Re: Factor V Leiden and OCs
From: ainsron@msn.com
Mon Nov 6 09:35:47 2000
Thanks for the reference.
At Fri, 3 Nov 2000, art fougner, md wrote:
>
>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.
>
--
Ronald E. Ainsworth, MD
