Carter C
Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, Canada.
Baillieres Clin Obstet Gynaecol. 1997 Sep;11(3):565-85. doi: 10.1016/s0950-3552(97)80028-4.
The oral contraceptive is one of the most widely taken medications in the healthy population. The clinically important side-effects are venous and arterial thrombosis. Accurate estimates of incidence of these side-effects have proven to be difficult. Diagnostic modalities for thrombosis are sub-optimal and the problems of study methodology, primarily a reliance on non-experimental studies, have limited the ability to define the attributable risk of thrombosis from oral contraception. Pharmacological attempts to further decrease venous thrombotic side-effects by the use of third-generation oral contraceptives have failed. This places a greater emphasis on the selection of patients to help avoid giving medication to those patients with underlying thrombotic risk factors. An example of this approach has been the clear confirmation of the adverse effects of cigarette smoking and arterial thrombosis in oral contraceptive users. At the biochemical level, hypercoagulability testing may be useful. Screening for high-frequency prothrombotic abnormalities, such as the Factor V Leiden genotype, represents an important addition to the process by which patients are selected, and may be prototypic of further advances.
口服避孕药是健康人群中服用最为广泛的药物之一。其临床上重要的副作用是静脉和动脉血栓形成。事实证明，准确估计这些副作用的发生率很困难。血栓形成的诊断方法并不理想，而且研究方法存在问题，主要依赖非实验性研究，这限制了确定口服避孕药导致血栓形成的归因风险的能力。使用第三代口服避孕药进一步降低静脉血栓形成副作用的药理学尝试已失败。这就更加强调了患者选择，以避免给那些有潜在血栓形成风险因素的患者用药。这种方法的一个例子是明确证实了口服避孕药使用者吸烟和动脉血栓形成的不良影响。在生化水平上，高凝状态检测可能有用。筛查高频促血栓形成异常，如凝血因子V莱顿基因型，是患者选择过程中的一项重要补充，可能是进一步进展的典范。
