Oral contraceptives and thrombosis.
Oral contraceptives (OCs) are used by many millions of healthy young women. Their ease of use and efficacy against unwanted pregnancy has made them an indispensable part of modern society. Despite various changes in formulation, they are clearly associated with an increased risk of venous thromboembolism (VTE). Case-control and prospective studies have developed a range of relative risks of VTE, but the important issue is the impact of VTE relative to perceived benefits of the OC. This involves societal as well as medical judgment. The development of third-generation OCs has led to considerable concerns that these newer preparations may be associated with additional thrombotic risks over and above those of the traditional second-generation preparations. The paradoxical effect, that a change in progestogen in the combined OC could lead to increased VTE, could be explained by the induction of activated protein C resistance. In a society that is less prepared to accept unwanted side effects from medications, it is recommended that increased attention be given to patient selection, and possibly the incorporation into this process of some of the more recently discovered hypercoagulability markers.
Department of Pathology and Laboratory Medicine, The University of British Columbia, UBC Hospital, Vancouver, Canada.
C J
CJ
Carter
D001780:Blood Coagulation Tests; D003276:Contraceptives, Oral / Q000009:adverse effects* / Q000737:chemistry; D005260:Female; D006801:Humans; D018579:Patient Selection; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000517:prevention & control
D003276:Contraceptives, Oral