Pulmonary embolism and deep vein thrombosis related to oral contraceptive use

ABSTRACT Use of combined oral contraceptive pill (COC) is associated with a three fold increase in venous thromboembolism (VTE) risk compared to nonuse.1 The absolute risk for deep vein thrombosis (DVT) in younger women without risk factor for VTE is extremely low. We report here a case of thrombosis of both deep and superficial venous system following use of second generation COC for just 2 months. How to cite this article Malhotra J, Garg R, Agrawal P. Deep Vein Thrombosis due to Oral Contraceptive use in a Young Female. J South Asian Feder Obst Gynae 2013;5(3):161-162.

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Venous Thrombosis, Oral Contraceptives and High Factor VIII Levels

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614323 ◽

1999 ◽

Vol 82 (09) ◽

pp. 1024-1027 ◽

Cited By ~ 41

Author(s):

K. W. M. Bloemenkamp ◽

F. M. Helmerhorst ◽

J. P. Vandenbroucke ◽

F. R. Rosendaal

Keyword(s):

Deep Vein Thrombosis ◽

Oral Contraceptive ◽

Venous Thrombosis ◽

Factor Viii ◽

Odds Ratio ◽

Contraceptive Use ◽

Vein Thrombosis ◽

Control Subjects ◽

Oral Contraceptive Use ◽

Deep Vein

SummaryRecently, it has been described that elevated plasma levels of factor VIII are a strong risk factor for venous thrombosis. We analysed the data of the Leiden Thrombophilia Study, a population based case-control study on the causes of venous thrombosis, to verify whether the risk due to oral contraceptive use was higher in women with higher factor VIII levels. Furthermore we investigated the joint risk of high factor VIII levels and oral contraceptive use.We selected 155 premenopausal women with deep-vein thrombosis and 169 control subjects, aged 15-49, who were at the time of their thrombosis (or similar date in control) not pregnant, nor in the puerperium, did not have a recent miscarriage, and were not using injectable progestogens. Of the patients, 109 (70%) women had used oral contraceptives during the month preceding their deep-vein thrombosis, in contrast to 65 (38%) of the control subjects (index date), yielding an odds ratio for oral contraceptive use of 3.8 (95% CI 2.4-6.0). Of the women who suffered a deep-vein thrombosis 56 (36%) had high factor VIII levels (≥150 IU/dl) as compared with 29 (17%) of the control subjects, yielding an odds ratio for high factor VIII of 4.0 (95% CI 2.0-8.0), relative to factor VIII levels <100 IU/dl. The joint effect of oral contraceptive use and high factor VIII resulted in an odds ratio of 10.3 (95% CI 3.7-28.9), comparing women who had both with women who had neither. We conclude that there is an increase in risk due to oral contraceptive use in women with higher factor VIII levels and that both factors have additive effects.

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Hemostatic Effects of Oral Contraceptives in Women who Developed Deep-vein Thrombosis while Using Oral Contraceptives

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615216 ◽

1998 ◽

Vol 80 (09) ◽

pp. 382-387 ◽

Cited By ~ 48

Author(s):

Kitty Bloemenkamp ◽

Frans Helmerhorst ◽

Ted Koster ◽

Rogier Bertina ◽

Jan Vandenbroucke ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Oral Contraceptive ◽

Oral Contraceptives ◽

Protein C ◽

Contraceptive Use ◽

Protein S ◽

Factor Vii ◽

Factor Xii ◽

Vein Thrombosis ◽

Deep Vein

SummaryObjective: Comparison of the effect of oral contraceptives on hemostatic variables in venous thrombosis patients (thrombosis while using oral contraceptives) with the effect in healthy control subjects. Our aim was to assess whether some of these effects were more pronounced in women who had suffered thrombosis, i.e., whether these were “hemostatic hyperresponders”. Study Design: A population-based case-control study, the Leiden Thrombophilia Study. Materials and Methods: We investigated 99 pre-menopausal women, age 15-49 years, who had used oral contraceptives at the time of a first, objectively confirmed episode of deep-vein thrombosis. They were not pregnant, nor in puerperium, nor had had a recent miscarriage, and were not using injectable progestogens, nor suffering from inherited coagulation defects. The median time between occurrence of deep-vein thrombosis and venepuncture was 18 months, and 30 of the 99 women were still using oral contraceptives, while 69 had discontinued oral contraceptive use. In addition, a group of 153 control women (54 of them were oral contraceptive users and 99 were non-users) were studied. The following hemostatic variables were measured: APTT, factor VII, factor VIII, factor XII, fibrinogen, prothrombin, total antithrombin, normalised activated protein C sensitivity ratio (n-APC-sr), protein C, protein S and free protein S. Results: We found marked and significant effects of oral contraceptive use on the levels of several clotting factors, with an increase in factor VII, factor XII, protein C and a decrease in antithrombin, n-APC-sr and protein S. Less marked effects that were non-significant or only significant in either patients or controls, were an increase in factor VIII, fibrinogen and prothrombin and a decrease in the APTT and free protein S. In the former thrombosis patients several of these effects of oral contraceptives were more pronounced than in healthy women: specifically on factor VII, antithrombin, n-APC-sr and protein C. Conclusions: Our results of the effects of oral contraceptives generally confirm previous reports in healthy volunteers. Our data also show that in former deep-vein thrombosis patients these effects are more pronounced. Apparently some women become “high hemostatic responders” when exposed to oral contraceptives, and they may be the women most vulnerable to its thrombogenic effects.

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