Norris L A, Bonnar J
Department of Obstetrics and Gynaecology, Coombe Women's Hospital, Dublin.
Br J Obstet Gynaecol. 1996 Mar;103(3):261-7. doi: 10.1111/j.1471-0528.1996.tb09716.x.
To determine the effect of oestrogen dose and progestogen type on the coagulation and fibrinolytic systems of a group of normal healthy women taking three different oral contraceptive combinations.
Plasma levels of factor VII, X, antithrombin III, protein C, fibrinogen, tissue plasminogen activator activity, plasminogen activator inhibitor I antigen and fibrin (D-dimer) degradation products were measured at pretreatment, 6, 14, 22 weeks of treatment and at 6 weeks post-treatment in a group of 67 women taking either 30 micrograms ethinyloestradiol/150 micrograms desogestrel (n = 21), 20 micrograms ethinyloestradiol/150 micrograms desogestrel (n = 24), 30 micrograms ethinyloestradiol/75 micrograms gestodene (n = 22).
Sixty-seven healthy normal women, 18 to 34 years, smoking fewer than 15 cigarettes per day. The subjects were within 10% of their normal body weight and had no history of thromboembolic disease.
Coombe Women's Hospital and St James's Hospital, Dublin, Ireland.
Factor VII and X levels were significantly raised on treatment with both the 30 micrograms ethinyloestradiol/desogestrel and gestodene combinations. Higher levels of factor VII activity were observed in the 30 micrograms ethinyloestradiol/desogestrel combination compared with the gestodene combination. Factor VII and X were not significantly affected by the 20 micrograms ethinyloestradiol combination. Increased plasminogen, fibrinogen and D-dimer levels and decreased plasminogen activator inhibitor I antigen levels were observed during the treatment phases in all three groups. Antithrombin III and protein C activity did not change during treatment with any of the oral contraceptives studied.
Low dose oral contraceptives cause an activation of the coagulation system which is balanced by an activation of the fibrinolytic system. Reducing the dose of ethinyloestradiol from 30 micrograms to 20 micrograms reduces the effect on factor VII and X. This effect can be modified by the progestogen. The lesser effect of the 20 micrograms combination may make this a safer option for some women than pills containing a higher dose of oestrogen.
确定雌激素剂量和孕激素类型对一组服用三种不同口服避孕药组合的正常健康女性凝血和纤溶系统的影响。
对67名服用30微克乙炔雌二醇/150微克去氧孕烯（n = 21）、20微克乙炔雌二醇/150微克去氧孕烯（n = 24）、30微克乙炔雌二醇/75微克孕二烯酮（n = 22）的女性，在治疗前、治疗第6、14、22周以及治疗后6周测量血浆中凝血因子VII、X、抗凝血酶III、蛋白C、纤维蛋白原、组织型纤溶酶原激活物活性、纤溶酶原激活物抑制剂I抗原和纤维蛋白（D - 二聚体）降解产物的水平。
67名健康正常女性，年龄18至34岁，每天吸烟少于15支。研究对象体重在正常体重的±10%以内，且无血栓栓塞性疾病史。
爱尔兰都柏林库姆女子医院和圣詹姆斯医院。
服用30微克乙炔雌二醇/去氧孕烯和孕二烯酮组合治疗时，凝血因子VII和X水平显著升高。与孕二烯酮组合相比，30微克乙炔雌二醇/去氧孕烯组合中凝血因子VII活性水平更高。20微克乙炔雌二醇组合对凝血因子VII和X无显著影响。在所有三组治疗阶段均观察到纤溶酶原、纤维蛋白原和D - 二聚体水平升高，纤溶酶原激活物抑制剂I抗原水平降低。在所研究的任何一种口服避孕药治疗期间，抗凝血酶III和蛋白C活性均未改变。
低剂量口服避孕药会引起凝血系统激活，同时纤溶系统激活可起到平衡作用。将乙炔雌二醇剂量从30微克降至20微克可降低对凝血因子VII和X的影响。这种影响可因孕激素而改变。20微克组合的影响较小，这可能使其对某些女性而言比含较高剂量雌激素的药丸更安全。
