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Previous Volume 344:1527-1535 May 17, 2001 Number 20 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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In the early 1960s, shortly after the introduction of oral contraceptives, the first case reports appeared describing venous thrombosis and pulmonary emboli in women using this method of birth control. Later, myocardial infarction and stroke were also found to be associated with the use of oral contraceptives. These observations led to numerous epidemiologic and clinical studies of oral-contraceptive pills and thrombosis and subsequently to the development of new oral contraceptives with a lower estrogen content. These lower-estrogen contraceptives were considered safer: changes in hemostatic factors remained small, inconsistent in direction, and mostly within the normal range.^1,2,3,4

Recent studies have challenged . . . [Full Text of this Article]

Risks Associated with Low-Dose Oral Contraceptives

The Effect of Progestins in Combined Preparations

Susceptibility to Prothrombotic States

Hereditary Resistance to Activated Protein C and the Factor V Leiden Mutation

Other Hereditary Prothrombotic Defects

Prothrombotic Conditions of Uncertain Heredity

Mechanisms of Venous Thrombosis Induced by Oral Contraceptives

Procoagulant Effects

Anticoagulant Effects

Fibrinolytic Effects

Overall Hemostatic Effect

Conclusions

Source Information

From the Department of Clinical Epidemiology (J.P.V., F.R.R.), the Department of Obstetrics, Gynecology, and Reproductive Medicine (K.W.M.B., F.M.H.), and the Thrombosis and Haemostasis Research Center (F.R.R.), Leiden University Medical Center, Leiden; the Department of Biochemistry, Cardiovascular Research Institute, Maastricht (J.R.); the Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M.); and the Thrombosis and Hemostasis Laboratory, Department of Hematology, University Hospital Utrecht, Utrecht (B.N.B.) — all in the Netherlands.

Address reprint requests to Dr. Vandenbroucke at the Department of Clinical Epidemiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands, or at vdbroucke@mail.medfac.leidenuniv.nl.

