Contraceptive Management for Women Who Are at High Risk of Thrombosis

Gray, Beverly; Floyd, Serina; James, Andra H.

doi:10.1097/grf.0000000000000356

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…This trend is reminiscent of the well-established relationship between serum estrogen levels and coaguability. 22 Future studies should study this question prospectively and assess whether there is clinical utility in repeating desmopressin responsiveness testing in female patients with type 1 VWD as they enter childbearing years and as they approach menopause.…”

Section: Discussionmentioning

confidence: 99%

Desmopressin responsiveness by age in type 1 von Willebrand disease

Goldberg

Nisenbaum

Song

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Patients with type 1 von Willebrand disease (VWD) undergo a desmopressin (DDAVP) responsiveness challenge at diagnosis to assess whether DDAVP reverses their coagulation deficits. Current practice assumes DDAVP responsiveness remains constant over the lifetime. In patients with type 1 VWD, VWF‐related parameters increase with age. This study explores whether DDAVP responsiveness also differs with age in this population. Methods We conducted a retrospective chart review of 106 patients enrolled at our center since 1990. Our primary outcome was DDAVP responsiveness at 1 hour after DDAVP challenge. Locally weighted scatterplot smoothing fit and Spearman correlation coefficients were used to study the relationship between age and DDAVP responsiveness. For female participants, we used the Kruskal‐Wallis test to compare absolute and relative changes in DDAVP responsiveness at various ages. Results We had 79 patients (56 female) with type 1 VWD with at least 1 DDAVP challenge. In women with type 1 VWD, the absolute change in DDAVP responsiveness did not vary significantly with age (VWF:antigen [Ag], −0.08, P = .56; VWF:ristocetin cofactor [RCo], −0.16, P = .26; low‐molecular‐weight component of factor VIII [FVIII:C], −0.01, P = .93), nor did the relative change in DDAVP responsiveness (VWF:Ag, −0.03, P = .86; VWF:RCo, −0.25, P = .09; FVIII:C, −0.14, P = .34). The data plot suggested a relationship. Conclusion In women with type 1 VWD, DDAVP responsiveness may vary over the life cycle. Our exploratory findings are limited by our retrospective data, cross‐sectional design, and small sample. Future studies should investigate the relationship between age and DDAVP responsiveness prospectively to evaluate whether there is clinical utility in rechallenging postpubertal female patients with type 1 VWD.

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Section: Discussionmentioning

confidence: 99%

Desmopressin responsiveness by age in type 1 von Willebrand disease

Goldberg

Nisenbaum

Song

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…(IUDs) and implants, are considered ideal for women at increased risk of VTE, because they are both estrogen-free and highly effective. 16,17 Among them, the LNG-releasing intrauterine system (LNG-IUS) is a POC that can reduce the abnormal bleeding sometimes associated with anticoagulant use. [10][11][12] However, safety data on LNG-IUS use and risk of arterial thrombosis are lacking for women at increased risk of VTE.…”

Section: Long-acting Reversible Contraceptives Such As Intrauterine mentioning

confidence: 99%

“…8,9 Venous and arterial thromboembolic disorders are usually considered to be two separate pathophysiologic entities. 16 However, arterial thrombosis is even rarer than VTE, 5 making it difficult to evaluate either complication among women of reproductive age, especially among those who have had a previous VTE. [13][14][15] Hormonal contraceptives prescribed for women with a history of VTE or thrombophilia should not be associated with an increased risk of arterial thrombosis.…”

mentioning

confidence: 99%

“…16,17 Among them, the LNG-releasing intrauterine system (LNG-IUS) is a POC that can reduce the abnormal bleeding sometimes associated with anticoagulant use. 16,17 Among them, the LNG-releasing intrauterine system (LNG-IUS) is a POC that can reduce the abnormal bleeding sometimes associated with anticoagulant use.…”

mentioning

confidence: 99%

“…[13][14][15] Hormonal contraceptives prescribed for women with a history of VTE or thrombophilia should not be associated with an increased risk of arterial thrombosis. 16 However, arterial thrombosis is even rarer than VTE, 5 making it difficult to evaluate either complication among women of reproductive age, especially among those who have had a previous VTE.…”

mentioning

confidence: 99%

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Effect of the levonorgestrel‐releasing intrauterine system on cardiovascular risk markers among women with thrombophilia or previous venous thromboembolism

