Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Semin Thromb Hemost. 2020 Nov;46(8):865-871. doi: 10.1055/s-0040-1715793. Epub 2020 Oct 5.
The risk of venous thrombosis (VT) varies according to the type of progestogen that is found in combined oral contraceptives (COCs). When combined with the estrogen component ethinylestradiol (EE), the androgenic progestogens are better able to counteract the EE-induced stimulation of liver proteins and hence are associated with a twofold decreased risk of VT compared with non- or antiandrogenic progestogens, which exert limited counteraction of EE. Because EE is responsible for the increased risk, novel estrogens such as estradiol were developed and seem to have a lower risk of VT than EE. Besides COCs, there are other methods of hormonal contraceptives, such as progestogen-only contraceptives, which do not increase VT risk, except for injectables. Other nonoral contraceptives are combined vaginal rings and patches. There is insufficient evidence regarding the risk of VT associated with these two methods compared with COCs. The increased risk associated with COCs is more pronounced in women with inherited thrombophilia. In these women, the progestogen levonorgestrel seems to be associated with the lowest risk of VT. Currently, there are no studies that have investigated the risk of VT in women who switch COCs. We hypothesize that switching COCs, even when switching from a high- to a low-risk COC, increases the risk of VT. Finally, risk prediction models in women who use COCs are lacking. Since there is a large number of VT cases associated with COC use, it is important to identify women at risk of VT and advise them on alternative contraception methods.
静脉血栓形成（VT）的风险因复方口服避孕药（COC）中所含孕激素的类型而异。当与雌激素成分炔雌醇（EE）联合使用时，雄激素孕激素能更好地对抗 EE 诱导的肝脏蛋白刺激，因此与 VT 的风险降低两倍相关，而非或抗雄激素孕激素则对 EE 的对抗作用有限。由于 EE 是导致风险增加的原因，因此开发了新型雌激素，如雌二醇，其 VT 风险似乎低于 EE。除了 COC 外，还有其他激素避孕药方法，如仅孕激素避孕药，除了注射剂外，不会增加 VT 风险。其他非口服避孕药包括阴道环和贴剂。与 COC 相比，这两种方法与 VT 相关的风险的证据不足。COC 相关的风险增加在遗传性血栓形成倾向的女性中更为明显。在这些女性中，左炔诺孕酮似乎与 VT 的最低风险相关。目前，尚无研究调查与 COC 相比，更换 COC 的女性 VT 的风险。我们假设，即使从高风险 COC 更换为低风险 COC，也会增加 VT 的风险。最后，使用 COC 的女性的 VT 风险预测模型也缺乏。由于与 COC 使用相关的 VT 病例数量众多，因此确定 VT 风险的女性并为她们提供替代避孕方法非常重要。
