Screening for activated protein C resistance before oral contraceptive treatment: a pilot study.
The feasibility and cost-effectiveness of screening women for congenital thrombophilic alterations before oral contraceptive (OC) treatment was investigated. A total of 525 women (mean age 21.9 years, 73% aged < 25 years) were examined before their first OC course. At first screening, completely normal results were recorded in 485 (92.4%) women, the remaining showing single (n = 34) or multiple (n = 6) alterations. At second examination (possible in 37 of 40), activated protein C resistance (APCR) was confirmed in 21 cases (4.0%, 18 with factor V Leiden), protein C, or protein S reduction in 8 (1.5%) and 2 (0.4%) cases, respectively. No cases with antithrombin III deficiency were detected. The global estimated cost ($US) to detect one altered case was: $7795 for protein S, $2696 for antithrombin III (no case found), $1374 for protein C and $433 for APCR. The present study confirms that extensive thrombophilic screening before OC treatment is not currently advisable. APCR assessment, however, seems to have a favorable cost-effectiveness ratio: the alteration is frequent and has a synergistic effect with OC; sensibility and specificity of some methods are good; family history is unreliable to single out possible carriers; finally, carriers can be fully informed of their increased thrombotic risk if treated with OC and can receive thromboprophylaxis during life situations associated with high thrombotic risk (e.g., pregnancy and puerperium).
Palareti
G
G
Department of Angiology and Blood Coagulation, University Hospital S. Orsola-Malpighi, Bologna, Italy. palareti@tin.it
Legnani
C
C
Frascaro
M
M
Flamigni
C
C
Gammi
L
L
Gola
G
G
Fuschini
G
G
Coccheri
S
S
D020016:Activated Protein C Resistance / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000990:Antithrombin III / Q000032:analysis; D003276:Contraceptives, Oral / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D005165:Factor V / Q000032:analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D008403:Mass Screening / Q000191:economics; D010865:Pilot Projects; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D011644:Puerperal Disorders / Q000517:prevention & control
D003276:Contraceptives, Oral; D011486:Protein C; D017293:Protein S; C095381:factor V Leiden; D000990:Antithrombin III; D005165:Factor V