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Curtis KM, Nguyen AT, Tepper NK, Zapata LB, Snyder EM, Hatfield-Timajchy K, Kortsmit K, Cohen MA, Whiteman MK. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73:1-77. [PMID: 39106301 DOI: 10.15585/mmwr.rr7303a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
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Affiliation(s)
- Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Antoinette T Nguyen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Emily M Snyder
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Megan A Cohen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Cruz ML, Farooq S, Testai FD. Neurological and Neurosurgical Emergencies in Patients with Hematological Disorders. Curr Neurol Neurosci Rep 2017; 17:24. [PMID: 28283960 DOI: 10.1007/s11910-017-0728-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Hematologic diseases are blood disorders which can affect different organs, including the central and peripheral nervous systems. Some of them are associated with increased risk of permanent disability and death. This review highlights a selected group of primary and acquired hematologic disorders that can present as neurologic or neurosurgical emergencies. RECENT FINDINGS There is an increasing recognition of the broad neurologic presentations of hematologic disorders. Diagnostic criteria continue to be revised as we learn more about these diseases. Treatment options are varied depending on the hematologic syndrome. Clinical judgment is important on a case by case basis given the complexity of these patients. Early recognition of neurologic manifestations of hematologic disorders is important as emergent treatment may be warranted. Clinical signs, appropriate laboratory testing and progression of disease must be taken into consideration to make a timely and definitive diagnosis which will aid in guiding treatment.
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Affiliation(s)
- Martha L Cruz
- Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center, 912 S Wood Street, Suite 164C, Neuropsychiatric Institute (NPI Building, M/C 796), Chicago, IL, 60612-7330, USA
| | - Shama Farooq
- Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center, 912 S Wood Street, Suite 164C, Neuropsychiatric Institute (NPI Building, M/C 796), Chicago, IL, 60612-7330, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center, 912 S Wood Street, Suite 164C, Neuropsychiatric Institute (NPI Building, M/C 796), Chicago, IL, 60612-7330, USA.
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3
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Kazmerski TM, Borrero S, Tuchman LK, Weiner DJ, Pilewski JM, Orenstein DM, Miller E. Provider and Patient Attitudes Regarding Sexual Health in Young Women With Cystic Fibrosis. Pediatrics 2016; 137:peds.2015-4452. [PMID: 27244858 DOI: 10.1542/peds.2015-4452] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the attitudes, preferences, and experiences of patients with cystic fibrosis (CF) and CF providers toward sexual and reproductive health (SRH) care for young women with CF. METHODS Young women with CF aged 18 to 30 years from a US CF care center and pediatric and adult CF program directors from a national sample participated in qualitative interviews investigating their experiences regarding SRH care and their attitudes and preferences toward SRH care provision in the CF setting. Interviews were audio-recorded, transcribed, and coded by using a thematic analysis approach. RESULTS Twenty-two patient participants and 16 CF program directors were interviewed. Themes shared by both groups included the importance of SRH discussion in the CF care setting, patient and provider discomfort as a barrier to SRH care, and the need for SRH educational resources and provider training to improve SRH care. Providers highlighted the lack of standardization around SRH care in the current CF care model. Patients desired SRH educational resources coupled with early SRH discussions initiated by their CF provider. CONCLUSIONS Both CF providers and patients agree that the CF provider has a fundamental role in providing CF-specific SRH care. Educational resources coupled with individualized SRH discussions may facilitate improved SRH care for young women with CF. Investigation into the implementation of SRH education and services into pediatric-onset chronic disease care models is needed.
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Affiliation(s)
- Traci M Kazmerski
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, and
| | - Sonya Borrero
- Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, and Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania; VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania; and
| | - Lisa K Tuchman
- Division of Adolescent and Young Adult Medicine, Children's National Health System, Washington, District of Columbia
| | - Daniel J Weiner
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC
| | - Joseph M Pilewski
- Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Elizabeth Miller
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh School of Medicine, and
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Singh R, Cope WP, Zhou Z, De Witt ME, Boockvar JA, Tsiouris AJ. Isolated cortical vein thrombosis: case series. J Neurosurg 2015; 123:427-33. [DOI: 10.3171/2014.9.jns141813] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECT
Isolated cortical vein thrombosis (ICVT) accounts for less than 1% of all cerebral infarctions. ICVT may cause irreversible parenchymal damage, rendering early and accurate diagnosis critical. This case series and literature review presents the clinical and radiological findings in 7 patients with ICVT, and highlights risk factors and imaging modalities that may be most beneficial in rendering an accurate and timely diagnosis.
METHODS
Patients with CT and MRI findings consistent with ICVT examined between January 2011 and June 2014 were included in this retrospective review.
