Oral contraception and thrombophilia.
OBJECTIVE
To describe current knowledge related to the association between oral contraception and the thrombophilias.


RESULTS
The use of oral contraception increases the risk of venous thromboembolism as well as arterial thrombosis. Third-generation pills seem to increase the risk of venous thromboembolism compared with second-generation pills. This effect seems to be reversed or absent for the risk of arterial thrombosis. The effect of oral contraception on the risk of venous thromboembolism is more pronounced during the first year of use. All these risks are further increased in patients with an inborn or acquired tendency for coagulation (thrombophilia).


CONCLUSIONS
Prospective users of oral contraception are potential candidates for screening/testing, because a positive screen may substantially decrease the risk of a thrombotic event. At present, the available testing methods are not cost effective, and the absolute risk is not defined for each thrombophilia. Until these shortcomings are solved, it is not recommended to test every woman who wishes to use oral contraception. Nevertheless, before starting on oral contraception, each patient should be carefully screened by a physician who should identify an increased risk of thrombophilia and tailor the laboratory testing.
Blickstein
Dorit
D
Hemato-Gynecology Service, Institute of Hematology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel. blick@netvision.net.il
Blickstein
Isaac
I
D001780:Blood Coagulation Tests / Q000191:economics / Q000379:methods; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D003280:Contraceptives, Oral, Synthetic / Q000008:administration & dosage / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications* / Q000175:diagnosis*; D013927:Thrombosis / Q000139:chemically induced*
D003278:Contraceptives, Oral, Hormonal; D003280:Contraceptives, Oral, Synthetic