Braga

Brito

Ferriani

et al. 2019

Intl J Gynecology & Obste

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Objective:To assess the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on standard cardiovascular risk markers among women with thrombophilia and/or previous venous thromboembolism (VTE).Methods: A prospective cohort study enrolled women aged 18-45 years with thrombophilia and/or a history of VTE who received the 52-mg LNG-IUS (20 μg/d initial release) at the University of Ribeirão Preto Medical School, Brazil, from January 2006 to December 2015. Before and 12 months after LNG-IUS placement, the following cardiovascular risk markers were assessed: lipid profile, body mass index (BMI), blood glucose, systolic blood pressure, diastolic blood pressure, and waist circumference. The primary outcome was changes in cardiovascular risk markers. A subanalysis of anticoagulant users versus non-users was also conducted. Results:In total, 45 women were enrolled. BMI increased by 2.3% after 12 months of LNG-IUS placement (P < 0.01), but the other risk factors did not change. Cardiovascular risk markers were similar between anticoagulant users and non-users after 12 months of LNG-IUS use.Conclusion: Among women with thrombophilia and/or previous VTE, cardiovascular risk markers were not found to change significantly after 12 months of LNG-IUS use.The study adds safety information regarding use of the LNG-IUS for women at risk of thromboembolism. K E Y W O R D SCardiovascular diagnostic techniques; Contraception; Intrauterine devices; Medicated intrauterine devices; Thrombophilia; Thrombosis | INTRODUCTIONPregnancy, which is traditionally associated with a higher risk of venous thromboembolism (VTE), is also associated with a higher risk of complications, especially VTE recurrence, among women with a previous history of VTE and/or thrombophilia. 1,2 Therefore, the prevention of unplanned pregnancies for these women is extremely important, because VTE is one of the leading causes of maternal mortality. 3According to the WHO eligibility criteria for contraceptive use, women with a history of VTE or thrombophilia may use nonhormonal methods or progestogen-only contraceptives (POCs). 4This recommendation is based on evidence that most POCs are not non-hormonal contraceptives. 19 Both HDL-C and total cholesterol levels were lower in LNG-IUS users than in users of non-hormonal contraceptives even after adjusting for BMI. 19 In addition, a randomized clinical trial comparing lipid profile between copper intrauterine device (Cu-IUD) users and LNG-IUS users for 18 months found no negative effects of the LNG-IUS on lipid profile among healthy Asian women. 20In populations at risk of cardiovascular disease, such as obese individuals, 21,22 use of the LNG-IUS as compared with non-hormonal contraceptives (e.g., Cu-IUD) has previously presented reassuring results regarding cardiovascular risk markers. 21,22 In the present study, a slight increase in BMI after 12 months of LNG-IUS use was observed.However, a previous study found no difference in weight gain between A few studies have evaluated LNG-IUS use among women w...

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Contraception for the Cardiac Patient: a Cardiologist’s Primer

Florio

Kao

Johnson

et al. 2020

Curr Treat Options Cardio Med

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Purpose of review Cardiovascular disease (CVD) is the number one cause of maternal mortality in the USA. There are many cardiac conditions which pose significant risk to maternal health, and these women should be offered options to avoid unwanted pregnancies. Individualized contraceptive counseling focusing on woman’s desire for future pregnancy, comorbid conditions, and desire for hormone or non-hormonal (contraceptive) options is paramount to avoid adverse or unwanted side effects. The purpose of this review is to give general guidance on prescribing both hormonal and non-hormonal contraceptives for providers caring for women with heart disease. Recent findings Specific recommendation for the use of either non-hormonal or hormonal contraception requires knowledge of the types of contraceptive options available, cost, failure rates, and contraindications to use. Newer progestin-only options have become available and should be considered first-line therapy for women with cardiovascular disease. Summary The physiologic burden of pregnancy on the cardiovascular system can cause significant maternal morbidity and mortality for women with underlying CVD. These women should be offered safe and effective options for birth control, and both cardiology and obstetrical providers alike should possess fundamental knowledge of appropriate options.

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Contraceptive Management for Women Who Are at High Risk of Thrombosis

Cited by 6 publications

References 19 publications

Desmopressin responsiveness by age in type 1 von Willebrand disease

Desmopressin responsiveness by age in type 1 von Willebrand disease

Effect of the levonorgestrel‐releasing intrauterine system on cardiovascular risk markers among women with thrombophilia or previous venous thromboembolism

Contraception for the Cardiac Patient: a Cardiologist’s Primer

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