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CME Evaluation

Oral Communication Session

Women's Hemostasis and Thrombosis

Session: Hormonal and anticoagulant management in women

OC 62.3 - The risk of cerebral vein thrombosis associated with different types of oral contraceptives: a case-control study

Tuesday, June 25, 2024
15:15 – 15:30 ICT
Room: Ballroom B2

    Co-Author(s)

  • Maria Abbattista

    Clinical Researcher
    Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
    Milan, Lombardia, Italy

    • Presenting Author(s)

  • Addolorata Truma, MD

    Research fellow
    Università degli studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy.
    milano, Lombardia, Italy

    • Co-Author(s)

  • Andrea Artoni

    MD
    Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
    Milan, Lombardia, Italy

  • Flora Peyvandi, MD, PhD

    Full Professor
    Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, Department of Pathophysiology and Transplantation
    Milan, Lombardia, Italy

  • Paolo Bucciarelli

    MD
    Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
    Milano, Lombardia, Italy

Background: Cerebral vein thrombosis (CVT) is a rare manifestation of thrombosis. CVT typically affects young adults and is more common in women than in men because of sex-specific risk factors such as oral contraceptive (OC) use and pregnancy/puerperium. So far, data on the risk stratification of CVT according to different types of OC are scarce.

Aims: To assess the risk of CVT according to different types of OC and the joint effect with thrombophilia abnormalities and family history.

Methods: This case-control study included women of childbearing age after an episode of CVT and healthy women (friends or acquaintances of patients) referred to our Center from 1992 to 2019 for a thrombophilia work-up.
Odds ratios (OR) with their relative 95% confidence intervals (CI) were calculated to quantify the association between different types of OC, thrombophilia and family history, and the risk of CVT.

Results: The study was conducted on 206 cases (157 OC users and 49 non-users) and 869 controls (198 OC users and 671 non-users) (Table.1). Overall, the risk of CVT in OC users was 10-fold higher than in non-users (OR 10.9; 95%CI:7.6-15.6). The risk estimates increased with the progestin generation with the highest figures observed for the fourth-generation pills (OR 28.3, 95%CI:14.6- 54.9). Estrogen doses >30 μg are associated with the highest risk (OR 12.4; 95%CI:8.0-19.0), while biphasic or triphasic OCs carried a 6-fold increased risk, similar to that observed for only progestin OCs. Thrombophilia abnormalities were associated with a 5-fold increased risk of CVT showing a synergistic effect with the use of OC (OR 67.8; 95%CI:34.6-133.0). For OC users with positive family history the joint effect ranged from 25.3(95%CI:7.2-88.8) to 168.7 (95%CI:36.7-775.8) according to different progestin generations(Table.2).

Conclusion(s): The risk of CVT in women during OC use is influenced by complex interactions between OC type and positive family history.