van Vliet Huib A A M, Tchaikovski Svetlana N, Rosendaal Frits R, Rosing Jan, Helmerhorst Frans M
Department of Gynaecology and Reproductive Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Thromb Haemost. 2009 Apr;101(4):691-5.
Exogenously administered estrogens and progestogens as during combined oral contraceptive use increase the risk of venous thrombosis. The thrombin generation-based APC resistance assay is a global coagulation test that enables quantification of the net prothrombotic effect of combined oral contraceptives and that predicts the risk of thrombosis. The thrombotic risk of the levonorgestrel-releasing intrauterine system is unknown. It was the objective of this study to evaluate the thrombotic risk by comparing the APC resistance before and after insertion of a levonorgestrel-releasing or a copper-containing intrauterine device. We measured normalized APC-sensitivity ratios (nAPCsr) before and three months after insertion of the levonorgestrel-intrauterine system in 56 women and the copper-intrauterine device in 18 women. In women without hormonal contraceptive use or a pregnancy in the three months before collection of the baseline samples, nAPCsr were lower three months after insertion of the levonorgestrel-intrauterine system than at baseline (difference -0.29; 95% CI -0.04 to -0.53) and hardly changed after insertion of the copper-intrauterine device (difference -0.11; 95% CI -1.03 to 0.82). In women who switched from a combined oral contraceptive to the levonorgestrel-system the difference was more pronounced (-1.48; 95% CI -0.85 to -2.11). In this study we observed that the levonorgestrel-intrauterine system decreases the resistance to APC which indicates that the levonorgestrel-intrauterine system does not have a prothrombotic effect.
外源性给予雌激素和孕激素，如在使用复方口服避孕药期间，会增加静脉血栓形成的风险。基于凝血酶生成的活化蛋白C抵抗试验是一种全面的凝血检测方法，它能够量化复方口服避孕药的净促血栓形成作用，并预测血栓形成的风险。左炔诺孕酮宫内节育系统的血栓形成风险尚不清楚。本研究的目的是通过比较插入左炔诺孕酮宫内节育器或含铜宫内节育器前后的活化蛋白C抵抗情况，来评估血栓形成风险。我们测量了56名插入左炔诺孕酮宫内节育系统的女性和18名插入含铜宫内节育器的女性在插入前及插入三个月后的标准化活化蛋白C敏感率（nAPCsr）。在基线样本采集前三个月未使用激素避孕或未怀孕的女性中，插入左炔诺孕酮宫内节育系统三个月后的nAPCsr低于基线水平（差值-0.29；95%置信区间-0.04至-0.53），而插入含铜宫内节育器后几乎没有变化（差值-0.11；95%置信区间-1.03至0.82）。从复方口服避孕药改用左炔诺孕酮宫内节育系统的女性中，差异更为明显（-1.48；95%置信区间-0.85至-2.11）。在本研究中，我们观察到左炔诺孕酮宫内节育系统降低了对活化蛋白C的抵抗，这表明左炔诺孕酮宫内节育系统没有促血栓形成作用。
