Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: What advice should we be giving?

Lakasing, Lorin; Khamashta, Munther A.

doi:10.1783/147118901101195029

Cited by 31 publications

(16 citation statements)

References 34 publications

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“…65,66 Antiphospholipid syndrome is less common, but is identified more often in women with recurrent miscarriage than in the general population. 65,67,68 Women with factor V Leiden mutation who use a COC have up to a 35-fold increased risk of VTE. 66 Even this degree of increase in relative risk results in a low absolute risk (around three additional cases of VTE per year per 1000 pill-users with factor V Leiden).…”

Section: Is Screening For Thrombophilia Needed Before Prescribing Hormentioning

confidence: 99%

Venous thromboembolism and hormonal contraception

Pundir¹,

Coomarasamy

2016

Gynaecology: Evidence-Based Algorithms

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The aim of this guidance is to present evidence-based recommendations and statements on venous thromboembolism (VTE) and hormonal contraception. the Cochrane Library (to 2003) and the US National Guideline Clearing House. Searches used relevant medical subject headings (MeSH) terms and text words. The Cochrane Library was searched for systematic reviews, meta-analyses and controlled trials. Previous guidance from the Royal College of Obstetricians and Gynaecologists (RCOG), the Faculty of Family Planning and Reproductive Health Care (FFPRHC) and the World Health Organization (WHO) was reviewed. Key publications were appraised according to standard methodological checklists before conclusions were considered as evidence.The definitions of types of evidence used in this guideline originate from the US Agency for Health Care Research and Quality.Where possible, recommendations are based on and explicitly linked to the evidence that supports them.Areas lacking evidence were designated 'good practice points.' Does combined oral contraception increase the risk of venous thromboembolism?The relative risk of venous thromboembolism is increased with combined oral contraceptive use. Nevertheless, the rarity of venous thromboembolism in women of reproductive age means that the absolute risk remains small.The term 'combined oral contraception' is used here to describe monophasic preparations containing a low dose (20-35 micrograms) of ethinyl estradiol in combination with a progestogen. Progestogens include norethisterone and levonorgestrel:'second generation'; desogestrel and gestodene:'third generation'; and the newest progestogen, drospirenone:'fourth generation'.The terms second, third or fourth generation can be confusing and will not be used further. 11 Risk of venous thromboembolismCombined oral contraceptives containing levonorgestrel or norethisterone are associated with a lower risk of venous thromboembolism than those containing desogestrel or gestodene. A levonorgestrel-or norethisterone-containing combined oral contraceptive should be advised as a pill of first choice. However, after counselling, a woman may choose a desogestrel-or gestodenecontaining combined pill.Epidemiological studies show a three-to five-fold increase in the risk of VTE with COC use, which does not appear to be related to the dose of ethinyl oestradiol (when less than 50 micrograms is used) but to the type of progestogen. 12,13 Meta-analyses provide further support for this increased risk. 4,14 COCs containing gestodene or desogestrel are associated with an almost two-fold increase in the risk of VTE compared with COCs containing norethisterone or levonorgestrel (adjusted OR 1.7, 95% CI 1.4-2.0). 4 The apparent relationship between progestogen type and risk of VTE 3 may be due to confounding or bias, inherent in observational studies. 15,16 However, this increased risk has biological plausibility (section 4.8). 17The relative risk of venous thromboembolism increases in the first 4 months after starting combined oral contraception. This ris...

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Section: Is Screening For Thrombophilia Needed Before Prescribing Hormentioning

confidence: 99%

Venous thromboembolism and hormonal contraception

Pundir¹,

Coomarasamy

2016

Gynaecology: Evidence-Based Algorithms

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“…Clearly, venous thromboembolism and aPL positivity absolutely contraindicates further oral estrogen use [ 67 , 68 ]. Combined oral contraceptives have deleterious hemostatic procoagulant effects, related to estrogen content, that favour venous thrombosis [ 67 , 69 ].…”

Section: Unanswered Questionsmentioning

confidence: 99%

Controversies in the antiphospholipid syndrome: can we ever stop warfarin?

Fonseca

D’Cruz

2008

J Autoimmune Dis

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Patients with antiphospholipid syndrome are at increased risk for recurrent arterial and venous thrombosis and therefore benefit from long term warfarin therapy. The optimal duration of warfarin therapy after a first venous thromboembolic event is however a matter of some controversy and many questions remain unanswered. After reviewing and analysing the available evidence, we discuss some common scenarios in everyday clinical practice where treatment decisions are difficult.

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“…33,34 Women with the most common thrombophilia, factor V Leiden mutation, have up to a 35-fold increased risk of VTE with COC use. 35,36 However, many such women will never develop venous thrombosis. The low incidence of VTE in women of reproductive age also means that even such an increase in relative risk results in a low absolute risk (around three additional cases of VTE per year per 1000 pill users with factor V Leiden).…”

Section: Recommendations -Examination and Testsmentioning

confidence: 99%

“…The low incidence of VTE in women of reproductive age also means that even such an increase in relative risk results in a low absolute risk (around three additional cases of VTE per year per 1000 pill users with factor V Leiden). 36 Women with a family history of VTE in a first-degree relative under the age of 45 years may be at increased risk of VTE. However, not all women with a family history and an identified thrombophilia will develop venous thrombosis.…”

Section: Recommendations -Examination and Testsmentioning

confidence: 99%

FFPRHC Guidance (October 2003): First Prescription of Combined Oral Contraception

2003

j fam plann reprod health care

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What is combined oral contraception (COC)?Combined oral contraception (COC) is the most commonly used contraceptive method by women aged 16 to 49 years. 2 This Guidance provides evidence-based recommendations and good practice points for clinicians advising women considering their first prescription of COC. A holistic approach to contraceptive provision involves considering the individual's overall sexual and reproductive health needs. By informing women of potential risks, benefits and uncertainties in language they can understand, clinicians can enable women to reach their own contraceptive choices. Access for women can be enhanced by service innovations such as nurse prescribing, Patient Group Directions and convenient clinic times.In current practice, low-dose COCs, containing 20-35 micrograms (mg) ethinyl oestradiol (EE) in combination with a progestogen, have generally replaced older COCs containing 50 mg EE or more. In this Guidance, the term COC refers to low-dose (20-35 mg EE) monophasic preparations, unless otherwise stated. Progestogens include: norethisterone and levonorgestrel; desogestrel and gestodene; norgestimate; and the newest progestogen, drospirenone. The terms 'second' and 'third' generation can be confusing and unhelpful and so will not be used in this Guidance.Recommendations 3 A holistic approach should be taken when advising women about contraceptive choices.

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Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: What advice should we be giving?

Abstract: Summary Introduction. Systemic lupus erythematosus (SLE) is an

Cited by 31 publications

References 34 publications

Venous thromboembolism and hormonal contraception

Venous thromboembolism and hormonal contraception

Controversies in the antiphospholipid syndrome: can we ever stop warfarin?

FFPRHC Guidance (October 2003): First Prescription of Combined Oral Contraception

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