Oral contraceptives and blood coagulation: a critical review

Based on epidemiologic data, women who take oral contraceptives seem to have an increased risk of developing thromboembolic disease. In order to explain this association, some studies have been undertaken to find abnormalities in the hemostasis system. Many conflicting test results have been reported, probably reflecting in part the technical difficulties in use of reliable, reproducible, and specific assay systems. None of the data obtained seems to be specific for users of oral contraceptive drugs, and none was found uniformly in all takers of the drugs. Many findings are probably unimportant from the overall point of view of the physiology of hemostasis. Unfortunately, there seems to be no test procedure or even combination of tests that will reliably predict which patient might develop a thromboembolic episode in association with oral contraceptives or in association with any other condition recognized as being a risk factor. Even in most patients who do have a thrombosis, the test procedures fail to signal this event with reliability and predictability. At this time, it is not known whether oral contraceptives do or do not trigger the hemostasis system to develop a thrombosis or by which mechanism they could trigger the event. Fortunately, only a very small number of women develop thrombosis in association with oral contraceptives.