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Risks of cerebrovascular disorders in using combined hormonal contraceptives

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.202

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Abstract

Introduction. Cerebral circulation disorders (CCD) rank third in the structure of complications of taking combined oral contraceptives (СОСs). Acute disturbance of the blood supply to the brain is the main etiological factor of this complication; hidden signs play an important role in the development of the disease – a predisposition to thrombophilic conditions.

Aim: to determine the frequency of detection of genetic thrombophilic hemostatic defects, congenital and acquired ADAMTS-13 deficiency, antiphospholipid antibodies (APA), antibodies to phospholipid cofactors, hyperhomocysteinemia in patients with impaired cerebral circulation while taking СОСs.

Materials and Methods. A prospective analysis of 89 cases of COCs use among women of reproductive age was carried out, and 60 cases were selected for this study satisfied the relevant criteria of inclusion and exclusion. Group I consisted of 30 patients who had different variants of CCD associated with hormonal contraceptives intake, Group II consisted of 30 women have been using hormonal contraceptives for at least 1 year without any thrombotic complications.

Results. Women taking COCs have the greatest risk of CCD in the first 2 months from the start of use. Somatic diseases differed little in patients of groups I and II. In group I, 7 (58.3%) patients with venous thrombosis had genetic thrombophilia, 5 (41.7 %) did not have classical thrombophilia, but 4 (33.3 %) women had antibodies to ADAMTS-13 in combination with an increase in von Willebrand factor (vWF). In patients with arterial thrombosis and transient ischemic attack (TIA), genetic thrombophilia was detected less frequently: 1 (5.5 %) case of Leiden factor V mutation compared to patients with venous blood flow disorders (p 0.05).These patients had criteria APA (61.1 %), and 5 (27.8 %) patients had more than one type of criterial APA. In 4 (22.2 %) cases, these were patients with ischemic stroke, 3 (37.5 %) of whom had APA (triple positivity) and 1 (12.5 %) APA (double positivity); there were 50.0 % of them in total. One patient (double positivity) was with TIA.

Conclusion. Firstly, genetic and acquired factors are present in patients with CCD when using COCs in a high percentage, contributing to coagulopathy (86.7 %); secondly, in cases of venous thrombotic CCD, when using COCs, genetic thrombophilia (58.3 %) predominates, in arterial thrombosis – APA circulation (50.0 %); thirdly, the etiopathogenetic role of APA circulation in impaired cerebral blood flow depends on the type of antibodies (criterial APA) and their titer; fourthly, preexisting hypercoagulability leading to impaired cerebral circulation when using COCs may be associated with the presence of several thrombophilic defects that are not related to classical thrombophilia.

About the Author

M. G. Novosartyan
Kuban State Medical University, Health Ministry of Russian Federation
Russian Federation
MD, Postgraduate Student, Department of Obstetrics, Gynecology and Perinatology

4 Mitrofana Sedina Str., Krasnodar 350063, Russia



References

1. Arnett D.K., Blumenthal R.S., Albert M.A. et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596–e646. https://doi.org/10.1161/CIR.0000000000000678.

2. Champaloux S.W., Tepper N.K., Monsour M. et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol. 2017;16(5):489.e1–489.e7. https://doi.org/10.1016/j.ajog.2016.12.019.

3. Denorme F., Kraft P., Pareyn I. et al. Reduced ADAMTS13 levels in patients with acute and chronic cerebrovascular disease. PLoS One. 2017;12(6):e0179258. https://doi.org/10.1371/journal.pone.0179258.

4. Dhont М. History of oral hormonal contraception. Eur J Contracept Reprod Health Care. 2010;15(Suppl 2):S12–8. https://doi.org/10.3109/13625187.2010.513071.

5. Hugon-Rodin J., Horellou M., Conard J. et al. Combined hormonal contraceptives and first venous thrombosis in young french women: impact of thrombotic family history. J Endocr Soc. 2017;1(6):762–71. https://doi.org/10.1210/js.2017-00090.

6. Isiadinso I, Wenger NK. Do we need a different approach to assess cardiovascular risk in women? US Cardiol Rev. 2017;11:5–9. https://doi.org/10.15420/usc.2016:8:2.

7. Lidegaard Ø., Edström B., Kreiner S. Oral contraceptives and venous thromboembolism: a fiveyear national case-control study. Contraception. 2002;65(3):187–96. https://doi.org/10.1016/s0010-7824(98)00033-x.

8. Карахалис Л.Ю., Федорович О.К. Дифференцированное применение комбинированных пероральных контрацептивов. Акушерство и гинекология. 2006;(6):51–4.

9. Макацария А.Д., Дадак К., Бицадзе В.О. и др. Клинические особенности у пациенток с гормонально-зависимыми состояниями и дефицитом магния. Акушерство и гинекология. 2017;(5):124–31. https://doi.org/10.18565/aig.2017.5.124-131.

