Abstract

Background. Oral contraceptives (OCs) modify the hemostatic system in the direction of hypercoagulability, which leads to an increased risk of venous thromboembolism. The risk of venous thrombosis with oral contraceptives (OCs) use is estimated at 2-3x, or 4-7x normal with third-generation OCs. Aim. The effect of OCs, taken for >3 months, on hemostatic disorders in young women was examined. Objectives were to examine whether OCs, or OCs together with smoking, induced a hypercoagulable state. Material and methods: Healthy women (n=73), aged 19-25 years, formed two groups: OC group (n=37): OCs used for >3 previous months; Control group (n=36): never used OCs. Most important assessed parameters were: prothrombin time (PT), activated partial thromboplastin time (APTT), global activity of protein C (PiCi) and resistance to activated protein C (APCR). Results. OC group had lower PiCi/APTT mean values relative to controls (PiCi: 79.9 ± 6 vs 84.2±4%, p=0.0006; APTT: 29.7±2.7 vs 32.1±2.6 s, p=0.0003), suggesting hemostatic disturbance in anticoagulant protein C pathway (PiCi) and plasma coagulation (APTT). Smoking women taking OCs had lower APRC (2.70±0.46 vs 3.02±0.20, p= 0.037). Moreover, lower APCR had high correlation with shorter APTT (r=0.65, p=0.081) or PT (r=0.77, p=0.025), indicating changes in the protein C anticoagulant pathway under influence of smoking and OCs. Conclusions. OCs possibly induce hemostatic disorders with hypercoagulation condition. This on the one hand weakness manifested protein C anticoagulant activity, expressed most strongly among women smokers, on the other hand the activation of plasma coagulation. Hypercoagulability activates anticoagulant compensatory mechanisms including increases in fibrinolytic and antithrombotic activities. Absolute indication for nicotine abstinence and healthy body mass are recommended for women using OCs.

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