Hugon-Rodin Justine, Horellou Marie-Hélène, Conard Jacqueline, Gompel Anne, Plu-Bureau Geneviève
University Paris-Saclay and Paris-Sud, UVSQ, CESP, U1018, INSERM, 94800 Villejuif, France.
Gynecology Endocrinology Unit, Hôpital Universitaire Paris Centre, APHP, 75014 Paris, France.
J Endocr Soc. 2017 Apr 20;1(6):762-771. doi: 10.1210/js.2017-00090. eCollection 2017 Jun 1.
In UK and French, but not World Health Organization (WHO), guidelines for combined hormonal contraception (CHC), family history of a venous thromboembolism (VTE) is a condition for which the theoretical risks usually outweigh the advantages of using CHC.
We estimated the prevalence of inappropriate prescriptions of CHC according to several international guidelines and their impact on VTE.
A single-center observational study.
Hemostasis unit outpatient clinic (Paris, France).
A total of 2088 French CHC users of childbearing age with a first documented VTE who were referred to our unit between 2000 and 2009.
Data were collected by a standardized questionnaire during a medical consultation. Family history of VTE was analyzed according to definitions from international recommendations (VTE before age 45 years, United Kingdom; before age 50 years, France). A CHC prescription was considered inappropriate for women with vascular contraindications and/or a family history of VTE. Cross-sectional analysis of the clinical and biological characteristics was performed.
Prevalence of inappropriate prescription of CHC and potentially preventable events were estimated.
According to the WHO, UK, or French guidelines, 8.8%, 18.9%, and 25.9%, respectively, of CHC prescriptions were considered inappropriate. Compliance with these guidelines could reduce the corresponding number of VTEs by 6.3%, 13.5%, and 18.5%, respectively. Characteristics of the women were similar.
Our results suggest inappropriate CHC prescriptions are prevalent among CHC users with first VTE. The appropriate way to take family history of VTE into account should be further clarified.
在英国和法国的复方激素避孕（CHC）指南中，但并非世界卫生组织（WHO）的指南，有静脉血栓栓塞（VTE）家族史是一种理论风险通常超过使用CHC益处的情况。
我们根据若干国际指南估计了CHC不适当处方的患病率及其对VTE的影响。
单中心观察性研究。
止血科门诊（法国巴黎）。
2000年至2009年间转诊至我们科室的2088名有首次记录VTE的法国育龄期CHC使用者。
在医疗咨询期间通过标准化问卷收集数据。根据国际建议的定义（英国为45岁之前发生VTE；法国为50岁之前发生VTE）分析VTE家族史。对于有血管禁忌证和/或VTE家族史的女性，CHC处方被视为不适当。对临床和生物学特征进行横断面分析。
估计CHC不适当处方的患病率和潜在可预防事件。
根据WHO、英国或法国的指南，分别有8.8%、18.9%和25.9%的CHC处方被认为不适当。遵循这些指南可分别将相应的VTE数量减少6.3%、13.5%和18.5%。女性的特征相似。
我们的结果表明，在首次发生VTE的CHC使用者中，CHC不适当处方很普遍。应进一步明确考虑VTE家族史的恰当方式。