10. Trenor C.C., Chung R.J., Michelson A.D. et al. Hormonal contraception and thrombotic risk: a multidisciplinary approach. Pediatrics. 2011;127(2):347–57. https://doi.org/10.1542/peds.2010-2221.

11. Карахалис Л.Ю. Персонифицированный выбор гормональной контрацепции. Гинекология. 2018;20(4):52–4. https://doi.org/10.26442/2079-5696_2018.4.52-54.

12. Карахалис Л.Ю., Папова Н.С., Майорова А.В. Лечение генитального эндометриоза гормональными контрацептивами. Медицинский совет. 2016;(2):6–11. https://doi.org/10.21518/2079-701X-2016-2-6-11.

13. Макацария А.Д., Бицадзе В.О., Акиньшина С.В. Тромбозы и тромбоэмболии в акушерско-гинекологической клинике. M.: МИА, 2007. 1064 с.

14. Baart S.J., Dam V., Scheres L.J.J. et al.; CREW consortium. Cardiovascular risk prediction models for women in the general population: A systematic review. PLoS One. 2019;14(1):e0210329. https://doi.org/10.1371/journal.pone.0210329.

15. Lloyd-Jones D.M., Hong Y., Labarthe D. et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586–61. https://doi.org/10.1161/CIRCULATIONAHA.109.192703.

16. Carlton C., Banks M., Sundararajan S. Oral contraceptives and ischemic stroke risk. Stroke. 2018;49(4):e157–e159. https://doi.org/10.1161/STROKEAHA.117.020084;

17. Блинов Д.В., Ушакова Т.И., Макацария А.Д. и др. Гормональная конфацепция и дефицит магния: результаты субанализа исследования MAGYN. Акушерство, Гинекология и Репродукция. 2017;11(1):36–48. https://doi.org/10.17749/2313-7347.2017.11.1.036-048.

18. Gourdy P., Bachelot A., Catteau-Jonard S. et al. Hormonal contraception in women at risk of vascular and metabolic disorders: guidelines of the French Society of Endocrinology. Ann Endocrinol (Paris). 2012;73(5):469–87. https://doi.org/10.1016/j.ando.2012.09.001.

19. Belbasis L., Savvidou M.D., Kanu C. et al. Birth weight in relation to health and disease in later life: an umbrella review of systematic reviews and meta-analyses. BMC Med. 2016;14(1):147. https://doi.org/10.1186/s12916-016-0692-5.

20. Timmis A., Townsend N., Gale C.P. et al.; European Society of Cardiology. European Society of Cardiology: Cardiovascular Disease Statistics 2019. Eur Heart J. 2020;41(1):12–85. https://doi.org/10.1093/eurheartj/ehz859.

21. Сукoнцeвa Т.A., Кaплинa O.Ю. К вoпpoсу o пaтoгeнeзe тpoмбoзoв пpи aнтифoсфoлипиднoм синдpoмe. Aкушepствo, Гинекология и Репродукция. 2018;12(3):72–8. https://doi.org/10.17749/2313-7347.2018.12.3.072-078.

22. Макацария А.Д., Саидова Р.А. Гормональная контрацепция и тромбофилические состояния. M.: Триада-Х, 2004. 240 с.

23. Rott H. Birth control pills and thrombotic risks: differences of contraception methods with and without estrogen. Hamostaseologie. 2019;39(1):42–8. https://doi.org/10.1055/s-0039-1677806.

24. Proia K.K., Thota A.B., Njie G.J. et al. Team-based care and improved blood pressure control: a community guide systematic review. Am J Prev Med. 2014;47:86–99. https://doi.org/10.1016/j.amepre.2014.03.004.

25. Хамани Н.М., Саидова Р.А., Хамани И.В. и др. Ретроспективный анализ факторов риска тромботических осложнений при приеме комбинированных оральных контрацептивов. Акушерство и гинекология. 2019;(6):108–14. https://doi.org/10.18565/aig.2019.6.108-114.

26. Мeдицинскиe кpитepии пpиeмлeмoсти для испoльзoвaния мeтoдoв кoнтpaцeпции. 5-e изд. Жeнeвa: ВOЗ, 2015. 192 с. Peжим дoступa: http://www.euro.who.int/__data/assets/pdf_file/0005/348116/MEC-merged.pdf.

27. Тромбогеморрагические осложнения в акушерско-гинекологической практике. Руководство для врачей. Под ред. А.Д. Макарация. M.: МИА, 2011. 1050 с.


For citation:


Novosartyan M.G. Risks of cerebrovascular disorders in using combined hormonal contraceptives. Obstetrics, Gynecology and Reproduction. 0;. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.202

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