Abstract Number: PB2494
Meeting: ISTH 2020 Congress
Background: Combined oral contraceptives (COC) induce several changes in the levels of coagulation factors. These effects on hemostasis are more pronounced with third or fourth generation COC compared to second-generation COC and risk minimization measures are required to reduce the risk.
Aims: To review the strategies aiming at assessing the thrombotic risk in women taking COC in order to identify inherited or acquired hemostasis abnormalities associated with thrombotic events.
Methods: An literature review was performed on PubMed from inception to January 2020.
Results: COC use causes changes in coagulation that modify the prothrombotic state induced by pre-existing hemostatic alterations in a supra-additive manner. Therefore, testing appears to be of importance not only before implementing COC but also in order to monitor potential thrombogenicity induced by COC. Namely, inherited genetic factors like FV Leiden, G20210A prothrombin mutation, antithrombin, protein C or protein S deficiencies, non-O blood group, as well as the CYP2C9*2 and rs4379368 mutations, have all been identified as genetic predictive risk factors of venous thromboembolism in these women. Nevertheless, the screening of all these genetic biomarkers is costly and does not allow a global estimation of the prothrombotic risk.The “ideal” testing should be able to assess the additive expression of inherited or acquired thrombophilia with hormonal-induced coagulopathy. The ETP-based APC resistance is sensitive towards all the coagulation defects that are frequently recognized individually as prothrombotic factors and fit particularly well with the relative risk increase observed in epidemiological studies of vulnerable populations.
Conclusions: Thus, while further works are still needed to confirm its status as a non-expensive, widely implementable and generic coagulation screening test for the assessment of the prothrombotic state in women taking contraceptive or other hormonal therapies, the ETP-based APC resistance already demonstrated the capacity of detecting prothrombotic state which is the Holy Grail of preventive medicine in the field of thrombosis.
To cite this abstract in AMA style:Douxfils J, Morimont L, Bouvy C, Dogné J-. Oral Contraceptives and Venous Thromboembolism: Focus on Testing that May Enable Prediction and Assessment of the Risk [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/oral-contraceptives-and-venous-thromboembolism-focus-on-testing-that-may-enable-prediction-and-assessment-of-the-risk/. Accessed September 27, 2023.
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