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Arterial Thrombosis in Oral Contraceptive Users

Arterial Thrombosis in Oral Contraceptive Users Abstract A striking characteristic of thrombosis associated with oral contraceptive use is its localization to vessels that are only rarely the sites of spontaneous thrombosis in healthy, nonpregnant women in the same age group who do not use oral contraception. For example, thrombosis has been reported at such sites as the subclavian, axillary, femoral, renal, mesenteric, internal carotid, vertebral, basilar, and cerebral arteries, the hepatic, mesenteric, and cerebral veins, and intracranial venous sinuses. An increased incidence of myocardial infarction has also been noted, particularly in relatively older women who are cigarette smokers. Infarction of the bowel consequent on the thrombotic occlusion of mesenteric vessels is of particular interest to internists because diagnosis, critical to survival, is difficult. Beginning in 1963, cases have been reported in which women taking oral contraceptives experienced mesenteric vascular occlusion. The syndrome has appeared in several forms. In some women, the occlusion (whether arterial or venous is References 1. Kilpatrick ZM, Silverman JF, Belancourt E, et al: Vascular occlusion of the colon and oral contraceptives: Possible relation. N Engl J Med 1968;278:438-440.Crossref 2. Ward GW Jr, Stevensen JR: Colonic disorder and oral contraceptives. N Engl J Med 1968;278:910. 3. Cotton PB, Thomas ML: Ischemic colitis and the contraceptive pill. Br Med J 1971;3:27-28. 4. Egger G, Mangold K: Ischaemic colitis and oral contraceptives: Case report and brief review of the literature. Acta Hepatogastroenterol 1974;21:221-224. 5. Lowry JB, Orr KJ, Wade WG: Infarction of the small intestine associated with oral contraceptives. J Irish Med Assoc 1969;62:260-262. 6. Reed DL, Coon WW: Thromboembolism in patients receiving progestational drugs. N Engl J Med 1963;269:622-624.Crossref 7. Brindle MJ, Henderson IN: Vascular occlusion of the colon associated with oral contraception. Can Med Assoc J 1969;100:681-682. 8. Hurwitz RL, Martin AJ, Grossman BC, et al: Oral contraceptives and gastrointestinal disorders. Ann Surg 1970;172:892-896.Crossref 9. Civetta JM, Kolodny M: Mesenteric venous thrombosis associated with oral contraceptives. Gastroenterology 1970;58:713-716. 10. Rose MB: Superior mesenteric vein thrombosis and oral contraceptives. Postgrad Med J 1972;48:430-433.Crossref 11. Brennan MF, Clarke AM, Macbeth WAAG: Infarction of the midgut associated with oral contraceptives: Report of two cases. N Engl J Med 1968;279:1213-1214.Crossref 12. Keown D: Review of arterial thrombosis in association with oral contraceptives. Br J Surg 1969;56:486-488.Crossref 13. Poiget B, Cheynier JM: Infarctus mésénterique et hypertension artérielle après thérapeutique oestroprogestative à visée hémostatique. Rev Fr Gynecol Obstet 1973;68:325-329. 14. Koh KS, Dazinger RG: Massive intestinal infarction in young women: Complication of use of oral contraceptives? Can Med Assoc J 1977;116:513-515. 15. Beral V: Mortality among oral contraceptive users: Royal College of General Practitioners' Oral Contraception Study. Lancet 1977;2:727-731. 16. Veller ID, Doyle JC: Acute mesenteric ischaemia. Aust NZ J Surg 1977;47:54-61.Crossref 17. Wessler S: Thrombosis and sex hormones: A perplexing liaison. J Lab Clin Med 1980;96:757-761. 18. Gordon EM, Ratnoff OD, Saito H, et al: Rapid fibrinolysis, augmented Hageman factor (factor XII) titers, and decreased Cl esterase inhibitor titers in women taking oral contraceptives. J Lab Clin Med 1980;96:762-769. 19. Rochet Y, Lapeyre B: Le risque chirurgical thrombo-embolique chez les femmes soumises au traitement oestro-progestatif (à propos de trois observations). Gynecol Obstet 1969;68:59-64. 20. Vessey MP, Doll R, Fairbairn AS, et al: Postoperative thromboembolism and the use of oral contraceptives. Br Med J 1970;3:123-126.Crossref 21. Greene GR, Sartwell PE: Oral contraceptive use in patients with thromboembolism following surgery, trauma, or infection. Am J Public Health 1972;62:680-685.Crossref 22. Sagar S, Stamatakis JD, Thomas DP, et al: Oral contraceptives, antithrombin-III activity and postoperative deep-vein thrombosis. Lancet 1976;1:509-511.Crossref 23. Sartwell PE: Preoperative discontinuation of contraceptives. N Engl J Med 1974;290:576. 24. Böttiger LE, Bowman G, Ekland G, et al: Oral contraceptives and thromboembolic disease: Effects of lowering oestrogen content. Lancet 1980;1:1097-1101.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Arterial Thrombosis in Oral Contraceptive Users

