (2 patients), protein C deficiency (2 patients), anticardiolipin (2 patients) and low-titre antinuclear antibodies (2 patients).
  
  
  CONCLUSIONS
  Pulmonary embolism in patients on oral contraceptives persists despite changes in the hormone content of the drugs. Diagnosis is often delayed. Family history of thrombosis or biological risk factors are often found.
authors.affiliation: Services de Médecine interne, Hôpital Purpan, Toulouse. lauque.d@chu-toulouse.fr
authors.forename: D
authors.initials: D
authors.lastname: Lauque
authors.forename: J
authors.initials: J
authors.lastname: Mazières
authors.forename: P
authors.initials: P
authors.lastname: Rouzaud
authors.forename: P
authors.initials: P
authors.lastname: Sié
authors.forename: B
authors.initials: B
authors.lastname: Chamontin
authors.forename: D
authors.initials: D
authors.lastname: Carrié
authors.forename: C
authors.initials: C
authors.lastname: Hermant
authors.forename: M
authors.initials: M
authors.lastname: Tubery
authors.forename: P
authors.initials: P
authors.lastname: Carles
mesh_terms: D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects*; D003280:Contraceptives, Oral, Synthetic / Q000009:adverse effects; D004967:Estrogens / Q000009:adverse effects; D005260:Female; D006801:Humans; D011655:Pulmonary Embolism / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D003277:Contraceptives, Oral, Combined; D003280:Contraceptives, Oral, Synthetic; D004967:Estrogens
vernacular_title: Embolies pulmonaires sous contraception estro-progestative.