Oral contraception pulmonary embolism

Lenalidomide (Revlimid) Possible birth defects (since analogue of thalidomide), neutropenia, thrombocytopenia, deep vein thrombosis, pulmonary embolism, pruritis, fatigue Dose is 10 mg orally taken with water once daily Women of childbearing age must use two forms of contraception Pregnancy test must be taken before and during use... 

These potential benefits are balanced by a slightly increased risk of gallbladder disease, hypertension, myocardial infarction, cerebral infarction, and pulmonary embolism. The increased risk of stroke and heart attack associated with the pill is accentuated when compounded by other risk factors, including smoking, migraine headaches, and advancing age. Indeed, convincing data support an upper age limit of 35 years for oral contraceptive use by women who smoke. 

Similarly, a massive Finnish mortality study, covering 1 585 000 women-years of oral contraceptive use and two million women-years of copper-bearing intrauterine device use, showed no increase in relative risk among oral contraceptive users for myocardial infarction or cerebral hemorrhage deaths however, there might have been an increased risk of death from pulmonary embolism among users of oral contraceptives (43). 

Hedenmalm K, Samuelsson E, Spigset O. Pulmonary embolism associated with combined oral contraceptives reporting incidences and potential risk factors for a fatal outcome. Acta Obstet Gynecol Scand 2004 83 576-85. 

Combination oral contraceptives have been associated with venous and arterial thromboembolism, pulmonary embolism, myocardial infarction, and thrombotic stroke. 

Following the first reported case of pulmonary embolism on an oral contraceptive (a mestranol (75 ig)/norethynodrel (5 0 mg) combination [200]), regulatory authorities have followed the picture with concern. 

For a report of pulmonary embolism in a patient taking valdecoxib with a combi ned oral contraceptive, and for the effects of coxibs on contraceptive metabolism, see Hormonal contraceptives or HRT + Coxibs , p.994. 

Rofecoxib increases contraceptive steroid levels to a small extent, and would not therefore be expected to reduce contraceptive efficacy. Etoricoxib raises ethinylestradiol levels by 50 to 60%, and also appears to raise the levels of conjugated oestrogens in HRT. Celecoxib appears to have no effect on combined oral contraceptive levels. One case of pulmonary embolism has been reported in a patient taking valdecoxib with a combined oral contraceptive. 

Westgate EJ, Fitzgerald GA. Pulmonary embolism in a worn an taking oral contraceptives and valdecoxib. PLoSMed(2005) 2, el97. 

As is the case with most invasive procedures, deep venous thrombosis and pulmonary embolus represent rare but potential complications of the uterine artery embolization procedure [53]. Patients taking oral contraception are known to be at increased risk for venous thromboembolic disease and there may be a transient hypercoagulability after embolization [92-94],... 

To conclude, the epidemiological studies on oral contraceptives and thromboembolism all point to the same direction, i.e. to an increased risk of thromboembolic disease (deep vein thrombosis, pulmonary embolism, cerebral thrombosis, myocardial infarction) in women using oral contraceptives of the combined type. Support can also be obtained from the studies on changes in the fibrinolytic system (see below). For thrombosis with rare localization, e.g. in the mesenteric vessels, epidemiological data are still lacking. It remains to be seen whether the risk of thrombosis is reduced with the new low-dose combinations. 

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