Activated protein C resistance in women using second generation oral contraceptives | [Rawal Medical Journal • 2023]

Author(s):

1. Namra Mahmood: Department of Pathology, Central Park Medical College,Lahore -,Pakistan

Abstract:

Objective: To observe the effect of Combined oral contraceptive pills (COCPs) on activated protein C (APC) resistance after three months of its use and mean change from baseline and was stratified according to age groups and parity. Methodology: This cross-sectional prospective descriptive study was conducted in Department of Pathology, Post Graduate Medical Institute, Lahore from 1/03/2018 to 02/03/2019. It included 54 female patients aged between 18-45 years who were scheduled by the family planning clinic of Lahore General Hospital, Lahore to start second generation oral contraceptive pills (OCP). Blood samples were collected and activated protein C resistance was assessed before the start of OCP and then after 3 months of onset of contraceptive use. Results: Mean age of women was 29.5±5.3 years. The parity ranged from 1 to 6 (mean 3.06±1.20). APC resistance increased significantly as seen from a decrease in PCAT/PCAT-0 ratio with a mean change of 0.39±0.23 (p<0.001). Similar change was observed across various subgroups based on patient’s age and parity. Conclusion: Continuous use of second-generation OCP for 3 months induces a prothrombotic state in the women by developing APC resistance in the absence of any prothrombotic condition. The monitoring of coagulation profile in a patient on oral contraceptives can aid in timely identification and management of hypercoagulable state, which may improve the outcome of such cases in future.

Page(s): 926-929

DOI: DOI not available

Published: Journal: Rawal Medical Journal, Volume: 48, Issue: 4, Year: 2023

Keywords:

Protein C , Hormonal contraceptives , Oral Contraceptives , APC Resistance , Activated Protein C Resistance , hypercoagulability

References:

[1] 1 Esmon C. The Protein C Pathway .2003 .. Chest, 124 : 26S32S.

[2] Schroder L,Muller J,Sukhitashvili S,Welz J,Kuhn W .2014 .Impact of Hormone-Associated Resistance to Activated Protein C on the Thrombotic Potential of Oral Contraceptives: A Prospective Observational Study. PLOS One, 9 : e105007.

[3] Kemmeren J,Algra A,Meijers J,Tans G,Bouma B,Curvers J B .2004 .Effect of second- and third-generation oral contraceptives on the protein C system in the absence or presence of the factor V Leiden mutation: a randomized trial. Blood, 103 : 927-33.

[4] Momodu I.,Buseri F. .2015 .Protein C and Antithrombin III Activities in Healthy Nigerian Women. Int J Hematol Res, 1 : 20-23.

[5] Lackie E,Fairchild A .2016 .The birth control pill, thromboembolic disease, science and the media: a historical review of the relationship. Contraception, 94 : 295-302.

[6] Rahhal A,Khir F,Adam M,Aljundi A,Mohsen M,J M .2020 .Low dose combined oral contraceptives induced thrombotic anterior wall myocardial infarction: a case report. BMC Cardiovasc Disord, 20 : 182-5.

[7] Practice .2017 .Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertil Steril, 107 : 43-51.

[8] Speroff L,Darney P. . .A clinical guide for contraception. 2020 Philadelphia: Lippincott Williams & Wilkins, : 40.

[9] Salman S,Hussein A,Saadi R .2018 .Effect of Combined Oral Contraception on Coagulation Profiles in Women Attending Fertility Control Clinic in Baqubah City- Iraq. J Faculty Med Baghdad, 60 : 47-51.

[10] Mohamed A,Kelchtermans H,Konings J,van Daal J,Al Marzouki A,Harakeh S .2018 .The effects of oral contraceptive usage on thrombin generation and activated protein C resistance in Saudi women, with a possible impact of the body mass index. PLOS One, 13 : e0206376.

[11] Reda S,Morimont L,Douxfils J,Ruhl H.,Can We H. .2020 .Measure the Individual Prothrombotic or Prohemorrhagic Tendency by Global Coagulation Tests? Hämostaseologie. , 40 : 364-78.

[12] Hiedemann B,Vernon E,Bowie B.,Re-Examining Genetic B. .2019 .Oral Contraceptives: A PatientCentered Review. J Person Med, 9 : 4-8.

[13] Khialani D,Cessie S,Lijfering W,Cannegieter S,Rosendaal F .2020 .Hylckama Vlieg A. The joint effect of genetic risk factors and different types of combined oral contraceptives on venous thrombosis risk. Br J Haematol, 191 : 90-97.

[14] Machado-Alba J,Gallo-Gomez Y,Hinojosa-Millan S Y .2016 .Prevalence of incorrect joint prescription of anticonvulsant drugs and hormonal contraceptives. Col J Obstetr Gynecol, 67 : 13-19.

[15] Polderdijk S,Baglin T,Huntington J .2017 .Targeting activated protein C to treat hemophilia. Curr Opin Hematol, 24 : 446-52.

[16] Inman WH,Vessey MP .2017 .Investigation of deaths from pulmonary, coronary, and cerebral thrombosis and embolism in women of child-bearing age. BMJ, 2 : 193-9.

[17] Jang Y,Lee E,Kim Y .2021 .Venous thromboembolism associated with combined oral contraceptive use: a single-institution experience. Obst Gynecol Sci, 64 : 337-44.

[18] Huisman MV,Bller HR,Tencate JW,Vreeken J .2017 .Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. N Engl J Med, 314 : 823-28.

[19] Tans G,Curvers J,Middeldorp S,Thomassen M,Meijers J,Prins M .2000 .A Randomized Cross-over Study on the Effects of Levonorgestrel- and esogestrel-containing Oral Contraceptives on the Anticoagulant Pathways. Thrombhaemost, 84 : 15-21.

Citations

Downloads

Views