Unity 1018 in Centre de recherche en Épidémiologie et Santé des Populations (CESP), University Paris-Saclay and Paris-Sud, INSERM, Villejuif, France.
Gynecology Endocrinology Unit, Hôpital Universitaire Paris-Centre, APHP, Paris, France.
Thromb Haemost. 2018 May;118(5):922-928. doi: 10.1055/s-0038-1641152. Epub 2018 Apr 3.
This article estimates the interaction between types of combined hormonal contraception (CHC) and factor V Leiden (FVL) mutation on the risk of venous thrombosis event (VTE).
All premenopausal women with first incident VTE who were referred to our unit (Paris, France) between 2000 and 2009 were included in this case-only study. Differences in interactions by progestin type were assessed on a multiplicative scale, assuming the independence of genotype and prescription of type of CHC.
Among 2,613 women with VTE, 15.9% had a FVL and 69% used CHC. The interaction between CHC use and presence of FVL on VTE risk was statistically significant (1.37, 1.06-1.77 95% confidence interval [CI]). This interaction appeared higher for drospirenone 1.99 (1.18-3.38 95% CI) ( = 98) or cyproterone acetate users 1.71 (1.20-2.45 95% CI) ( = 326), but not significant for 1st or 2nd or norgestimate CHC users. The results were similar when excluding women with a family history of VTE or with provoked VTE. In this sub-group of women, these interactions appeared higher for third generation, cyproterone acetate and drospirenone CHC users as compared with 1st or 2nd or norgestimate CHC users (odds ratio [OR], 1.68 [1.04-2.70; 95% CI], 2.91 [1.71-4.95 95% CI], 3.22 [1.54-6.73 95% CI], respectively).
Our results show that the interaction between FVL and CHC use differ by progestin type, which is higher in CHC containing third-generation progestin, drospirenone or cyproterone acetate, compared with second generation. Further studies are needed to assess the cost-effectiveness of biological thrombophilia screening (FVL) when such prescription of CHC is planned.
本文旨在评估不同类型联合激素避孕药（CHC）与因子 V 莱顿（FVL）突变对静脉血栓栓塞（VTE）事件风险的交互作用。
本病例对照研究纳入了 2000 年至 2009 年间在我们单位（法国巴黎）就诊的所有首发 VTE 的绝经前女性。在乘法尺度上评估孕激素类型的差异交互作用，假设基因型和 CHC 类型的处方是独立的。
在 2613 例 VTE 患者中，15.9%存在 FVL，69%使用 CHC。CHC 使用与 FVL 对 VTE 风险的交互作用具有统计学意义（1.37，1.06-1.77 95%置信区间[CI]）。这种交互作用在使用屈螺酮 1.99（1.18-3.38 95%CI）（ = 98）或醋酸环丙孕酮的患者中更高，而在使用第一代或第二代或诺孕酯 CHC 的患者中不显著。当排除有 VTE 家族史或获得性 VTE 的女性时，结果相似。在这组女性中，与第一代或第二代或诺孕酯 CHC 使用者相比，第三代、醋酸环丙孕酮和屈螺酮 CHC 使用者的这种交互作用更高（比值比[OR]，1.68 [1.04-2.70；95%CI]，2.91 [1.71-4.95 95%CI]，3.22 [1.54-6.73 95%CI]）。
我们的结果表明，FVL 和 CHC 使用之间的相互作用因孕激素类型而异，在含有第三代孕激素、屈螺酮或醋酸环丙孕酮的 CHC 中，这种相互作用高于第二代。当计划使用 CHC 时，需要进一步研究生物血栓形成倾向（FVL）筛查的成本效益。
