Risk factors for venous thromboembolism in women under combined oral contraceptive

Suchon, Pierre; Frouh, Fadi Al; Henneuse, Agathe; Ibrahim, Manal; Brunet, D.; Barthet, Marie-Christine; Aillaud, Marie-Françoise; Venton, Geoffroy; Alessi, Marie‐Christine; Trégouët, David‐Alexandre; Morange, Pierre‐Emmanuel

doi:10.1160/th15-01-0045

Cited by 34 publications

(9 citation statements)

References 31 publications

(43 reference statements)

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“…Although we cannot demonstrate that these differences are not due to selection bias, all five characteristics are known risk factors for VTE development, thus the minor observed differences are not surprising. The modest differences observed in our samples reinforce the current evidence that clinical information is not sufficient to distinguish women at risk to develop VTE [ 8 , 9 ].…”

Section: Resultssupporting

confidence: 82%

“…As the standard of care nowadays, prescribing physicians assess the risk of thrombosis using clinical parameters, mostly focusing on age, body mass index, smoking habits and personal and familial history of DVT or related diseases that are known risk factors for VTE development. However, diverse studies demonstrate that clinical informations, notably familial history, are insufficient to reliably estimate risk of VTE [ 8 , 9 ]. When the familial history of thrombosis is positive, physicians might use the first-level laboratory test for thrombophilia screening that includes analysis of only 2 genetic risk factors: the F5-Leiden and the F2 mutations; eventually, some laboratories, also include genetic tests allowing to assess for the ABO blood group.…”

Section: Introductionmentioning

confidence: 99%

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Risk prediction of developing venous thrombosis in combined oral contraceptive users

et al. 2017

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BackgroundVenous thromboembolism (VTE) is a complex multifactorial disease influenced by genetic and environmental risk factors. An example for the latter is the regular use of combined oral contraceptives (CC), which increases the risk to develop VTE by 3 to 7 fold, depending on estrogen dosage and the type of progestin present in the pill. One out of 1'000 women using CC develops thrombosis, often with life-long consequences; a risk assessment is therefore necessary prior to such treatment. Currently known clinical risk factors associated with VTE development in general are routinely checked by medical doctors, however they are far from being sufficient for risk prediction, even when combined with genetic tests for Factor V Leiden and Factor II G20210A variants. Thus, clinical and notably genetic risk factors specific to the development of thrombosis associated with the use of CC in particular should be identified.Methods and findingsStep-wise (logistic) model selection was applied to a population of 1622 women using CC, half of whom (794) had developed a thromboembolic event while using contraceptives. 46 polymorphisms and clinical parameters were tested in the model selection and a specific combination of 4 clinical risk factors and 9 polymorphisms were identified. Among the 9 polymorphisms, there are two novel genetic polymorphisms (rs1799853 and rs4379368) that had not been previously associated with the development of thromboembolic event. This new prediction model outperforms (AUC 0.71, 95% CI 0.69–0.74) previously published models for general thromboembolic events in a cross-validation setting. Further validation in independent populations should be envisaged.ConclusionWe identified two new genetic variants associated to VTE development, as well as a robust prediction model to assess the risk of thrombosis for women using combined oral contraceptives. This model outperforms current medical practice as well as previously published models and is the first model specific to CC use.

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Section: Resultssupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Risk prediction of developing venous thrombosis in combined oral contraceptive users

et al. 2017

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“…Only a few small studies have previously evaluated the characteristics of CHC users with VTE. [ 9 – 12 , 14 ] A study by Blanco-Molina et al, [ 10 ] based on the RIETE observational registry, assessed 593 CHC users and 1074 nonusers at the time of a VTE event. In contrast to their study, we included only the first VTE and excluded recurrences.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, women with hormone-related VTE were more likely to be carriers of the factor V Leiden mutation than women with nonhormone-related VTE. [ 18 , 19 ] More recently, Suchon et al [ 9 ] evaluated the risk factors for VTE in CHC-users. In their cohort, 12.1% of women with VTE were carriers of the factor V Leiden mutation.…”

Section: Discussionmentioning

confidence: 99%

“…However, to date, only a few small studies have been conducted comparing the clinical and biological characteristics of women with the first VTE who use CHC with those who do not. [ 9 – 12 ] Consequently, larger studies will help specify clinical and biological characteristics of CHC-associated VTE. In this perspective, we conducted a cross-sectional study to assess the characteristics of women with the first documented VTE according to hormonal contraceptive with the COREVE (COntraception and REcurrent Venous Event) data.…”

Section: Introductionmentioning

confidence: 99%

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First venous thromboembolism and hormonal contraceptives in young French women

et al. 2017

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Information on the clinical and biological characteristics of combined hormonal contraceptives (CHC) users experiencing a venous thromboembolism (VTE) event is scarce. Better knowledge of factors determining the VTE risk in CHC users could help identify women at high risk.Data were obtained from a large cohort of consecutive women with the first documented VTE event. Cross-sectional analysis of clinical and biological characteristics of the women was performed.Of the 3009 women with the first VTE included, 31% were nonusers and 69% CHC users at time of VTE. CHC users were significantly younger (29.0 ± 7.2) than nonusers (31.6 ± 7.1) (P < .001). No difference in VTE familial history was observed between the 2 groups. Compared with nonusers, the CHC users experienced more frequently pulmonary embolism: odds ratio (OR) = 1.28 (1.06–1.55; 95% confidence interval [CI]), factor V Leiden mutations were more frequent in this group (OR = 1.41 [1.11–1.80; 95% CI]). Venous sclerotherapy and travel were associated with VTE in CHC users, whereas surgery and bed rest were significantly associated with VTE in nonusers. Finally, 2/3 of CHC users with VTE had additional VTE risk factors.CHC users experiencing the first VTE differ from nonusers with respect to clinical and genetic background. Better understanding of the characteristics of VTE and associated risk factors could allow more appropriate management of these women and contribute to more accurate benefit-risk assessment before prescribing a CHC.

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Interaction of a genetic risk score with physical activity, physical inactivity, and body mass index in relation to venous thromboembolism risk

Kim

Kraft

Hagan

et al. 2018

Genetic Epidemiology

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Risk factors for venous thromboembolism in women under combined oral contraceptive

Cited by 34 publications

References 31 publications

Risk prediction of developing venous thrombosis in combined oral contraceptive users

Risk prediction of developing venous thrombosis in combined oral contraceptive users

First venous thromboembolism and hormonal contraceptives in young French women

Interaction of a genetic risk score with physical activity, physical inactivity, and body mass index in relation to venous thromboembolism risk

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