Botzenhardt S, Toni I, Rascher W, Neubert A
Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Germany.
Klin Padiatr. 2013 Sep;225(5):268-76. doi: 10.1055/s-0033-1351288. Epub 2013 Aug 26.
Venous thromboembolism (VTE) is a rare, but feared adverse drug reaction of combined oral contraceptives. Modern oral contraceptives contain novel progestins, which are suspected of causing thrombotic events more frequently than well-known progestins. Drospirenone is one of those new fourth-generation progestins with antiandrogenic and antimineralocorticoid effects. Especially girls and young women do not only wish for contraception, but also for positive effects on skin and body weight. In the last decade, however, the safety of this progestin was often under discussion.A detailed literature search was conducted to obtain an overview of currently available data on the risk of VTE among girls and young women using drospirenone-containing contraceptives. It appears that drospirenone-containing contraceptives have a similar increase in risk as third-generation oral contraceptives and antiandrogens. Compared to second-generation contraceptives containing the progestin levonorgestrel there is an approximate 2-fold risk increase (1.0 to 2.8-fold) in women aged 10-55 years. Accurate data regarding the risk in the age group under 18 years are lacking. Nevertheless, the risk of VTE appears to be higher in young -women during the first months of treatment. Until more data for nov-el progestins are available and the safety profile is well defined well-studied second-generation oral contraceptives with low dose estrogen and better risk-benefit ratio should be preferred in young women. In any case, all patients should be comprehensively informed regarding the benefits and risks of each contraceptive method.
静脉血栓栓塞（VTE）是复方口服避孕药罕见但令人担忧的不良反应。现代口服避孕药含有新型孕激素，人们怀疑这些新型孕激素比知名孕激素更易引发血栓形成事件。屈螺酮是那些具有抗雄激素和抗盐皮质激素作用的新型第四代孕激素之一。尤其是女孩和年轻女性，她们不仅希望避孕，还期望药物对皮肤和体重有积极作用。然而，在过去十年中，这种孕激素的安全性常常受到讨论。
我们进行了详细的文献检索，以全面了解目前关于使用含屈螺酮避孕药的女孩和年轻女性发生VTE风险的现有数据。含屈螺酮的避孕药似乎与第三代口服避孕药和抗雄激素药物的风险增加情况相似。与含有孕激素左炔诺孕酮的第二代避孕药相比，10至55岁女性的风险增加约2倍（1.0至2.8倍）。缺乏18岁以下年龄组风险的准确数据。尽管如此，年轻女性在治疗的头几个月发生VTE的风险似乎更高。在获得更多关于新型孕激素的数据并明确其安全性之前，对于年轻女性，应优先选择雌激素剂量低且风险效益比更佳的、经过充分研究的第二代口服避孕药。无论如何，都应让所有患者全面了解每种避孕方法的益处和风险。
