Thromboembolism oral contraceptives

Frederiksen H, Ravenholt RT. Thromboembolism, oral contraceptives, and cigarettes. Public Health Rep 1970 85(3) 197-205. 

There is an increased risk of post-operative thromboembolic complications in women taking oral contraceptives Ifposs-bte, use of the drug is discontinued at least 4 weeks before a surgical procedure associated with thromboembolism or during prolonged immobilization. 

Adverse effects include nausea, weight gain, breast tenderness, and breakthrough bleeding. Oral contraceptives have also been associated with an increased incidence of thromboembolic disease, particularly in women who use tobacco products or have other risk factors for thromboembolism. The development of these complications is significantly reduced when low-dose estrogen formulations of oral contraceptives are used.3... 

Spannagl, M., et al., "Are Factor V Leiden Carriers Who Use Oral Contraceptives at Extreme Risk for Venous Thromboembolism " Eur. ]. Contracept. Reprod. Hlth. Care, 5, 105-112 (2000). 

Cilest contains ethinylestradiol and norgestimate whereas Yasmin contains ethinylestradiol in combination with drospirenone. Both are combined oral contraceptives available as tablets, which have to be taken once daily for 21 days. Both are contraindicated in patients with venous thromboembolic diseases. 

Current estimates are that oral contraceptive use doubles to triples the overall risk of thromboembolic disease. The increased use in recent years of oral contraceptives with lower estrogen content probably contributes to the decreased risk. However, the risk is... 

The cardiovascular complications of oral contraceptives include venous thrombosis and thromboembolism, arterial damage, and hypertension. 

The Medicines Commission of the UK has reviewed all currently available relevant data and has confirmed that the incidence of venous thromboembolism is about 25 per 100 000 women per year of use (21). The incidence of venous thrombembolism in users of second-generation combined oral contraceptives is about 15 per 100 000 women per year of use. This indicates a small excess risk... 

The incidence of venous thromboembolic disease in about 540 000 women born between 1941 and 1981 and taking oral contraceptives was 4.1-4.2 cases per 10 000 woman-years (22). 

Cyproterone acetate in combination with ethinylestra-diol is indicated for the treatment of women with severe acne and moderately severe hirsutism. This product has been associated with a greater risk of venous thromboembolism than oral contraceptives. However, in a rigorous case-control study the risk of venous thromboembolism with cyproterone acetate + ethinylestradiol was not significantly greater than the risk in women who took conventional oral contraceptives (25). 

By 1980 it was considered clear that the risk of thromboembolic events was further increased under particular conditions. It was higher in smokers, in older women, and in the obese, and appropriate warnings were issued. The fact that these warnings to a large extent eliminated the high-risk individuals who had formed part of the early population of oral contraceptive users means that data from the early period cannot be used to provide a valid historical comparison with later findings (42,43). 

Much of the evidence on the occurrence of thromboembolic complications with oral contraceptives or hormone replacement therapy has been gathered from European or American populations, and it can be helpful to identify data from other parts of the world, where factors such as... 

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