RESULTS
Seven patients (5 females, 2 males), ranging in age from 11 months to 34 years, met the inclusion criteria. The most common clinical presentations were headaches (n = 4) and seizures (n = 3). The most common comorbidities noted in these patients were hypercoagulable states (n = 4) and intracranial hypotension (n = 3). Five patients had intraparenchymal involvement. CT suggested the correct diagnosis in 4 patients, and MRI confirmed the diagnosis in all 7 patients. All patients who received anticoagulation therapy (n = 5) experienced complete resolution of their symptoms.
CONCLUSIONS
The majority of these patients were adult females, consistent with published data. Seizures and headaches were the most common presenting symptoms. Hypercoagulable state and intracranial hypotension, both known risk factors for thrombosis, were the most commonly noted ICVT risk factors. Intraparenchymal involvement was prevalent in nearly all ICVT cases and presented as vasogenic edema, early intraparenchymal hemorrhage, or hemorrhagic venous infarction. Susceptibility-weighted imaging was the most sensitive imaging technique in diagnosing ICVT.
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Affiliation(s)
| | | | | | | | - John A. Boockvar
- 3Department of Neurosurgery, Lenox Hill Hospital, New York, New York
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5
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van der Woude C, Ardizzone S, Bengtson M, Fiorino G, Fraser G, Katsanos K, Kolacek S, Juillerat P, Mulders A, Pedersen N, Selinger C, Sebastian S, Sturm A, Zelinkova Z, Magro F. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 2015; 9:107-24. [PMID: 25602023 DOI: 10.1093/ecco-jcc/jju006] [Citation(s) in RCA: 318] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. In this updated consensus on the reproduction and pregnancy in inflammatory bowel disease reproductive issues including fertility, the safety of drugs during pregnancy and lactation are discussed.
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Affiliation(s)
- C.J. van der Woude
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - S. Ardizzone
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, ‘Luigi Sacco’ University Hospital, Milan, Italy
| | - M.B. Bengtson
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - G. Fiorino
- Department of Gastroenterology, IBD Center, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - G. Fraser
- eIBD Unit, Department of Gastroenterology, Rabin Medical Center and University of Tel-Aviv, Petah Tikva, Israel
| | - K. Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - S. Kolacek
- Children’s Hospital Zagreb, Zagreb University Medical School, Zagreb, Croatia
| | - P. Juillerat
- Department of Gastroenterology, Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
| | - A.G.M.G.J. Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - N. Pedersen
- Gastroenterological Unit, Herlev University Hospital, Herlev, Denmark
| | - C. Selinger
- Department of Gastroenterology, St James’ University Hospital Leeds, Leeds, UK
| | - S. Sebastian
- Hull & East Yorkshire Hospitals and Hull & York Medical School, Hull, UK
| | - A. Sturm
- Department of Internal Medicine and Gastroenterology, Hospital Waldfriede, Berlin, Germany
| | - Z. Zelinkova
- Gastroenterology Unit, 5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia
| | - F. Magro
- Department of Pharmacology & Therapeutics, University of Porto, Porto, Portugal
- MedInUP, Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
- Department of Gastroenterology, Hospital de São João, Porto, Portugal
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Abstract
In women ages 15-45 years, an additional set of risk factors are important in the pathogenesis of ischemic stroke. Some of these pertain strictly to women, and relate to exogenous hormones and pregnancy. Various other conditions are more common in women, which include migraine with aura, selected vascular disorders and autoimmune conditions. These differences do have implications for management in both the primary and secondary prevention of stroke in this age group.
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Pezzella FR, Santalucia P, Vadalà R, Giugni E, Zedde ML, Sessa M, Anticoli S, Caso V. Women Stroke Association Statement on Stroke. Int J Stroke 2014; 9:20-27. [PMID: 28051365 DOI: 10.1111/ijs.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe the current and future objectives of the Women Stroke Association, a nonprofit multidisciplinary organization promoting research awareness on medical, psychological, and social issues concerning women affected by cerebrocardiovascular disease. In this paper, we deal with only cerebrovascular disease, whereas cardiovascular disorders will be addressed in a future paper. Gender differences in the clinical presentation of cerebrovascular diseases have been repeatedly suggested, and some treatment options may not be as effective and safe in men and women. For many years, women have either been underrepresented or excluded from randomized clinical trials, and the majority of therapeutic research has been carried on predominantly male populations. Furthermore, gender differences have been shown to contribute to different responses to cerebrovascular drugs in women when compared with men, regarding pharmacokinetics, pharmacodynamics, and physiology. In this statement, we discuss main research fields relevant to Women Stroke Association's mission and commitment, highlighting opportunities and critical from the women's health perspective. Future directions and goals of the Women Stroke Association arise from these considerations and represent the association's commitment to combating stroke.
