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104 - Update on administration of oral contraceptives thrombophilia: coagulation screening pros and cons

Autor(s): P. Simioni, D. Tormene

Issue: RIMeL - IJLaM, Vol. 5, N. 2, 2009 (MAF Servizi srl ed.)

Update on administration of oral contraceptives thrombophilia: coagulation screening pros and cons In fertile age women belonging to thrombophilic families, testing for thrombophilia may be helpful for counseling on administration of oral contraceptives. In asymptomatic women with severe thrombophilia (antithrombin, protein C, protein S defects, homozygous FV Leiden or PT G20210A, double heterozygous, and others) hormonal therapy should be avoided. However, most asymptomatic women are identified because of family screening and are carriers of the less severe thrombophilic defects (heterozygous FVL or PT G20210A). Thus, appropriate counseling on the relative risk of VTE is required when oral contraceptives are administered to these women including the evaluation of the risk-to-benefit ratio of the treatment. In addition, in women belonging to families with a strong history of thrombotic manifestations, the use of oral contraceptives should be discouraged even in the presence of single less severe thrombophilic defects because of the possible co-existence of other unknown thrombophilic conditions in the same family. Universal screening for thrombophilia before the administration of oral contraceptives is not warranted. However, selective screening of women with a family history of thrombosis and thrombophilia before administration of hormonal therapy might be cost-effective. This consideration is also based on how much one is willing to spend to prevent one VTE event (fatal and non-fatal) related to oral contraceptives.
Key-words: oral contraceptives, venous thromboembolism, inherited thrombophilia, screening tests.

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