Cerebral venous thrombosis associated with repeated use of emergency contraception

Horga, Alejandro; Santamarina, Estevo; Quílez, Alejandro; Francisco, Jaume; García-Martinez, Rita; Alvarez-Sabín, J

doi:10.1111/j.1468-1331.2006.01646.x

Cited by 13 publications

(8 citation statements)

References 6 publications

(7 reference statements)

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“…2,7 Further success in reestablishing venous sinus patency has been reported using direct sinus perfusion of thrombolytic enzymes; that is, urokinase or streptokinase. 13,17 Also, activated tissue plasminogen may have some advantage in local treatment of sinus thrombosis, 18 but a definitive conclusion awaits further trials.…”

Section: Discussionmentioning

confidence: 99%

“…Seven patients had lesions in the paraventricular re gions or cortico-subcortical area. Lobar lesions (7) in cluded the cortico-subcortical temporooccipital area located on the right side in 4 cases, with 2 other lesions located in eloquent areas. Hemorrhage, which was present in 7 patients, was deeply located in 4 cases, corticosubcortical in 2, and both in 1 case.…”

Section: Neuroimaging Findingsmentioning

confidence: 99%

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Cerebral venous sinus thrombosis associated with oral contraceptives: the case for neurosurgery

Galarza

Gazzeri²

2009

FOC

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Object The goal of this study was to provide data about neurosurgical management of cerebral venous sinus thrombosis in young women after use of oral contraceptives. Methods Between 1990 and 2007, the authors treated 15 women (age range 23–45 years) in whom neurosurgical management was used for overt thrombosis of cerebral sinus. All were healthy, with a history of use of oral contraceptives. Severe headache was the most common symptom, followed by motor focal deficits and comatose state. Deep infarcts were located in the thalamic and basal ganglia region in 11 cases. Seven women had associated intracerebral hemorrhage, and 3 had ventricular dilation. Angiographic MR imaging was done in 10 patients, and conventional angiography was done in 7. Genetic analysis of chromosomal abnormalities associated with stroke was done in 5 cases. Results The intracranial pressure (ICP) was monitored in all cases. Three patients underwent external ventricular drainage, and 1 had a decompressive craniotomy. All had absence of signal in the cerebral sinus rectus, with associated thrombosis of the transverse sinus in 7 cases. Angiograms were negative for additional vascular malformation. Medical treatment included sodium heparin and mannitol in 9 cases, and enoxaparin in the other 6 patients. Genetic analysis was positive for prothrombin mutation G20210A (factor II variant) in 2 cases. The mean follow-up duration of 53 months demonstrated no neurological deficit in 10 patients, hemiparesis in 3, and severe hemiparesis with aphasia in 1 case. One woman died 5 days after a decompressive craniotomy. Conclusions Cerebral venous sinus thrombosis secondary to oral contraception in young women, including lesions in critical and deep regions, can be treated medically with acceptable morbidity. In spite of this, a subgroup of patients needed basic neurosurgical management of the lesions, including surgical measures for controlling raised ICP.

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Section: Discussionmentioning

confidence: 99%

Section: Neuroimaging Findingsmentioning

confidence: 99%

Cerebral venous sinus thrombosis associated with oral contraceptives: the case for neurosurgery

Galarza

Gazzeri²

2009

FOC

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“…However, it is disputable whether emergency contraception may cause venous thrombosis. There exists a single report of CVST after repeated use of postcoital contraceptive pills [22].…”

Section: Oral Contraceptivesmentioning

confidence: 99%

Risk Factors of Cerebral Vein and Sinus Thrombosis

Freitas

Bogousslavsky

2007

Handbook on Cerebral Venous Thrombosis

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The risk factors for deep venous thrombosis (and for cerebral vein and sinus thrombosis, CVST) differ from those for arterial disease. The risk factors for venous thrombosis are linked to the Virchow triad of stasis of the blood, changes in the vessel wall, and changes in the composition of the blood, especially the first and third of these. Risk factors are usually divided into acquired (e.g. surgery, trauma, pregnancy, puerperium, lupus anticoagulant, malignant disease, and female hormones) and genetic (congenital thrombophilia). However, the separation of genetic and acquired risk factors is somewhat artificial, since they have additive effects and venous thrombosis is often multifactorial. In this review, we discuss acquired risk factors for CVST. These include hormonal changes (e.g. oral contraceptives use, hormone replacement therapy, pregnancy and puerperium), mechanical precipitants (e.g. head trauma, jugular catheterization, surgery, lumbar puncture), local and generalized infections, cancer, acquired prothrombotic states (e.g. hyperhomocysteinemia, nephrotic syndrome), inflammatory diseases (e.g. vaculitis, intestinal inflammatory disease), hematological disorders, neurological diseases (e.g. dural arteriovenous malformations, spontaneous intracranial hypotension), drugs and other situations. However, only some conditions are consistently present in case series, while many appear only in anecdotal reports. Thus, in most situations, a causal link cannot be established. Determining a cause-and-effect relationship is essential for developing preventive, diagnostic, and therapeutic strategies. Therefore, further multicentered, case-controlled studies are crucial for better understanding the pathogenesis of CVST.

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“…Most of the severe cases detected through spontaneous reporting were precisely unintended pregnancy or ectopic pregnancy—this can be expected as they are severe, are included in the SmPC, and are well known by health professionals; besides, and through spontaneous reporting, we also identified other severe events such as thrombophlebitis, stroke, and porphyria—the case of porphyria has also been published, and this condition is not included in the SmPC. With regard to the possibility of ECP‐LNG inducing thrombosis‐related events, a rapid activation of hemostasis has been observed after hormonal emergency contraception; additionally, a case of cerebral venous thrombosis associated with repeated use of emergency contraception has been described; the two observations would be consistent with the condition that would occur. Acute porphyria, on the other hand, is known to be precipitated among other factors by hormones; in a study carried out in Sweden ( n = 166), about half of the women with acute intermittent porphyria had used oral hormonal contraceptives …”

Section: Discussionmentioning

confidence: 96%

Emergency contraceptive pill safety profile. Comparison of the results of a follow-up study to those coming from spontaneous reporting

Carvajal

Sáinz

Velasco

et al. 2014

Pharmacoepidemiol Drug Saf

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Cerebral venous thrombosis associated with repeated use of emergency contraception

Cited by 13 publications

References 6 publications

Cerebral venous sinus thrombosis associated with oral contraceptives: the case for neurosurgery

Cerebral venous sinus thrombosis associated with oral contraceptives: the case for neurosurgery

Risk Factors of Cerebral Vein and Sinus Thrombosis

Emergency contraceptive pill safety profile. Comparison of the results of a follow-up study to those coming from spontaneous reporting

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