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Clinical Crossroads: A 36-Year-Old Woman Recuperating From Stroke

Clinical Crossroads: A 36-Year-Old Woman Recuperating From Stroke To the Editor. —We read with interest Dr Alexander's Clinical Crossroads, which discussed a 36-year-old woman recuperating from a stroke,1 but we are surprised that, despite advising the patient to increase activities at home, including resumption of her sex life, there is no discussion of contraception issues in this married, apparently fertile woman with 4 previous pregnancies. Pregnancy prevention is particularly important in this patient recuperating from a life-threatening event. In addition, warfarin is a teratogen; 15% to 20% of infants exposed to coumarin derivatives in the first trimester develop the fetal warfarin embryopathy syndrome.1 Contraceptive issues in this patient are complex. Certainly barrier methods would be considered safe. An intrauterine device would be another reasonable option. Oral contraceptives should be considered with caution since the risk of both ischemic and hemorrhagic stroke is slightly increased in older users of combined oral contraceptive agents.2,3 Male or female sterilization is another reasonable http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Clinical Crossroads: A 36-Year-Old Woman Recuperating From Stroke

JAMA , Volume 278 (13) – Oct 1, 1997

Clinical Crossroads: A 36-Year-Old Woman Recuperating From Stroke

Abstract



To the Editor.
—We read with interest Dr Alexander's Clinical Crossroads, which discussed a 36-year-old woman recuperating from a stroke,1 but we are surprised that, despite advising the patient to increase activities at home, including resumption of her sex life, there is no discussion of contraception issues in this married, apparently fertile woman with 4 previous pregnancies. Pregnancy prevention is particularly important in this patient...
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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.1997.03550130035023
Publisher site
See Article on Publisher Site

Abstract

To the Editor. —We read with interest Dr Alexander's Clinical Crossroads, which discussed a 36-year-old woman recuperating from a stroke,1 but we are surprised that, despite advising the patient to increase activities at home, including resumption of her sex life, there is no discussion of contraception issues in this married, apparently fertile woman with 4 previous pregnancies. Pregnancy prevention is particularly important in this patient recuperating from a life-threatening event. In addition, warfarin is a teratogen; 15% to 20% of infants exposed to coumarin derivatives in the first trimester develop the fetal warfarin embryopathy syndrome.1 Contraceptive issues in this patient are complex. Certainly barrier methods would be considered safe. An intrauterine device would be another reasonable option. Oral contraceptives should be considered with caution since the risk of both ischemic and hemorrhagic stroke is slightly increased in older users of combined oral contraceptive agents.2,3 Male or female sterilization is another reasonable

Journal

JAMAAmerican Medical Association

Published: Oct 1, 1997

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