Thrombotic risks of oral contraceptives

  title={Thrombotic risks of oral contraceptives},
  author={Hannelore Rott},
  journal={Current Opinion in Obstetrics and Gynecology},
  • H. Rott
  • Published 1 August 2012
  • Medicine, Biology
  • Current Opinion in Obstetrics and Gynecology
Purpose of review To inform about the risk of venous thromboembolism (VTE) of different hormonal contraceptives in different patient groups. Recent findings Combined oral contraceptives (COCs) differ significantly regarding VTE risk depending on amount of estrogen and type of progestogen: COCs containing desogestrol, gestoden or drospirenone in combination with ethinylestradiol (so called third-generation or fourth-generation COCs) are associated with a higher VTE risk than COCs with… 
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Because of the special partial effect pattern of progesterone and dydrogesterone, there is no undue thrombotic risk with these progestogens, even in combination with estrogens, and the type and the dose of the estrogens and in addition the oral and non-oral routes do have an influence.
The Risk of Venous Thromboembolism with Different Generation of Oral Contraceptives; a Systematic Review and Meta-Analysis
It seems that the risk of VTE is not same between different generations of OCs, so that third-generation has highest risk.
The Risk of Venous Thromboembolism Associated with Oral Contraceptive; the Search Is Still On
The third generation of oral contraceptive pills with lower doses of progesterone-like compounds with contraceptive efficacy was released and contain the new progestins such as Drospirenone, Norgestimate, Desogestrel and Gestodene.
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  • 2019
The risk of VTE in FVL carriers seems to outweigh the benefit of contraception even when using progestin-only contraception, and non-hormonal contraception, such as copper IUD, seems to be the only safe alternative for contraception in this population.
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    Expert opinion on pharmacotherapy
  • 2015
This article reviews the features of each of the four new oral contraceptives that have been introduced in the United States and/or Europe in the last few years and concludes that cost will continue to be the determining factor in the acceptance of these new products, unless substantial health benefits can be conclusively proven.
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Contraception for Adolescents and Young Women with Type 2 Diabetes–Specific Considerations
Progestin-only or nonhormonal long-acting reversible contraception (LARC) should be recommended for women with T2D with compliance issues or adverse cardiovascular risk profiles.
Contraception in Patients with Rheumatic Disease.
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Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism
Multicenter, prospective studies are needed to identify and confirm risk factors for pediatric VTE in order to create a pediatric risk-assessment tool and optimize preventive measures and reduce unintended harm.
Pregnancy and Autoimmune Disease, Reproductive and Hormonal Issues


The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study
A high risk of venous thrombosis during the first months of oral contraceptive use irrespective of the type of oral contraceptives is confirmed, and many women do not use the safest brands.
Thrombotic risk during oral contraceptive use and pregnancy in women with factor V Leiden or prothrombin mutation: a rational approach to contraception.
It is advocated that detailed counseling on all contraceptive options, including COCs, is provided, addressing the associated risks of both VTE and unintended pregnancy, enabling these women to make an informed choice.
Third generation oral contraceptives and risk of venous thrombosis: meta-analysis
This meta-analysis supports the view that thirdgeneration oral contraceptives are associated with an increased risk of venous thrombosis compared with second generation oral contraceptives, and cannot be explained by several potential biases.
The Risk of Deep Venous Thrombosis Associated With Injectable Depot–Medroxyprogesterone Acetate Contraceptives or a Levonorgestrel Intrauterine Device
The risk of venous thrombosis was increased for injectable depot–medroxyprogesterone acetate contraceptive users, while the authors were able to reliably exclude an increased risk associated with levonorgestrel intrauterine device use.
Different effects of oral contraceptives containing different progestogens on protein S and tissue factor pathway inhibitor
It is observed that the differences in APC resistance induced by OC containing different progestogens can at least in part be explained by different effects of OC on free protein S and TFPI.
Haemostatic effects of a new combined oral contraceptive, nomegestrol acetate/17β-estradiol, compared with those of levonorgestrel/ethinyl estradiol. A double-blind, randomised study.
The NOMAC/E2 pill regimen has fewer adverse effects on blood biological coagulation and fibrinolysis markers than LNG/EE, and could have a more favourable venous thromboembolism risk profile than Lng/EE.
Effects of oral and transvaginal ethinyl estradiol on hemostatic factors and hepatic proteins in a randomized, crossover study.
Evidence is provided that the customary effects of combined hormonal contraceptives on hemostatic variables and estrogen-sensitive liver proteins are largely related to EE and independent of delivery route during short-term treatment.
Effects of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol compared with one containing levonorgestrel and ethinylestradiol on haemostasis, lipids and carbohydrate metabolism
  • U. ÅgrenMarjatta Anttilat E. Mommers
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The monophasic COC NOMAC/E2 had less influence on haemostasis, lipids and carbohydrate metabolism than the COC LNG/EE.