Risks of cerebrovascular disorders in using combined hormonal contraceptives

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.

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