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Re: Factor V Leiden and OCs From: art fougner, md (evsono@pipeline.com) Fri Nov 3 14:32:15 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Re: Factor V Leiden and OCs" Previous message: John Robertson MD: "Many threads" In reply to: Efrain Ramirez: "Re: Factor V Leiden and OCs" Next in thread: Efrain Ramirez: "Re: Factor V Leiden and OCs" Reply: Efrain Ramirez: "Re: Factor V Leiden and OCs" Reply: ainsron@msn.com: "Re: Factor V Leiden and OCs" would think OC's are contra-indicated - : Eur J Contracept Reprod Health Care 2000 Jun;5(2):105-12 Related Articles, Books Are factor V Leiden carriers who use oral contraceptives at extreme risk for venous thromboembolism? Spannagl M, Heinemann LA, Schramm W Ludwig-Maximilian University, Department of Hemostasiology, City Center Clinic, Medical Hospital, Munich, Germany. [Medline record in process] BACKGROUND: Major concern was raised by an earlier study regarding oral contraceptive use in women with the factor V Leiden mutation. A more than 30-fold increase in relative risk for venous thromboembolism was reported; for homozygotes, the relative risk was as much as 100-fold or more. OBJECTIVE: To replicate the reported risk estimates with a new population-based case-control study. METHODS: Eighty women with a diagnosis of venous thromboembolism were consecutively identified and compared with population-based controls (n = 406). Factor V Leiden mutation was identified by genotype analysis. The evaluation was performed with conditional logistic regression (matched for 5-year age group). RESULTS: Matched, adjusted odds ratios (OR) for idiopathic venous thromboembolism in women without and with the factor V Leiden mutation who used oral contraceptives were 4.1 (95% confidence interval (CI) 2.1-7.8) and 10.2 (95% CI 1.2-88.4), respectively. The adjusted OR for factor V Leiden carriers was 2.0 (95% CI 1.0-4.4). The OR for women with the factor V Leiden mutation and oral contraceptive use versus no factor V Leiden mutation and no oral contraceptive use was 10.2 (95% CI 3.8-27.6). CONCLUSION: The results confirm the increased relative risk ofidiopathic venous thromboembolism for users of oral contraceptives and factor V Leiden carriers. However, we suspect that the true risk for women who are factor V Leiden carriers may be increased two- to four-fold rather than seven-fold or more, and that the risk for the combination of factor V Leiden and oral contraceptive use may be increased in the order often- to 15-fold rather than over 30-fold. PMID: 10943572, UI: 20397481 there are other references including a sobering case report of Budd Chiari Syndrome associated with pill use in a woman with Factor V Leiden. art At Fri, 3 Nov 2000, Efrain Ramirez wrote: > >Femhrt,Activelle? I don't think they are contraindicated.. > >At Thu, 2 Nov 2000, ainsron@msn.com wrote: >> >>I have a 47 yo non-smoking female with perimenopausal DUB, secretory >>endometrium on biopsy. I'm considering placing her on BCPs to regulate >>her cycles for a few months/years, but it turns out that she is positive >>for Factor V Leiden mutation. No personal history of thrombophlebitis. >>On reviewing information on the pill and thrombophlebitis, I'm uncertain >>whether or not this is an absolute contraindication to the pill. Speroff >>says that "studies of the blood coagulation system have concluded that >>both monophasic and multiphasic low dose OCs have no significant >>clinical impact on the coagulation system." Then in the next paragraph >>he says, "The minimal risk of thrombosis associated with OC use does not >>justify the cost of routine screening for deficiencies in the >>coagulation system. If a patient develops a thrombotic complication >>while taking OCs, an evaluation to search for an underlying abnormality >>in the coag system is warranted." Any opinions on whether or not OCs >>should be offered (short term or long term) to patients like this would >>be appreciated. Or if you know any other references that more directly >>address this issue, let me know. >> >>-- >>Ronald E. Ainsworth, MD >> >-- >"Do not take life too seriously. You will never get out of it alive." > >Marianne Williamson > -- art fougner, md A series of 1000 cases begins with but a single anecdote. Next message: Efrain Ramirez: "Re: Factor V Leiden and OCs" Previous message: John Robertson MD: "Many threads" In reply to: Efrain Ramirez: "Re: Factor V Leiden and OCs" Next in thread: Efrain Ramirez: "Re: Factor V Leiden and OCs" Reply: Efrain Ramirez: "Re: Factor V Leiden and OCs" Reply: ainsron@msn.com: "Re: Factor V Leiden and OCs"

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