Abstract Number: PB2500
Meeting: ISTH 2020 Congress
Theme: Women Health » Estrogens and Progestinics
Background: Use of oral contraceptives (OCs) has been associated with increased thrombin generation (TG) and acquired resistance to the anticoagulant action of the activated Protein C (aPC) contributing to a hypercoagulability state.
Aims: To evaluate the association between current and past use of OCs and TG and resistance to aPC in a sample of Brazilian female civil servants.
Methods: Participants of this cross-sectional study were women of childbearing age enrolled in the baseline wave of the ELSA-Brasil cohort (N = 641). Thrombin generation test (TGT) was performed with low and high tissue factor (TF), with and without aPC and normalized aPC sensitivity ratio (nAPCsr) were calculated for the determination of acquired resistance to aPC. The participants were questioned about the use of OCs and categorized in current users, former users and nonusers. Association between OCs and TG was investigated by multivariable linear regression, using the non-users as a reference category.
Results: Most current users of OCs used 30-40µg of estrogen and 3rd generation progestogen for more than one year. TGT in the low TF condition showed that current users of COs had significantly lower means of lag time and time-to-peak and significantly higher means of peak and ETP when comparing to non-users, even after adjustments for age and total cholesterol/HDL cholesterol ratio. There was no association between former use of COs and TGT. We found same results for all TGT parameters in the high TF condition as well as for nAPCsr. No difference in TGT parameters was observed between ex-users and nonusers suggesting that the effect of OCs on blood clotting is reversible.
Conclusions: Current use of COs, but not former use, showed to be associated with both higher TG and nAPCsr confirming resistance to aPC in women by OCs use.
| Parameters | Former users | Current users | Former users (after adjustments for age and total cholesterol/HDL cholesterol ratio) | Current users (after adjustments for age and total cholesterol/HDL cholesterol ratio) |
| β (95%CI) | β (95%CI) | β (95%CI) | β (95%CI) | |
| Lagtime (min) | -0.13 (-0.45-0.18) | -1.21 (-1.75 – -0.68)* | -0.08 (-0.40-0.23) | -1.06 (-1.60 – -0.52)* |
| Time to peak (min) | -0.13 (-0.60-0.35) | -1.97 (-2.77 – -1.16)* | -0.06 (-0.54-0.41) | -1.77 (-2.59 – -0.95)* |
| Peak (nM) | 0.77 (-14.64-16.19) | 82.44 (56.21-108.66)* | 1.92 (-13.56-17.40) | 85.96 (59.16-112.77)* |
| ETP (nM.min) | 6.51(-62.32-75.35) | 352.79 (235.67- 469.90)* | 19.87 (-48.24-87.97) | 388.85 (270.93-506.76)* |
| normETP | 0.00 (-0.03-0.03) | 0.14 (0.09-0.20)* | 0.01 (-0.02-0.04) | 0.16 (0.11-0.21)* |
[Crude and adjusted beta coefficients for the association between GT parameters in the Low FT condition and the categories of CO use. *P<0.001]
| Parameters | Former users | Current users | Former users | Current users |
| β (95%CI) | β (95%CI) | β (95%CI) | β (95%CI) | |
| Lagtime (min) | -0.13 (-0.28-0.03) | -0.41 (-0.67 – -0.15)* | -0.11 (-0.27-0.04) | -0.35 (-0.62 – -0.09)* |
| Time to peak (min) | -0.01 (-0.16-0.13) | -0.49 (-0.74–0.25)* | 0.01 (-0.13-0.15) | -0.42 (-0.67-0.17)* |
| Peak (nM) | -3.14 (-13.15-6.88) | 43.57 (26.57-60.57)* | -1.06 (-10.92-8.80) | 49.03 (32.00-66.06)* |
| ETP (nM.min) | 1.16 (-63.9-66.25) | 263.35 (152.86-373.84)* | 15.48 (-48.48-79.44) | 301.76 (191.29-412.23)* |
| normETP | -0.01 (-0.04-0.03) | 0.12 (0.07-0.18)* | .001(-0.03-0.03) | 0.15 (0.09-0.20)* |
| nAPCsr | 0.03 (-0.15-0.21) | 1.17 (0.87-1.47)* | 0.03 (-0.15-0.21) | 1.16 (0.86-1.47)* |
[Crude and adjusted beta coefficients for the association between GT parameters in the High FT condition, nAPACs and the categories of CO use. *P<0.001]
To cite this abstract in AMA style:
Rios DR, Batista T, Silva AP, Carvalho MDG, Maluf C, Ribeiro AL, Barreto S, de Figueiredo R. Use of Oral Contraceptives (OCs) and Thrombin Generation: Cross-sectional Analysis of the Longitudinal Study of Adult Health (ELSA-Brazil) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/use-of-oral-contraceptives-ocs-and-thrombin-generation-cross-sectional-analysis-of-the-longitudinal-study-of-adult-health-elsa-brazil/. Accessed September 24, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/use-of-oral-contraceptives-ocs-and-thrombin-generation-cross-sectional-analysis-of-the-longitudinal-study-of-adult-health-elsa-brazil/