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340160031005
Publisher site
See Article on Publisher Site

Abstract

Abstract A striking characteristic of thrombosis associated with oral contraceptive use is its localization to vessels that are only rarely the sites of spontaneous thrombosis in healthy, nonpregnant women in the same age group who do not use oral contraception. For example, thrombosis has been reported at such sites as the subclavian, axillary, femoral, renal, mesenteric, internal carotid, vertebral, basilar, and cerebral arteries, the hepatic, mesenteric, and cerebral veins, and intracranial venous sinuses. An increased incidence of myocardial infarction has also been noted, particularly in relatively older women who are cigarette smokers. Infarction of the bowel consequent on the thrombotic occlusion of mesenteric vessels is of particular interest to internists because diagnosis, critical to survival, is difficult. Beginning in 1963, cases have been reported in which women taking oral contraceptives experienced mesenteric vascular occlusion. The syndrome has appeared in several forms. In some women, the occlusion (whether arterial or venous is References 1. Kilpatrick ZM, Silverman JF, Belancourt E, et al: Vascular occlusion of the colon and oral contraceptives: Possible relation. N Engl J Med 1968;278:438-440.Crossref 2. Ward GW Jr, Stevensen JR: Colonic disorder and oral contraceptives. N Engl J Med 1968;278:910. 3. Cotton PB, Thomas ML: Ischemic colitis and the contraceptive pill. Br Med J 1971;3:27-28. 4. Egger G, Mangold K: Ischaemic colitis and oral contraceptives: Case report and brief review of the literature. Acta Hepatogastroenterol 1974;21:221-224. 5. Lowry JB, Orr KJ, Wade WG: Infarction of the small intestine associated with oral contraceptives. J Irish Med Assoc 1969;62:260-262. 6. Reed DL, Coon WW: Thromboembolism in patients receiving progestational drugs. N Engl J Med 1963;269:622-624.Crossref 7. Brindle MJ, Henderson IN: Vascular occlusion of the colon associated with oral contraception. Can Med Assoc J 1969;100:681-682. 8. Hurwitz RL, Martin AJ, Grossman BC, et al: Oral contraceptives and gastrointestinal disorders. Ann Surg 1970;172:892-896.Crossref 9. Civetta JM, Kolodny M: Mesenteric venous thrombosis associated with oral contraceptives. Gastroenterology 1970;58:713-716. 10. Rose MB: Superior mesenteric vein thrombosis and oral contraceptives. Postgrad Med J 1972;48:430-433.Crossref 11. Brennan MF, Clarke AM, Macbeth WAAG: Infarction of the midgut associated with oral contraceptives: Report of two cases. N Engl J Med 1968;279:1213-1214.Crossref 12. Keown D: Review of arterial thrombosis in association with oral contraceptives. Br J Surg 1969;56:486-488.Crossref 13. Poiget B, Cheynier JM: Infarctus mésénterique et hypertension artérielle après thérapeutique oestroprogestative à visée hémostatique. Rev Fr Gynecol Obstet 1973;68:325-329. 14. Koh KS, Dazinger RG: Massive intestinal infarction in young women: Complication of use of oral contraceptives? Can Med Assoc J 1977;116:513-515. 15. Beral V: Mortality among oral contraceptive users: Royal College of General Practitioners' Oral Contraception Study. Lancet 1977;2:727-731. 16. Veller ID, Doyle JC: Acute mesenteric ischaemia. Aust NZ J Surg 1977;47:54-61.Crossref 17. Wessler S: Thrombosis and sex hormones: A perplexing liaison. J Lab Clin Med 1980;96:757-761. 18. Gordon EM, Ratnoff OD, Saito H, et al: Rapid fibrinolysis, augmented Hageman factor (factor XII) titers, and decreased Cl esterase inhibitor titers in women taking oral contraceptives. J Lab Clin Med 1980;96:762-769. 19. Rochet Y, Lapeyre B: Le risque chirurgical thrombo-embolique chez les femmes soumises au traitement oestro-progestatif (à propos de trois observations). Gynecol Obstet 1969;68:59-64. 20. Vessey MP, Doll R, Fairbairn AS, et al: Postoperative thromboembolism and the use of oral contraceptives. Br Med J 1970;3:123-126.Crossref 21. Greene GR, Sartwell PE: Oral contraceptive use in patients with thromboembolism following surgery, trauma, or infection. Am J Public Health 1972;62:680-685.Crossref 22. Sagar S, Stamatakis JD, Thomas DP, et al: Oral contraceptives, antithrombin-III activity and postoperative deep-vein thrombosis. Lancet 1976;1:509-511.Crossref 23. Sartwell PE: Preoperative discontinuation of contraceptives. N Engl J Med 1974;290:576. 24. Böttiger LE, Bowman G, Ekland G, et al: Oral contraceptives and thromboembolic disease: Effects of lowering oestrogen content. Lancet 1980;1:1097-1101.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1982

References