Authors' Reply

Abstract

Author's ReplyI would like to thank Dr. Fleiss for his important and germane comments about the thrombogenic effects of birth control pills. The pulmonary embolus mentioned in “Knee Joint Arthroscopy in the Morbidly Obese” was presumed to have occurred but was not confirmed by an autopsy. The indication for surgery was a locked knee of 1 week's duration that interfered with gait and work. Birth control pills may have been contraindicated in this patient who was obese, a smoker, and over age 30.It should be emphasized that the simple cessation of oral contraceptives will not immediately reverse their thrombogenic effect. Oral contraceptives and many of their metabolites increase the activity of antithrombin III, a thrombogenic factor. It is therefore recommended that birth control pills be stopped at least 1 month preoperatively and for 2 weeks after an elective procedure (Physician's Desk Reference. Ed. 50. Montvale, NJ: Medical Economics Press, 1996;2089).In women between the ages of 15 and 30, the actuarial risk of a pregnancy-related death as a consequence of unprotected sex is higher than death as a complication of the oral contraceptive agent. In nonsterile women over the age of 30, the mortality rate per 100,000 due to the pregnancy is equal to the death rate resulting from the complications of oral contraceptives in smokers (PDR, see above). My Ob-Gyn colleagues, therefore, feel it is safer to keep sexually active women on oral contraceptives while using a short course of anticoagulation prophylaxis for gynecologic procedures. Thus, while anticoagulation is not without its own morbidity, it is advisable when surgery is necessary in someone taking birth control pills. Respectfully yours, Author's ReplyI would like to thank Dr. Fleiss for his important and germane comments about the thrombogenic effects of birth control pills. The pulmonary embolus mentioned in “Knee Joint Arthroscopy in the Morbidly Obese” was presumed to have occurred but was not confirmed by an autopsy. The indication for surgery was a locked knee of 1 week's duration that interfered with gait and work. Birth control pills may have been contraindicated in this patient who was obese, a smoker, and over age 30.It should be emphasized that the simple cessation of oral contraceptives will not immediately reverse their thrombogenic effect. Oral contraceptives and many of their metabolites increase the activity of antithrombin III, a thrombogenic factor. It is therefore recommended that birth control pills be stopped at least 1 month preoperatively and for 2 weeks after an elective procedure (Physician's Desk Reference. Ed. 50. Montvale, NJ: Medical Economics Press, 1996;2089).In women between the ages of 15 and 30, the actuarial risk of a pregnancy-related death as a consequence of unprotected sex is higher than death as a complication of the oral contraceptive agent. In nonsterile women over the age of 30, the mortality rate per 100,000 due to the pregnancy is equal to the death rate resulting from the complications of oral contraceptives in smokers (PDR, see above). My Ob-Gyn colleagues, therefore, feel it is safer to keep sexually active women on oral contraceptives while using a short course of anticoagulation prophylaxis for gynecologic procedures. Thus, while anticoagulation is not without its own morbidity, it is advisable when surgery is necessary in someone taking birth control pills. Respectfully yours, I would like to thank Dr. Fleiss for his important and germane comments about the thrombogenic effects of birth control pills. The pulmonary embolus mentioned in “Knee Joint Arthroscopy in the Morbidly Obese” was presumed to have occurred but was not confirmed by an autopsy. The indication for surgery was a locked knee of 1 week's duration that interfered with gait and work. Birth control pills may have been contraindicated in this patient who was obese, a smoker, and over age 30. It should be emphasized that the simple cessation of oral contraceptives will not immediately reverse their thrombogenic effect. Oral contraceptives and many of their metabolites increase the activity of antithrombin III, a thrombogenic factor. It is therefore recommended that birth control pills be stopped at least 1 month preoperatively and for 2 weeks after an elective procedure (Physician's Desk Reference. Ed. 50. Montvale, NJ: Medical Economics Press, 1996;2089). In women between the ages of 15 and 30, the actuarial risk of a pregnancy-related death as a consequence of unprotected sex is higher than death as a complication of the oral contraceptive agent. In nonsterile women over the age of 30, the mortality rate per 100,000 due to the pregnancy is equal to the death rate resulting from the complications of oral contraceptives in smokers (PDR, see above). My Ob-Gyn colleagues, therefore, feel it is safer to keep sexually active women on oral contraceptives while using a short course of anticoagulation prophylaxis for gynecologic procedures. Thus, while anticoagulation is not without its own morbidity, it is advisable when surgery is necessary in someone taking birth control pills. Respectfully yours,