Related Experiment Videos
[Hormonal contraception and thromboembolic disease--pathophysiologic findings and practical recommendations]
1Oddĕlení klinické hematologie FN Hradec Králové.
Insights
Combined oral contraceptives users experience changes in their hemostatic system, including procoagulant and fibrinolytic activity. While differences exist between progestins, the risk of venous thromboembolism (VTE) primarily depends on patient history and counseling.
Area of Science:
- Hematology
- Pharmacology
Context:
- Combined oral contraceptives (COCs) are widely used by women of reproductive age.
- Understanding their impact on the hemostatic system is crucial for assessing thrombotic risk.
Purpose:
- To review and synthesize knowledge on hemostatic system alterations in COC users.
- Focus on studies published between 1997 and 2000.
Summary:
- Literature review indicates COCs affect procoagulant, fibrinolytic, and natural coagulation inhibitor systems.
- Recent studies suggest third-generation progestins, like desogestrel, may induce greater changes in hemostasis compared to levonorgestrel.
- Acquired resistance to activated protein C is more pronounced with third-generation progestins.
Impact:
- Findings highlight potential differences in thrombotic risk profiles associated with various progestins in COCs.
- Emphasizes the importance of individualized risk assessment, considering patient history and counseling, over solely progestin choice for minimizing venous thromboembolism (VTE) risk.
Objective:
Review the knowledge about changes in hemostatic system in combined oral contraceptives users (focused on studies published between 1997 and 2000).
Type Of Study:
Review of literature.
Setting:
Department of Clinical Hematology, University Hospital Hradec Králové, Czech Republic.
Methods:
Summary of the results of substantial studies published on this topic. Studies were identified by Medline database search.
Results:
Hemostatic changes were described in all subsystems (in both procoagulant and fibrinolytic systems, in natural inhibitors of coagulation) and could be seen also in molecular marks of coagulation and fibrinolysis activity. Substantial differences were not described for ethinylestradiol doses 20-50 micrograms and up to 1997 also not for different progestins. More expressed acquired resistance to activated protein C at 3rd generation progestins in comparison with levonorgestrel was described recently as well as greater inhibition of fibrinolysis at desogestrel users.
Conclusion:
The results of recent studies indicate the differences in hemostatic changes between users of 3rd generation progestins, respective desogestrel, and users of levonorgestrel. However, the practical recommendations (aiming at minimalization of VTE risk) are focused on personal and family history and on patient counseling. The choice of progestin could be important but it is not crucial.