Critical Care Medicine-Hematologic and Oncologic Disorders>>>>>Hypercoagulable StatesQuestion 4#
The combined oral contraceptive pill is associated with an increased risk of developing VTE.
Which of the following factors has been demonstrated to reduce the risk of VTE?
A. <50 µg of ethinyl estradiol
B. First-generation progestins
C. Oral contraceptive use of <1 year
D. Age >39 years
Correct Answer is AComment:
Correct Answer: A
VTE is the most common vascular complication of combined oral contraception (COC) use. Although the risk is higher than in nonusers, the absolute risk is low and much less than the risk of VTE in pregnancy and early postpartum.
Studies have demonstrated that the risk of VTE is reduced by use of lower doses of ethinyl estradiol (<50 µg) and second-generation progestins (levonorgestrel). The risk of VTE is actually highest in the first year of COC use. The risk of VTE rises sharply after the age of 39 years in women taking COC. Women who smoke also have a greater risk.
- Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national followup study. BMJ. 2009;339:b2890.
- van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, et al. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ. 2009;339:b2921.
- de Bastos M, Stegeman BH, Rosendaal FR, et al. Combined oral contraceptives: venous thrombosis. Cochrane Database Syst Rev. 2014; (3):CD010813.
- Nightingale AL, Lawrenson RA, Simpson EL, et al. The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives. Eur J Contracept Reprod Health Care. 2000;5:265.