Vandenbroucke J P, Helmerhorst F M, Bloemenkamp K W, Rosendaal F R
Department of Clinical Epidemiology, University Hospital Leiden, The Netherlands.
Am J Obstet Gynecol. 1997 Oct;177(4):887-91. doi: 10.1016/s0002-9378(97)70289-8.
Four epidemiologic studies showed a twofold increase in risk of deep venous thrombosis with the use of oral contraceptives containing third-generation progestins, relative to second-generation products. These findings have been strongly debated ever since, and new studies have been added. In the current article we examine whether the findings can be explained by potential biases or other shortcomings of the epidemiologic studies. We conclude that complete certainty cannot exist but that the most rational conclusion from the epidemiologic findings and their discussion is that an increased risk of deep venous thrombosis with third-generation contraceptives is likely, especially in first-time and young users. The controversy has recently led to new insights in coagulation: Women who use third-generation contraceptives acquire a resistance to the blood's own anticoagulation system, similar to the activated protein C resistance that is seen in persons who carry the factor V Leiden mutation but different from that in women using second-generation contraceptives.
四项流行病学研究表明，与第二代口服避孕药相比，使用含第三代孕激素的口服避孕药会使深静脉血栓形成风险增加两倍。自那以后，这些发现一直备受激烈争论，并且又有了新的研究。在当前这篇文章中，我们探讨这些发现是否可以用流行病学研究中的潜在偏倚或其他缺陷来解释。我们的结论是，完全确定是不可能的，但从流行病学研究结果及其讨论中得出的最合理结论是，第三代避孕药导致深静脉血栓形成的风险可能增加，尤其是在首次使用和年轻使用者中。最近这场争论促使人们对凝血有了新的认识：使用第三代避孕药的女性会对自身血液的抗凝系统产生抵抗，这类似于携带因子V莱顿突变者出现的活化蛋白C抵抗，但与使用第二代避孕药的女性不同。
