Re: GYN: Popliteal artery entrapment syndrome
From: Anna Meenan, MD (annam@uic.edu)
Sat May 28 14:14:45 2005
Sage? Wisdom? Yikes, I feel old. I actually just call it paranoia, but
if you want to call it wisdom...........
Joanne, I was actually thinking more of peripheral arterial thrombosis,
which I've NEVER seen in a 20-year-old, but of course, strokes and MI's
are also arterial thrombosis (some of them anyway), and we do have data
on them. Thanks for the reminder and update from the literature. Also,
not being a hematologist, i learned something. I was not aware that the
platelet and fibrinogen levels differed from arterial blood to venous
blood.
However, at the end of the day, I still rely on paranoia.
--
Anna Meenan, MD
At Fri, 27 May 2005, Garry E. Siegel, M.D. wrote:
>
>Joanne, your research is noted and appreciated.
>
>Anna, your wisdom is sage, and I have similar thoughts.
>
>I do have a call in to the vascular surgeon.
>
>Garry
>
>At Fri, 27 May 2005, Joanne Bulley, MD wrote:
>>
>>This is from Speroff & Darney "A Clinical guide for Contraception" 2005
>>
>>At the end of the discussion on oral contraceptives and the
>>
>>"Smoking has a lesser effect on the risk of venous thrombosis compared
>>with arterial thrombosis.
>>
>>"Smoking and estrogen have an additive effect on the risk of arterial
>>thrombosis. Why is there a difference between venous and arterial
>>clotting? The venous system has low flow with a state of high fibrinogen
>>and low platelets, in contrast to the high-flow state of the arterial
>>systemwith low fibrinogen and high platelets. Thus, it is
>>understandable why these two different systems can respond in different
>>ways.
>>
>>"Hypertension is a very importatn additive risk factor for stroke in
>>oral contraceptive users.
>>
>>"Low dose oral contraceptives (less than 50mcg ethinyl estradiol) do not
>>increase the risk of myocardial infarction or stroke in healthy,
>>non-smoking women, regardless of age.
>>
>>"Almost all myocardial infarctions and strokes in oral contraceptive
>>users occur in users of high-dose products or users with cardiovascular
>>risk factors over the age of 35. In the Oxford Family Planning
>>Association cphort, cardiac deaths occurred only in women who smoked 15
>>or more cigaretts per day.
>>
>>"Arterial thrombosis (myocardial infarction and stroke) has a dose
>>response relationship with the dose of estrogen, but there are
>>insufficient data to determine whether there is a diference in risk with
>>products that contain 20, 30 or 35 mcg ethinyl estradiol."
>>
>>Obviously there isnothing here about arterial thrombosis in arteries
>>that are not for the heart or CNS ... but I thought I would put this
>>out for the discussion.
>>
>>I would think that the primary cause for Garry's patient was the
>>congenital malformation and the OCPs may have had nothing to do with it
>>(especially if she were a non-smoking, normotensive 20 year old) -- but
>>the courts might not see it that way if she were re-started on even a 20
>>mcg product and had another somewhere else. As Anna pointed out ... the
>>prosecutions might say, "But doctor, did you KNOW with CERTAINTY that
>>she had no other arterial malformations before re-starting the OCPs"
>>
>>Joanne
>>
>>At Fri, 27 May 2005, Anna Meenan, MD wrote:
>>>
>>>I'm guessing there is not and never will be adequate information on the
>>>incidence of arterial thrombi in 20-year-old women on OCP's. However, I
>>>picture a courtroom and a lawyer and the words "blood clot" and "birth
>>>control pills" being hammered at a jury over and over. Not a pretty
>>>sight. This would be one of those byproducts of our current liability
>>>crisis that I spoke of in an earlier post, and I would tell this young
>>>woman that the unavailability of OCP's as a birth control option for her
>>>is a direct result of the current crisis and I would recommend she join
>>>the frustrated VBAC-ers at the state capitol.
>>>
>>>--
>>> Anna Meenan, MD
>>>
>>--
>>Joanne Bulley, MD
>>Keene, NH, USA
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
