Jang Yong-Su, Lee Eun Sil, Kim Yang-Ki
Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2021 Jul;64(4):337-344. doi: 10.5468/ogs.20374. Epub 2021 Apr 1.
Combined oral contraceptives (COCs) are used for various reasons. However, venous thromboembolism (VTE), a significant side effect, can be fatal. This study reports the first case series in Korea involving patients with COC-associated VTE registered at a university hospital.
This study recruited 13 patients diagnosed with COC-associated VTE between June 2006 and May 2018. Risk factors, including age, body mass index, smoking habits, estrogen dosage, type of progestin, and duration of COC use, were evaluated.
Among patients with VTE, 9 showed pulmonary embolism (PE) concomitant with deep vein thrombosis (DVT). However, the remaining patients showed DVT (1 patient), PE (1 patient), and cerebral venous thrombosis (2 patients). The median duration between the onset of symptoms and a hospital visit was 3 days, and it sometimes took as long as 32 days. Among the 10 patients with PE, 1 high-risk group and 2 intermediate-high risk groups were treated with tissue plasminogen activators before anticoagulants. There were no cases of recurrence among patients who continued to take anticoagulants for 3 months.
These findings emphasize that healthcare professionals who prescribe or dispense COCs to women must inform them of the risk of VTE, including the risk factors, differences in risk depending on the type of progestin present in the product, and pertinent signs and symptoms. Efforts should also be made to inform patients of VTE, even through information campaigns such as brochures. Most importantly, women should remain alert for signs and symptoms of VTE when using COCs.
复方口服避孕药（COCs）因多种原因被使用。然而，静脉血栓栓塞（VTE）作为一种严重的副作用，可能会致命。本研究报告了韩国首例在大学医院登记的与COC相关的VTE患者病例系列。
本研究招募了2006年6月至2018年5月期间被诊断为与COC相关的VTE的13名患者。评估了包括年龄、体重指数、吸烟习惯、雌激素剂量、孕激素类型以及COC使用时长等风险因素。
在VTE患者中，9例表现为肺栓塞（PE）合并深静脉血栓形成（DVT）。然而，其余患者表现为DVT（1例）、PE（1例）和脑静脉血栓形成（2例）。症状发作至就诊的中位时长为3天，有时长达32天。在10例PE患者中，1例高危组和2例中高危组在使用抗凝剂前接受了组织纤溶酶原激活剂治疗。持续服用抗凝剂3个月的患者中无复发病例。
这些发现强调，为女性开具或配发COCs的医护人员必须告知她们VTE的风险，包括风险因素、产品中孕激素类型不同导致的风险差异以及相关的体征和症状。还应努力通过诸如宣传册等信息宣传活动让患者了解VTE。最重要的是，女性在使用COCs时应保持对VTE体征和症状的警惕。