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Affiliation(s)
| | - Paola Santalucia
- 2 Direzione Scientifica and U.O. Medicina d'Urgenza, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Rita Vadalà
- 3 NeuroRadiology, IRCCS Fondazione S Lucia, Rome, Italy
| | | | - Maria Luisa Zedde
- 5 Neurology Department, Arcispedale Santa Maria Nuova, Reggio nell'Emilia, Italy
| | - Maria Sessa
- 6 Stroke Unit - Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Anticoli
- 1 Stroke Unit - Department of Emergency Medicine, AO S Camillo Forlanini, Rome, Italy
| | - Valeria Caso
- 7 Stroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
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Maxwell WD, Jacob M, Spiryda LB, Bennett CL. Selection of Contraceptive Therapy for Patients with Thrombophilia: A Review of the Evidence. J Womens Health (Larchmt) 2014; 23:318-26. [DOI: 10.1089/jwh.2013.4479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Whitney D. Maxwell
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Merna Jacob
- South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Lisa B. Spiryda
- Department of Obstetrics and Gynecology, University of Florida, College of Medicine, Gainesville, Florida
| | - Charles L. Bennett
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
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9
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Pillai P, Bonny AE, O'Brien SH. Contraception-related venous thromboembolism in a pediatric institution. J Pediatr Adolesc Gynecol 2013; 26:186-8. [PMID: 23566795 DOI: 10.1016/j.jpag.2013.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To define the thrombotic risk factors of young women presenting to a children's hospital with hormonal contraception-related venous thromboembolism (VTE). We hypothesized that the majority of patients would have additional risk factors for VTE. DESIGN Clinical and laboratory data obtained retrospectively from electronic medical records concerning history of presentation, body mass index (BMI), medical and family history, medication profile, and relevant laboratory studies. SETTING Nationwide Children's Hospital in Columbus, Ohio, November 2008-May 2012. PARTICIPANTS Twenty-six female patients, age 12-21 years, admitted for hormonal contraception-related VTE. RESULTS Fifty-seven VTE cases were reviewed, and 26 were identified as contraception-related VTE. 96% of patients had at least 1 additional risk factor for VTE, and 42% of patients had 2 or more additional risk factors. 50% patients had a BMI ≥ 25 kg/m(2). 35% of patients had a positive family history of VTE in a first or second-degree relative. 27% of patients were subsequently diagnosed with an inherited thrombophilia, 5 of whom had a positive family history. CONCLUSION In a small population of adolescents presenting to a children's hospital with contraception-related VTE, the majority of patients had multiple risk factors for VTE. Obesity was the most common additional risk factor (50%) identified in our study population. More research is needed regarding the impact of obesity on contraception-related VTE in young women, and whether the presence of obesity should influence thrombophilia screening practices prior to prescribing contraception.
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Affiliation(s)
- Prasanth Pillai
- Dual-Pediatrics Residency Program, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
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10
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Bhargava A, Chopra A, Bernabela L, Chopra T. Oral contraceptive causing renal artery thrombosis. BMJ Case Rep 2013; 2013:bcr-2012-008055. [PMID: 23349178 DOI: 10.1136/bcr-2012-008055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A young female presented with acute left lower quadrant pain followed by nausea and vomiting. She was found to have haematuria and elevated serum creatine. CT scan revealed a wedge-shaped hypodensity along with an intraluminal filling defect on the left kidney. Renal artery duplex showed no evidence for stenosis and MRI was negative for any atherosclerotic disease. Technetium scan confirmed the diagnosis of left renal infarct. Following day the patient became febrile and was noted to have leucocytosis and elevated serum lactate dehydrogenase. She was started on enoxaparin and low-dose aspirin. Blood cultures were negative. The oral contraceptive was stopped. Fever and leucocytosis resolved in the following 3 days. Extensive thrombophilic work-up was negative. No recurrence of thrombosis was found during a 6-month follow-up period. To the best of our knowledge, this is the first report of renal artery thrombosis leading to acute renal infarction associated with oral contraceptive use.
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Affiliation(s)
- Ashish Bhargava
- Internal Medicine, Detroit Medical Center, Detroit, MI, USA.
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11
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Abstract
Soon after the introduction of hormonal oral contraceptive agents reports of thrombotic complications appeared. In the past several decades, large epidemiological studies helped defined these risks for both arterial and venous complications. Clinicians can assess a patient's risk of thrombosis by both composition of the agent and patients' personal risk factors. For women with bleeding disorders these prothrombotic changes can help decrease bleeding complications. There is now also abundant data on future management of patients with estrogen related thrombosis.
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Affiliation(s)
- Thomas G DeLoughery
- Knight Cancer Center, Hematology/Laboratory Medicine, Departments of Medicine, Pathology, and Pediatrics, Oregon Health Sciences University, Portland, OR 97229-3098, USA.