References

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• Nelson, S. M., Greer, I. A. (2008). The potential role of heparin in assisted conception. Hum Reprod Update 14: 623-645 [Abstract] [Full Text]  
• Rathbun, S. (2008). Venous thromboembolism in women. Vasc Med 13: 255-266 [Abstract]  
• Baccarelli, A., Martinelli, I., Zanobetti, A., Grillo, P., Hou, L.-F., Bertazzi, P. A., Mannucci, P. M., Schwartz, J. (2008). Exposure to Particulate Air Pollution and Risk of Deep Vein Thrombosis. Arch Intern Med 168: 920-927 [Abstract] [Full Text]  
• Johnson, J. V., Lowell, J., Badger, G. J., Rosing, J., Tchaikovski, S., Cushman, M. (2008). Effects of Oral and Transdermal Hormonal Contraception on Vascular Risk Markers: A Randomized Controlled Trial. Obstet Gynecol 111: 278-284 [Abstract] [Full Text]  
• (2008). Contraception in Women with Medical Problems. JWatch Women's Health 2008: 2-2 [Full Text]  
• Committee on Adolescence, (2007). Contraception and Adolescents. Pediatrics 120: 1135-1148 [Abstract] [Full Text]  
• Fisher, W. A., Black, A. (2007). Contraception in Canada: a review of method choices, characteristics, adherence and approaches to counselling. CMAJ 176: 953-961 [Abstract] [Full Text]  
• Turgeon, J. L., Carr, M. C., Maki, P. M., Mendelsohn, M. E., Wise, P. M. (2006). Complex Actions of Sex Steroids in Adipose Tissue, the Cardiovascular System, and Brain: Insights from Basic Science and Clinical Studies. Endocr. Rev. 27: 575-605 [Abstract] [Full Text]  
• Piazza, G., Goldhaber, S. Z. (2006). Acute Pulmonary Embolism: Part I: Epidemiology and Diagnosis. Circulation 114: e28-e32 [Full Text]  
• Girolami, A., Tezza, F., Ruzzon, E., Fabris, F. (2005). Oral Contraceptives, Thrombosis and Socio-Ethical Values: An Inevitable Compromise is Needed Based Mainlyon a Careful Evaluation of Potential Users. CLIN APPL THROMB HEMOST 11: 497-499  
• Stam, J. (2005). Thrombosis of the Cerebral Veins and Sinuses. NEJM 352: 1791-1798 [Full Text]  
• van Vliet, H. A.A.M., Frolich, M., Christella, M., Thomassen, L.G.D., Doggen, C. J.M., Rosendaal, F. R., Rosing, J., Helmerhorst, F. M. (2005). Association between sex hormone-binding globulin levels and activated protein C resistance in explaining the risk of thrombosis in users of oral contraceptives containing different progestogens. Hum Reprod 20: 563-568 [Abstract] [Full Text]  
• Rosendaal, F. R. (2005). Venous Thrombosis: The Role of Genes, Environment, and Behavior. ASH Education Book 2005: 1-12 [Abstract] [Full Text]  
• (2004). Venous Thromboembolic Disease. Obstet Gynecol 104: 118S-127S [Full Text]  
• Varga, E. A., Moll, S. (2004). Prothrombin 20210 Mutation (Factor II Mutation). Circulation 110: e15-e18 [Full Text]  
• Girolami, A., Spiezia, L., Girolami, B., Zocca, N., Luzzatto, G. (2004). Effect of Age on Oral Contraceptive-Induced Venous Thrombosis. CLIN APPL THROMB HEMOST 10: 259-263 [Abstract]  
• Goldhaber, S. Z., Elliott, C. G. (2003). Acute Pulmonary Embolism: Part I: Epidemiology, Pathophysiology, and Diagnosis. Circulation 108: 2726-2729 [Full Text]  
• Kroon, C.D.d., Houwelingen, J.C.v., Trimbos, J.B., Jansen, F.W. (2003). The value of transvaginal ultrasound to monitor the position of an intrauterine device after insertion. A technology assessment study. Hum Reprod 18: 2323-2327 [Abstract] [Full Text]  
• Wilks, J. F (2003). Hormonal Birth Control and Pregnancy: A Comparative Analysis of Thromboembolic Risk. The Annals of Pharmacotherapy 37: 912-916 [Full Text]  
• Rimsza, M. E. (2003). Counseling the Adolescent About Contraception. Pediatr. Rev. 24: 162-170 [Full Text]  
• Girolami, A., Spiezia, L., Vianello, F., Girolami, B., Fabris, F. (2003). Changes in Prescription Patterns of Oral Contraceptives in a Northern Italian Province: Relation With Venous Thromboembolism. CLIN APPL THROMB HEMOST 9: 125-130 [Abstract]  
• Wooltorton, E. (2003). Diane-35 (cyproterone acetate): safety concerns. CMAJ 168: 455-456 [Full Text]  
• Deitcher, S. R, Gomes, M. P. (2003). Hypercoagulable state testing and malignancy screening following venous thromboembolic events. Vasc Med 8: 33-46 [Abstract]  
• Girolami, A., Spiezia, L., Vianello, F. (2003). Proposal of a Flow Chart for Thrombosis-Free Oral Contraceptive Therapy. CLIN APPL THROMB HEMOST 9: 33-37 [Abstract]  
• Hoetzer, G. L., Stauffer, B. L., Greiner, J. J., Casas, Y., Smith, D. T., DeSouza, C. A. (2003). Influence of oral contraceptive use on endothelial t-PA release in healthy premenopausal women. Am. J. Physiol. Endocrinol. Metab. 284: E90-E95 [Abstract] [Full Text]  
• Skegg, D. C G (2002). Oral contraceptives, venous thromboembolism, and the courts. BMJ 325: 504-505 [Full Text]  
• Hulley, S., Furberg, C., Barrett-Connor, E., Cauley, J., Grady, D., Haskell, W., Knopp, R., Lowery, M., Satterfield, S., Schrott, H., Vittinghoff, E., Hunninghake, D., for the HERS Research Group, (2002). Noncardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy: Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II). JAMA 288: 58-64 [Abstract] [Full Text]  
• Hannaford, P., Vandenbroucke, J. P., Kahlenborn, C., Li, S. F., Shapiro, S., Rosendaal, F. R., Tanis, B. C., van der Graaf, Y., Chasan-Taber, L., Stampfer, M. J. (2002). Oral Contraceptives and the Risk of Myocardial Infarction. NEJM 346: 1826-1829 [Full Text]  
• Bauer, K. A. (2002). Hormone Replacement Therapy and the Factor V Leiden Mutation. Arterioscler. Thromb. Vasc. Bio. 22: 879-880 [Full Text]  
• Joffe, H. V, Goldhaber, S. Z (2002). Laboratory thrombophilias and venous thromboembolism. Vasc Med 7: 93-102 [Abstract]  
• Girolami, A., Spiezia, L., Girolami, B., Vianello, F. (2002). Tentative Guidelines and Practical Suggestions to Avoid Venous Thromboembolism During Oral Contraceptive Therapy. CLIN APPL THROMB HEMOST 8: 97-102 [Abstract]  
• Girolami, A., Spiezia, L., Rossi, F., Zanon, E. (2002). Oral Contraceptives and Venous Thromboembolism: Which Are the Safest Preparations Available?. CLIN APPL THROMB HEMOST 8: 157-162 [Abstract]  
• Rosendaal, F.R., Helmerhorst, F.M., Vandenbroucke, J.P. (2002). Female Hormones and Thrombosis. Arterioscler. Thromb. Vasc. Bio. 22: 201-210 [Abstract] [Full Text]  
• Drife, J O (2001). The third generation pill controversy (""continued""). BMJ 323: 119-120 [Full Text]  
• Kemmeren, J. M, Algra, A., Grobbee, D. E (2001). Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. BMJ 323: 131-131 [Abstract] [Full Text]  
• Macik, B. G., Rand, J. H., Konkle, B. A. (2001). Thrombophilia: What's a Practitioner to Do?. ASH Education Book 2001: 322-338 [Abstract] [Full Text]