Yazarlar : van Vlijmen EF, Veeger NJ, Middeldorp S, Hamulyák K, Prins MH, Büller HR, Meijer K.

Yayın : Blood.

Yayın Yılı : 2011

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/21659542

Konu : Tromboz

Literatür İçeriği :

Abstract

Current guidelines discourage combined oral contraceptive (COC) use in women with hereditary thrombophilic defects. However, qualifying all hereditary thrombophilic defects as similarly strong risk factors might be questioned. Recent studies indicate the risk of venous thromboembolism (VTE) of a factorVLeiden mutation as considerably lower than a protein C, protein S-, or antithrombin deficiency. In a retrospective family cohort study, the risk of VTE during COC-use and pregnancy-postpartum was assessed in 798 female relatives of symptomatic probands with heterozygous, double heterozygous or homozygous factorVLeiden or prothrombin G20210A mutation. Overall absolute VTE risk in women with no, single or combined defects was 0.13 (95%CI:0.08-0.21), 0.35 (95%CI:0.22-0.53), and 0.94 (95%CI:0.47-1.67) per 100 person-years, while these were 0.19 (95%CI:0.07-0.41), 0.49 (95%CI:0.18-1.07), and 0.86 (95%CI:0.10-3.11) during COC-use, and 0.73 (95%CI:0.30-1.51), 1.97 (95%CI:0.94-3.63), and 7.65 (95%CI:3.08-15.76) during pregnancy-postpartum. COC-use and pregnancy-postpartum were independent risk factors for VTE, with highest risk during pregnancy-postpartum, as demonstrated by adjusted HRs of 16.0 (95%CI:8.0-32.2) versus 2.2 (95%CI:1.1-4.0) during COC-use, respectively. Rather than strictly contra-indicating COC-use, we advocate that detailed counseling on all contraceptive options, including COCs, should be performed, addressing the associated risks of both VTE and unintended pregnancy, in order to enable these women to make an informed choice.

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