Risk factors for venous thromboembolism in women under combined oral contraceptive. The PILl Genetic RIsk Monitoring (PILGRIM) Study.
Identifying women at risk of venous thromboembolism (VTE) is a major public health issue. The objective of this study was to identify environmental and genetic determinants of VTE risk in a large sample of women under combined oral contraceptives (COC). A total of 968 women who had had one event of VTE during COC use were compared to 874 women under COC but with no personal history of VTE. Clinical data were collected and a systematic thrombophilia screening was performed together with ABO blood group assessment. After adjusting for age, family history, and type and duration of COC use, main environmental determinants of VTE were smoking (odds ratio [OR] =1.65, 95% confidence interval [1.30-2.10]) and a body mass index higher than 35 kg.m⁻² (OR=3.46 [1.81-7.03]). In addition, severe inherited thrombophilia (OR=2.13 [1.32-3.51]) and non-O blood groups (OR=1.98 [1.57-2.49]) were strong genetic risk factors for VTE. Family history poorly predicted thrombophilia as its prevalence was similar in patients with or without first degree family history of VTE (29.3% vs 23.9%, p=0.09). In conclusion, this study confirms the influence of smoking and obesity and shows for the first time the impact of ABO blood group on the risk of VTE in women under COC. It also confirms the inaccuracy of the family history of VTE to detect inherited thrombophilia.
Pierre
P
Suchon
Fadi
F
Al Frouh
Agathe
A
Henneuse
Manal
M
Ibrahim
Dominique
D
Brunet
Marie-Christine
MC
Barthet
Marie-Françoise
MF
Aillaud
Geoffroy
G
Venton
Marie-Christine
MC
Alessi
David-Alexandre
DA
Trégouët
Pierre-Emmanuel Morange, Laboratory of Hematology, CHU Timone, 264, Rue Saint-Pierre, 13385 Marseille cedex 05, France, Tel.: +33 4 91 38 60 49, Fax: +33 4 91 94 23 32, E-mail: pierre.morange@ap-hm.fr.
Pierre-Emmanuel
PE
Morange
D000017:ABO Blood-Group System; D000328:Adult; D015992:Body Mass Index; D016009:Chi-Square Distribution; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D019851:Thrombophilia / Q000453:epidemiology / Q000235:genetics; D054556:Venous Thromboembolism / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics* / Q000517:prevention & control; D055815:Young Adult
D000017:ABO Blood-Group System; D003278:Contraceptives, Oral, Hormonal
Deep-vein thrombosis; oral contraceptives; thrombophilia