Case Study Friday: Blood Clots and Birth Control
5 tests you can get to see if you're in a high risk group
While most women on the pill can have no experience of clotting, women should figure out if they are at risk.
Life-Threatening Complications of Hormonal Contraceptives: A Case History
For severe adverse events, the dose of the estrogen and the type of progestin determine the risk of venous thromboembolism.
Hepatic adenoma- a benign liver tumor. It is a risk associated with using oral estrogens.
They present a case with the rare combination of thrombotic and hemorrhagic complications of oral contraceptives. Thrombotic and hemorrhagic complications of oral contraceptives.
A healthy 40-year-old woman suffered from cardiac arrest due to massive pulmonary embolism (blockage of one artery a clot in the lung).
She collapsed and had no pulse. Caused by oral contraceptives and immobilization during a flight.
She used a fourth-generation OAC (Yasmin: ethinylestradiol/drospirenone).
Yaz, Yasmin, Beyaz, Ocella and Zarah all contain drospirenone. Other forms of estrogen-containing contraceptives like the ring and the patch have also been shown to increase blood clots' risk.
After 55 minutes, she was resuscitated and brought to the hospital.
Her chest CT showed bilateral pulmonary embolism - ( blockage of an artery by a blood clot.) The clot moved from her leg to her chest. Symptoms include shortness of breath, chest pain, and cough.
She suffered from 2 life-threatening complications of OAC use.
1. Massive pulmonary embolism resulting in cardiac arrest
2. Contraceptive related hepatic adenoma with hemorrhage after thrombolysis. (Hepatic adenoma- a benign liver tumor. It is a risk associated with using oral estrogens. ) (Bleeding after treatment to dissolve the clots. )
Her shock necessitated thrombolysis and thereafter heparin. Anticoagulation was complicated by internal bleeding from contraceptive-related hepatic adenoma. She underwent arterial embolization, and anticoagulation was continued. On day 18, she was discharged in good condition. Signs of internal bleeding in such patients should prompt immediate abdominal ultrasound examination.
The question is, are women on OC's at higher risk of blood clots? Are there ways to determine or test if you are in a higher risk group?
Women who take birth control pills have a higher-than-average risk of developing blood clots than non-OC users.
The risk of developing VTE by 3 to 7 fold depends on estrogen dosage and the type of progestin present in the pill.
One out of 1,000 women using OC develops thrombosis. Often with life-long consequences, a risk assessment is so necessary before going on the pill.
WHAT TO TEST FOR?
Women with a family history of blood clots or known clotting disorders should also discuss with a specialist.
Even when combined with genetic tests
1. For inherited blood clotting disorder, Factor V Leiden
2. Factor II G20210A variants,
3. Prothrombin
4. D-dimer, which appears in the blood as a clot starts breaking apart. High levels suggest an increased likelihood of blood clots.
5. Test for MTHFR mutations ( homozygous for the MTHFR (C677T) mutations) - 23andMe.
Hormonal contraceptives are reported to increase the level of C-reactive protein (CRP).
The circulating level of CRP is commonly used as an inflammatory marker to assess cardiovascular disease risk (CVD) and stroke.
Resources:
Saheed Khan, Yvo M. Smulders, Johanna I. P. de Vries, Angélique M. E. Spoelstra-de Man, "Life-Threatening Complications of Hormonal Contraceptives: A Case History," Case Reports in Obstetrics and Gynecology, vol. 2013, Article ID 186230, 3 pages, 2013. https://doi.org/10.1155/2013/186230
McDaid A, Logette E, Buchillier V, Muriset M, Suchon P, Pache TD, et al. (2017) Risk prediction of developing venous thrombosis in combined oral contraceptive users. PLoS ONE 12(7): e0182041. https://doi.org/10.1371/journal.pone.0182041
Afshin A. Divani, Xianghua Luo, Yvonne H. Datta, James D. Flaherty, Angela Panoskaltsis-Mortari, "Effect of Oral and Vaginal Hormonal Contraceptives on Inflammatory Blood Biomarkers," Mediators of Inflammation, vol. 2015, Article ID 379501, 8 pages, 2015. https://doi.org/10.1155/2015/379501