Lévesque H, Courtois H
Département de médecine interne, CHU Rouen-Boisguillaume, France.
Rev Med Interne. 1997;18 Suppl 6:620s-625s. doi: 10.1016/s0248-8663(97)80708-4.
A link between venous thromboembolism and oral contraceptive users is well established. This paper analyzes recent epidemiological studies affecting risk of venous thromboembolism with the use of oral contraceptive or with postmenopausal hormone replacement therapy. Four epidemiological studies showed a two-fold increase of venous thromboembolism with the use of oral contraceptives containing third generation progestins (gestodene and desogesterel, relative to second-generations product (levonorgestrel); relative risk 3.8 per 100,000 women years in non-user women, 16 per 100,000 women years in women using levonorgestrel containing oral contraceptive) and 29 per 100,000 women years in women using gestodene containing oral contraceptive). Third-generation oral contraceptives induce a resistance to the activated protein C of almost the same magnitude as the resistance induced by a mutation in coagulation factor V. Studies with postmenopausal estrogen-replacement therapy show a two-fold risk of venous thromboembolism with estrogen only as well as with combined estrogen-progestagen hormone replacement therapy. However venous thromboembolism risk is very small compared with the cardiovascular and other benefits.
静脉血栓栓塞与口服避孕药使用者之间的联系已得到充分证实。本文分析了近期关于使用口服避孕药或绝经后激素替代疗法影响静脉血栓栓塞风险的流行病学研究。四项流行病学研究表明，使用含第三代孕激素（孕二烯酮和去氧孕烯，相对于第二代产品左炔诺孕酮）的口服避孕药会使静脉血栓栓塞风险增加两倍；在未使用避孕药的女性中，每10万名女性年的相对风险为3.8，在使用含左炔诺孕酮口服避孕药的女性中为每10万名女性年16，在使用含孕二烯酮口服避孕药的女性中为每10万名女性年29。第三代口服避孕药诱导的对活化蛋白C的抵抗程度几乎与凝血因子V突变诱导的抵抗程度相同。绝经后雌激素替代疗法的研究表明，仅使用雌激素以及联合雌激素 - 孕激素激素替代疗法都会使静脉血栓栓塞风险增加两倍。然而，与心血管和其他益处相比，静脉血栓栓塞风险非常小。
