RISK OF VENOUS THROMBOEMBOLIC DISEASE ASSOCIATED TO THE USE OF ORAL CONTRACEPTIVES

Abstract
The use of oral contraceptives has been associated with an increase in the risk of venous thromboembolic disease for about four decades. The reduction in the dose of ethinylestradiol from 50 to 30 μg in these hormone combinations has resulted in a reduction in the rate of thrombotic complicactions; this reduction has not been further improved by using the newer ultra-low dose formulations (15-20 μg of ethinylestradiol). The risk of venous thromboembolic disease is highest with the third generation oral contraceptives, during the first year of use and in certain subsets of women (such as first time users, those with a personal or a family history of venous thrombosis, thrombophilia or additional risk factors for thrombosis like gross obesity). The induction of changes to the haemostatic system (especially noted in the protein C system proteins) as well as an acquired resistance to activated protein C similar to that described for heterozygous factor V Leiden carriers seem to be major contributors to the thrombotic risk associated to the intake of oral contraceptives. Routine performance of thrombophilia screening prior to the start of oral contraceptive therapy cannot be justified on a cost-benefit basis and it should only be considered in women with a past personal or family history of venous thromboembolism.

Key words
Oral contraceptives, venous thromboembolic, thrombophilia, estrogens

Bibliografía del artículo

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