Key result
Combined oral contraceptives increase venous and arterial thrombosis risk, warranting individualized patient risk assessment.
Why the study?
Almost all combined oral contraceptives are associated with a risk of venous thrombosis regardless of drug composition and duration of therapy, warranting a review of pathogenetic mechanisms.
Does combined oral contraceptive use increase the risk of thrombosis in women?
Does combined oral contraceptive use increase the risk of thrombosis in women?
Answers are grounded in this paper and cite their sources.
Combined oral contraceptives significantly increase the risk of venous and arterial thrombosis through multiple complex coagulopathic mechanisms, underscoring the need for individualized risk assessment prior to prescription.
Combined oral contraceptives (COCs) remain one of the most popular reversible contraceptive methods worldwide. Still, regardless of the drug composition and duration of therapy, almost all COCs are associated with the risk of venous thrombosis. This review highlights the main pathogenetic mechanisms of thrombosis development during oral contraceptive use. Increase the production of certain clotting factors; a decrease in antithrombin and protein S levels; acquired resistance to activated protein C; a reduction in tissue factor pathway inhibitor (TFPI); indirect endothelial activation; inhibition of endogenous fibrinolysis; regulation of tissue factor by estradiol-sensitive microRNA; homocysteine imbalance caused by decreased intestinal reabsorption of folates and vitamin B-12; reduced bioavailability of nitric oxide (NO) due to high homocysteine levels; higher blood pressure, water retention, insulin resistance, increased levels of pro-inflammatory C-reactive protein (CRP) and uric acid, and antifibrinolytic (plasminogen activator inhibitor 1 type, PAI-1) biomarkers as consequences of NO deficiency; increased platelet adhesiveness and ADP-induced aggregation, which promote fibrinogen binding; and increased expression of pro-inflammatory cytokines are the main thrombotic effects of COCs use. Clinicians should carefully evaluate each patient's individual risk factors when prescribing COCs and conduct regular monitoring to reduce the risk of complications.
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Khizroeva et al. (2025) conducted a review in Thrombosis risk associated with oral contraceptive use. Combined oral contraceptives (COCs) vs. Non-users of combined oral contraceptives was evaluated on Risk of venous thromboembolism and arterial thrombosis. Combined oral contraceptives increase the risk of venous and arterial thrombosis through multiple mechanisms, requiring careful evaluation of individual risk factors before prescription.
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