Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology Karolinska Institutet, Stockholm, Sweden.
Thromb Res. 2012 Oct;130(4):636-9. doi: 10.1016/j.thromres.2011.11.006. Epub 2011 Dec 9.
The risk of venous tromboembolism (VTE) in women taking combined oral contraceptives (COCs) is attributed to changes in coagulation and fibrinolysis. The impact of the COCs may be greater in women with preexisting thrombophilic defects. Nevertheless most women who suffer from venous thrombosis do not have any of the well known hereditary or acquired risk factors. A simple and sensitive marker of"thrombogenicity" has not been identified.
To investigate the effects of two different monophasic combined oral contraceptives (COCs) on the plasma concentrations of activated protein C-inhibitor of protein C ( APC-PCI) and on comparable hemostatic factors in fertile women.
Forty four healthy nulliparous women with regular menstrual periods were included and randomly assigned to start with a monophasic preparation containing 30μg ethinylestradiol and 150μg levonogestrel (LNG/EE) or a preparation containing 30μg ethinylestradiol and 150 ug desogestrel (DG/EE). After a wash out period of two months, treatment with the alternate preparation was initiated and continued for two more cycles.
The plasma concentration of the APC-PCI complex and thrombin-antithrombin complex (TAT) increased during treatment with the two COCs. During DG/EE treatment the APC-PCI complex increased significantly more than during LNG/EE (p<0,01).The plasma concentration of D-dimer did not increase during OC treatment.
The APC-PCI complex concentration, which serves as a marker for thrombin generation and indicates hypercoagulability, was increased during COC treatment compared to baseline. The method is a sufficiently sensitive marker to detect even small differences in the activation of coagulation.
服用复方口服避孕药（COC）的女性发生静脉血栓栓塞（VTE）的风险归因于凝血和纤维蛋白溶解的变化。COC 的影响在存在预先存在的血栓形成缺陷的女性中可能更大。然而，大多数患有静脉血栓形成的女性没有任何已知的遗传性或获得性危险因素。尚未确定一种简单而敏感的“血栓形成性”标志物。
研究两种不同的单相复方口服避孕药（COC）对生育期妇女血浆活化蛋白 C 抑制剂-蛋白 C（APC-PCI）浓度和可比止血因子的影响。
纳入 44 名月经规律的健康未产妇，随机分为开始使用含 30μg 炔雌醇和 150μg 左炔诺孕酮（LNG/EE）的单相制剂或含 30μg 炔雌醇和 150ug 去氧孕烯（DG/EE）的单相制剂。在两个月的洗脱期后，开始使用交替制剂，并再继续两个周期。
两种 COC 治疗期间，APC-PCI 复合物和凝血酶-抗凝血酶复合物（TAT）的血浆浓度增加。在 DG/EE 治疗期间，APC-PCI 复合物的增加明显高于 LNG/EE（p<0.01）。OC 治疗期间血浆 D-二聚体浓度未增加。
与基线相比，COC 治疗期间 APC-PCI 复合物浓度增加，作为凝血酶生成的标志物，表明高凝状态。该方法是一种足够敏感的标志物，可检测到凝血激活的微小差异。
