Thrombotic risks of oral contraceptives

Rott, Hannelore

doi:10.1097/gco.0b013e328355871d

Cited by 54 publications

(35 citation statements)

References 18 publications

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“…Estrogen has a multitude of mechanisms that increase thrombotic risk including increases in pro-coagulant proteins, decreases in counter-regulatory proteins including protein S and antithrombin, and inducing protein C resistance (43). While differences exist between route of delivery, type of progesterone, and the doses of estrogen and progesterone, the highest level of risk is thought to occur in the first 3 months of use and gradually plateaus after 12 months of use (44). The overall relative risk is threefold to fivefold higher than non-users of COCPs.…”

Section: Risk Factorsmentioning

confidence: 99%

Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

Mahajerin

Croteau

2017

Front. Pediatr.

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The incidence of diagnosed venous thromboembolism (VTE) has been increasing concurrent with advances in technology and medical care that enhance our ability to treat pediatric patients with critical illness or complex multiorgan system dysfunction. Although the overall incidence of VTE is estimated at 0.07–0.49 per 10,000 children, higher rates are observed in specific populations including hospitalized children, those with central venous catheters (CVCs) or patients convalescing from a major surgery. While the absolute number of pediatric VTE events may seem trivial compared to adults, the increasing incidence, associated with increased mortality and morbidity, the availability of novel therapies, and the impact on the cost of care have made investigation of VTE risk factors and prevention strategies a high priority. Many putative risk factors for pediatric VTE have been reported, primarily from single-institution, retrospective studies which lack appropriate methods for verifying independent risk factors. In addition, some risk factors have inconsistent definitions, which vex meta-analyses. CVCs are the most prevalent risk factors but have not consistently been assigned the highest level of risk as defined by odds ratios from retrospective, case–control studies. Few risk-assessment models for hospital-acquired pediatric VTE have been published. Some models focus exclusively on hospitalized pediatric patients, while others target specific populations such as patients with cancer or severe trauma. Multicenter, prospective studies are needed to identify and confirm risk factors in order to create a pediatric risk-assessment tool and optimize preventive measures and reduce unintended harm.

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Section: Risk Factorsmentioning

confidence: 99%

Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

Mahajerin

Croteau

2017

Front. Pediatr.

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“…The increased use of progestogen-only contraceptives might be because they do not increase the VTE risk significantly compared to COCs 25. Conversely, the prescriptions of levonorgestrel decreased over the years, particularly in the younger age group.…”

Section: Discussionmentioning

confidence: 97%

Trends and patterns of hormonal contraceptive prescribing for adolescents in primary care in the UK

Rashed

Hsia

Wilton

et al. 2014

J Fam Plann Reprod Health Care

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BackgroundHormonal contraceptives are the most common method used worldwide by teenagers to prevent unwanted pregnancies. To date there are limited data about such use by teenagers in the UK. This study investigated trends and patterns of hormonal contraceptive prescribing to adolescents aged 12–18 years in UK primary care between 2002 and 2011.MethodsA retrospective cohort study using the IMS Disease Analyzer database was conducted. All females aged 12–18 years with ≥1 prescription for a contraceptive drug between 1 January 2002 and 31 December 2011 were included. Annual prevalence of contraceptive drug prescribing was calculated, and indications for prescribing, and types of contraceptive drug prescribed, were examined.ResultsIn 2002, 13.7% (6135/44 532) of female adolescents received prescriptions for hormonal contraceptives, compared to 19.0% (6597/34 676) in 2011. The majority of female adolescents [2002: 76.2% (4676/6135); 2011: 65.7% (4334/6597)] received a contraceptive drug for ‘contraceptive management’. The combined oral contraceptive (COC), ‘progestogen+estrogen’, was the most commonly prescribed. Although use of progestogen-only contraceptives was lower than COCs, the number of patients who received desogestrel pills and etonogestrel implants increased during the study period; levonorgestrel pill use declined. Only one injectable progestogen, long-acting depot medroxyprogesterone acetate, was prescribed.ConclusionsUse of hormonal contraceptives among adolescents increased between 2002 and 2011, and COC usage was dominant. The increasing use of hormonal contraceptives in adolescents, especially in younger adolescents, warrants further investigation, including research into the long-term safety of these medicines in this age group.

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“…Orally or parenterally, desogestrel and its metabolites alone do not cause clotting problems. [5] The third missing essential is an intrauterine device (IUD) or intrauterine system (IUS) the dimensions of which will accommodate the nulliparous or smaller uterus to provide a more anatomical fit. [6] The CHOICE project in St Louis, USA, has provided evidence of the success rate of a family planning programme that focuses on the use of longacting reversible contraception (LARC) to obtain better longterm outcomes.…”

mentioning

confidence: 99%

“…Desogestrel is not as useful in combination with oestrogen where, in common with other thirdgeneration progestins, it increases resistance to activated protein C and leads to a higher incidence of thrombosis compared with secondgeneration progestins. [4,5] Desogestrel is the parent compound of etonogestrel, which is the progestin used in the NuvaRing vaginal ring in combination with oestrogen, where it is also associated with an increased tendency to thrombosis. [5] Etonogestrel is also the progestin used in the Implanon NXT implant.…”

mentioning

confidence: 99%

“…[4,5] Desogestrel is the parent compound of etonogestrel, which is the progestin used in the NuvaRing vaginal ring in combination with oestrogen, where it is also associated with an increased tendency to thrombosis. [5] Etonogestrel is also the progestin used in the Implanon NXT implant. Orally or parenterally, desogestrel and its metabolites alone do not cause clotting problems.…”

mentioning

confidence: 99%

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