Zermatten Maxime G, Bertaggia Calderara Debora, Aliotta Alessandro, Alberio Lorenzo
Division of Haematology and Central Haematology Laboratory Lausanne University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland.
Res Pract Thromb Haemost. 2020 Mar 2;4(3):429-432. doi: 10.1002/rth2.12318. eCollection 2020 Mar.
Combined oral contraceptives and factor V Leiden mutation are multiplicative risk factors for venous thromboembolism. However, it remains unknown whether this multiplicative effect is reflected in thrombin generation assays. We report here the evolution of the thrombin generation profile while taking combined oral contraceptives and after their discontinuation in a woman with heterozygous factor V Leiden mutation. The proband exhibited a distinctly prothrombotic thrombin generation profile including markedly decreased thrombomodulin (TM) sensitivity, compared to the control population. This profile possibly reflected a high thrombotic risk. After discontinuation of combined oral contraceptives, thrombin generation and TM sensitivity improved greatly, leaving only a slightly prothrombotic profile. Therefore, the multiplied thrombotic risk occurring with simultaneous combined oral contraceptives and factor V Leiden mutation is reflected by a thrombin generation assay performed without and with TM. This could be a promising tool to identify women taking combined oral contraceptives at high risk for venous thromboembolism. Further studies are needed to verify this hypothesis.
复方口服避孕药与凝血因子V莱顿突变是静脉血栓栓塞的倍增风险因素。然而，这种倍增效应是否在凝血酶生成检测中有所体现仍不清楚。我们在此报告一名杂合子凝血因子V莱顿突变女性在服用复方口服避孕药期间及停药后的凝血酶生成情况演变。与对照人群相比，先证者表现出明显的促血栓形成的凝血酶生成情况，包括血栓调节蛋白（TM）敏感性显著降低。这种情况可能反映了高血栓形成风险。停用复方口服避孕药后，凝血酶生成及TM敏感性大幅改善，仅留下轻微的促血栓形成情况。因此，复方口服避孕药与凝血因子V莱顿突变同时存在时出现的倍增血栓形成风险，可通过有无TM的凝血酶生成检测反映出来。这可能是识别服用复方口服避孕药且有静脉血栓栓塞高风险女性的一个有前景的工具。需要进一步研究来验证这一假设。
