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  • Title: Changes in coagulation and anticoagulation in women taking low-dose triphasic oral contraceptives: a controlled comparative 12-month clinical trial.
    Author: Notelovitz M, Kitchens CS, Khan FY.
    Journal: Am J Obstet Gynecol; 1992 Nov; 167(5):1255-61. PubMed ID: 1442974.
    Abstract:
    OBJECTIVE: The effects of two triphasic oral contraceptives on coagulation and anticoagulation factors were compared in a 12-month open-label study. STUDY DESIGN: Fifty-two women (mean age 26 years) were enrolled in and completed the study; 20 had been randomly assigned to receive levonorgestrel plus ethinyl estradiol, 24 had been randomly assigned to receive norethindrone plus ethinyl estradiol, and eight surgically sterile women acted as untreated controls. Coagulation and anticoagulation factors were measured at baseline and during the sixth and twelfth months. RESULTS: Both oral contraceptives produced significant decreases from baseline in prothrombin time and partial thromboplastin time; there were also significant changes in laboratory control times. Factor XII was significantly increased in both oral contraceptive groups after 6 and 12 months. Fibrinogen antigen was significantly increased for norethindrone plus ethinyl estradiol after 6 and 12 months and for levonorgestrel plus ethinyl estradiol after 12 months. Platelet counts were unchanged. There was a significant increase in antithrombin III activity with norethindrone plus ethinyl estradiol at 12 months. Antithrombin III antigen was unchanged with the oral contraceptives; however, significant increases existed for alpha 1-antitrypsin antigen and plasminogen antigen and activity after 6 and 12 months and for alpha 2-macroglobulin antigen after 12 months for both oral contraceptives. alpha 2-Antiplasmin antigen was significantly increased for norethindrone plus ethinyl estradiol at the 12-month evaluation. There were no significant differences between the oral contraceptives for any coagulation or anticoagulation factor, and mean values generally remained within reference ranges. CONCLUSIONS: Levonorgestrel plus ethinyl estradiol and norethindrone plus ethinyl estradiol had equivalent, minimal effects on hemostasis, and changes in coagulation factors appeared to be balanced by changes in anticoagulation factors. Researchers from Gainesville, Florida compared data on 20 women who were randomly assigned the triphasic oral contraceptive (OC) Triphasil (ethinyl estradiol and levonorgestrel) with data on 24 women who were randomly assigned the triphasic OC Ortho-Novum (ethinyl estradiol and norethindrone) and data on 8 women who were controls to evaluate these 2 triphasic OCs' effects on coagulation and anticoagulation factors. They measured these factors at baseline and 6 and 12 months after beginning OC use. Both OCs significantly reduced prothrombin time (Triphasil at 6 and 12 months, p.001; Ortho-Novum at 6 months, p01, and at 12 months, p.001). They also decreased partial thromboplastin time (Triphasil at 6 months, p.01), and at 12 months, p.001; Ortho-Novum at 6 months, p.01). Both OCs significantly increased Factor XII after 6 and 12 months (Triphasil p.001 and p.01 for controls and p.05 from baseline, respectively; Ortho Novum p.01). Ortho-Novum considerably increased fibrinogen antigen at 6 and 12 months (p.05 and p.001 from baseline and p.05 for controls, respectively) while Triphasil increased it only at 12 months (p.05). Platelet counts remained the same. Ortho-Novum markedly increased antithrombin III activity after 6 months (p.05). Even though neither OC changed antithrombin III antigen, they did significantly increase alpha-1-antitrypsin antigen and plasminogen antigen and activity at 6 and 12 months as well as alpha-2-antiplasmin antigen at 12 months. Ortho-Novum increased alpha-s-antiplasmin antigen at 12 months. No great differences in coagulation or anticoagulation factors existed between the OCs. The mean values were within reference ranges. These results showed that the OCs had the same, limited effects on hemostasis and changes in coagulation factors offset changes in anticoagulation factors.
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