title: Comparative study of the effects of combined oral contraceptives in hemostatic variables: an observational preliminary study.
abstract: Thrombotic risk is associated with the estrogen dose and type of progestin in combined oral contraceptives. Studies published since 1990 showed that third-generation progestins have larger risk to contribute to thrombosis development than the second-generation. However, there are conflicts in the literature regarding the thrombotic risk associated to the drospirenone progestin. So, this study aimed to evaluate the effects of 3 formulations of contraceptives containing ethinylestradiol (EE) (20 and 30 μg) combined with drospirenone versus levonorgestrel combined with EE (30 μg) in hemostatic parameters. This cross-sectional study included 70 healthy women between 18 and 30 years, BMI 19 to 30 kg/m², not pregnant, non-smokers, and users or non-users (control) of contraceptives for a minimum period of 6 months. The following parameters were assessed: prothrombin time (PT), Factor VII, activated partial thromboplastin time (aPTT), Factor XII, fibrinogen, Factor 1 + 2, Protein C, Protein S, antithrombin, D-dimers, and plasminogen activator inhibitor-1. Significant alterations were found in PT, aPTT, fibrinogen, D-dimers, and protein S, all favoring a state of hypercoagulation for contraceptive containing DRSP/20EE. Both contraceptives containing DRSP/30EE and LNG/30EE promoted changes that favor the hypercoagulability in the coagulant variable PT and in the anticoagulant variables Protein S and Protein C, respectively. We suggest that the progestin drospirenone can contribute to an inadequate balance among procoagulant, anticoagulant, and fibrinolytic factors, since that the contraceptive containing the lowest dose of estrogen and drospirenone (DRSP/20EE) caused a higher number of hemostatic changes.
authors: From the Department of Clinical, Toxicological and Bromatological Analysis, Faculty of Pharmaceutical, Sciences of Ribeirão Preto, (BS, HFF, CMM-M, MRTT); Department of Gynecology and Obstetrics (SAF,MFSDS); and Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil (EZM).
authors: Bianca
authors: B
authors: Stocco
authors: Helen F
authors: HF
authors: Fumagalli
authors: Silvio A
authors: SA
authors: Franceschini
authors: Edson Z
authors: EZ
authors: Martinez
authors: Cleni M
authors: CM
authors: Marzocchi-Machado
authors: Marcos Felipe S
authors: MFS
authors: de Sá
authors: Maria Regina T
authors: MRT
authors: Toloi
mesh_terms: D000293:Adolescent; D000328:Adult; D000736:Androstenes / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood*; D003430:Cross-Sectional Studies; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D005167:Factor VII / Q000032:analysis; D005174:Factor XII / Q000032:analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D010314:Partial Thromboplastin Time; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D011517:Prothrombin Time; D055815:Young Adult
chemical_list: D000736:Androstenes; D015415:Biomarkers; D003277:Contraceptives, Oral, Combined; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; D017293:Protein S; C534342:drospirenone and ethinyl estradiol combination; C036309:fibrin fragment D; D004997:Ethinyl Estradiol; D016912:Levonorgestrel; D005167:Factor VII; D005174:Factor XII; D005340:Fibrinogen
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