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November 3, 2022Bleeding Thrombosis and Vascular BiologyOpen Access

Combined oral contraceptives and the risk of venous thromboembolism carriers of antithrombin, protein C or S deficiency: Sub-analysis of a prospective cohort study

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Why the study?

Although antithrombin, protein C, and S defects increase VTE risk in fertile women taking combined oral contraceptives, the magnitude of this association was uncertain.

Does estrogen-progestin therapy increase the risk of venous thromboembolism in women who are carriers of antithrombin, protein C, or S deficiency compared to non-carriers?

Population

197 women of child-bearing age from 88 families of probands with VTE and thrombophilia defects

Comparison

Combined oral contraceptives in thrombophilia carriers vs non-carriers

Design

Sub-analysis of a prospective cohort study

Authors

DTDaniela TormeneUniversity of PaduaECElena CampelloUniversity of PaduaCSChiara SimionUniversity of Padua

Discussion

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Implication

May warrant caution with estrogen-progestin therapy in carriers; leaves open whether family screening improves outcomes.

Structured PICO

Does estrogen-progestin therapy increase the risk of venous thromboembolism in women who are carriers of antithrombin, protein C, or S deficiency compared to non-carriers?

P
Population
197 women of child-bearing age from 88 families who were family members of a proband with an objectively diagnosed VTE event and a documented defect of antithrombin, protein C or S. 112 (57%) were carriers of an inherited defect, and 85 were non-carriers.
I
Intervention
Estrogen-progestin therapy (combined oral contraceptives) in carriers of inherited thrombophilia (antithrombin, protein C, or S deficiency)
C
Comparator
Estrogen-progestin therapy (combined oral contraceptives) in non-carriers of inherited thrombophilia
O
Outcome
Incidence of venous thromboembolism (VTE) occurring during treatment with combined oral contraceptiveshard clinical

The use of estrogen-progestin therapy in women with inherited defects of antithrombin, protein C, or S results in a more than 20-fold increased risk of VTE compared to non-carriers, supporting systematic screening in affected families.

Cite This Study

Tormene et al. (2022) studied this question.

synapsesocial.com/papers/6a8be36f210b9ed19c898469https://doi.org/10.4081/btvb.2022.42
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Risk of idiopathic cardiovascular death and rionfatal venous thromboembolism in women using oral contraceptives with differing progestagen components1995 · 734 citations
  2. 2Prothrombin antigen levels in symptomatic and asymptomatic carriers of the 20210A prothrombin variant1998 · 65 citations
  3. 3COCs containing dienogest and 30 µg ethinylestradiol may carry a higher VTE risk compared to corresponding preparations with levonorgestrel: A meta-analysis of four large cohort studies2020 · 8 citations
  4. 4Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases2015 · 215 citations
  5. 5Incidence of Venous Thromboembolism in Families with Inherited Thrombophilia1999 · 323 citations