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12
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Stegnar M. Thrombophilia screening--at the right time, for the right patient, with a good reason. Clin Chem Lab Med 2010; 48 Suppl 1:S105-13. [PMID: 21054190 DOI: 10.1515/cclm.2010.367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Thrombophilia can be identified in about half of all patients presenting with venous thromboembolism (VTE). Thrombophilia screening for various indications has increased tremendously, but whether the results of such tests help in the clinical management of patients is uncertain. Here, current recommendations for thrombophilia screening in selected groups of patients, and considerations whether other high-risk subjects should be tested are reviewed. The methods for determination of the most common thrombophilic defects (antithrombin, protein C, protein S deficiencies, Factor V Leiden and prothrombin G20210A) associated with strong to moderate risk of VTE are described, indicating the timing and location of thrombophilia screening. Circumstances when a positive result of thrombophilia screening helps clinicians decide if adjustments of the anticoagulant regime are needed are discussed. Finally, psychological, social and ethical dilemmas associated with thrombophilia screening are indicated.
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Affiliation(s)
- Mojca Stegnar
- Department of Vascular Diseases, University Medical Centre, Ljubljana, Slovenia.
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13
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European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis 2010; 4:493-510. [PMID: 21122553 DOI: 10.1016/j.crohns.2010.07.004] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 07/12/2010] [Indexed: 02/08/2023]
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The changed ultrastructure of fibrin networks during use of oral contraception and hormone replacement. J Thromb Thrombolysis 2010; 30:502-6. [DOI: 10.1007/s11239-010-0502-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dietrich JE, Yee DL. Thrombophilic conditions in the adolescent: the gynecologic impact. Obstet Gynecol Clin North Am 2009; 36:163-75. [PMID: 19344854 DOI: 10.1016/j.ogc.2008.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
As Virchow's triad suggests, a fine balance exists between the vascular wall, intravascular contents, and dynamic blood flow, such that a shift in this balance predisposes to thrombosis. Although thromboembolic events (TEs) are relatively infrequent in adolescents, the morbidity and mortality associated with TEs can be significant. Over the past 15 years, TEs and inherited and acquired thrombophilic conditions underlying them have become increasingly recognized in teens at risk, with combined hormonal contraception constituting one of the most significant of these risk factors. Therefore, managing gynecologic problems in teens who have thrombophilic conditions can be challenging. It is important to have a clear understanding about safe options available to help address adolescent gynecologic concerns in this setting and to manage situations collaboratively with a hematologist.
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Affiliation(s)
- Jennifer E Dietrich
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 6620 Main Street, Suite 1450, Houston, TX 77030, USA.
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Dulícek P, Malý J, Pecka M, Beránek M, Cermáková E, Malý R. Venous thromboembolism in young female while on oral contraceptives: high frequency of inherited thrombophilia and analysis of thrombotic events in 400 czech women. Clin Appl Thromb Hemost 2008; 15:567-73. [PMID: 19117968 DOI: 10.1177/1076029608325544] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Oral contraceptive use is a common risk factor for venous thromboembolism in women of reproductive age. The presence of inherited thrombophilia further increases this risk. METHODS We analyzed a large group of 400 Czech women with venous thromboembolism in association with oral contraceptive with regard to duration of use at the time of manifestation of venous thromboembolism, the frequency of inherited and acquired thrombophilia, the frequency of eliciting risk factor for thrombosis including immobilization, surgery, administration of plaster cast, long travel, and so on, and the type of thrombosis. The mean age of the women was 26 years, and the average duration of use was 45 months at the onset of thrombosis. RESULTS Venous thrombosis solely due to the pill occurred in 57% of the women, and in the other 43%, an additional transient eliciting factor was recognized. Among the clinical manifestation, distal thrombosis prevailed (N = 231, 58%) followed by proximal deep vein thrombosis (N = 65, 16%), pulmonary embolism (N = 21, 5%), and thrombosis in unusual sites (N = 20, 5%). Inherited or acquired thrombophilia was diagnosed in 195 (49%) women: factor V Leiden mutation in 35%, congenital deficiency of antithrombin in 1.8%, protein C in 0.8%, protein S in 1%, F IIG20210A in 5%, and antiphospholipid syndrome (APS) in 5.3%. Among the most common risk factors were immobilization of lower limb, minor and major surgery, and trauma. CONCLUSION The results confirm that venous thromboembolism is a multifactorial disease in which thrombophilia screening is needed in young symptomatic women on the pill with thrombosis. The results also emphasize the value of proper thromboprophylaxis in women while on oral contraceptive in situations of increased risk for venous thromboembolism.
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Affiliation(s)
- Petr Dulícek
- Second Department of Internal Medicine - Division of Hematology, University Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic.
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Uchikova E, Pehlivanov B. Effect of two low-dose gestodene containing monophasic oral contraceptives on hemostasis in Bulgarian women. Expert Opin Pharmacother 2008; 9:1839-44. [DOI: 10.1517/14656566.9.11.1839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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