Article

Effect of second- and third-generation oral contraceptives on the protein C system in the absence or presence of the factor VLeiden mutation: a randomized trial.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room D.01.335, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Blood (impact factor: 9.9). 03/2004; 103(3):927-33. DOI:10.1182/blood-2003-04-1285 pp.927-33
Source: PubMed

ABSTRACT A plausible mechanism to explain thrombotic risk differences associated with the use of second- and third-generation oral contraceptives (OCs), particularly in carriers of factor V(Leiden), is still lacking. In a double-blind trial, 51 women without and 35 women with factor V(Leiden) were randomized to either a second- (30 microg ethinylestradiol/150 microg levonorgestrel) or third- (30 microg ethinylestradiol/150 microg desogestrel) generation OC. After 2 cycles of use and a wash-out of 2 cycles, the participants continued with the corresponding progestagen-only preparation. Hemostatic variables that probe the activity of the anticoagulant protein C system were determined. Compared with levonorgestrel, desogestrel-containing OCs significantly decreased protein S and increased activated protein C (APC) resistance in both groups. OCs with desogestrel had the most pronounced effects in carriers of factor V(Leiden). Progestagen-only preparations caused changes of anticoagulant parameters opposite to those of combined OCs, which in a number of cases were more pronounced with levonorgestrel. Our data show that progestagens in combined OCs counteract the thrombotic effect of the estrogen component. The higher thrombotic risk associated with third-generation OCs compared with second-generation OCs may be explained by the fact that desogestrel appeared less antithrombotic than levonorgestrel, especially in women with factor V(Leiden).

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Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

2 cycles
 
30 microg ethinylestradiol/150 microg desogestrel
 
30 microg ethinylestradiol/150 microg levonorgestrel
 
activated protein C
 
anticoagulant parameters
 
anticoagulant protein C system
 
corresponding progestagen-only preparation
 
desogestrel-containing OCs
 
double-blind trial
 
estrogen component
 
higher thrombotic risk
 
plausible mechanism
 
Progestagen-only preparations
 
pronounced effects
 
protein S
 
second-generation OCs
 
third-generation OCs
 
third-generation oral contraceptives
 
thrombotic risk differences
 
wash-out