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  • Title: [Oral contraception and cerebral embolisms].
    Author: Riedel M, Lichtlen PR.
    Journal: Dtsch Med Wochenschr; 1993 Oct 15; 118(41):1506-7. PubMed ID: 8404516.
    Abstract:
    Sex steroids, especially estrogens, can have effects on the cardiovascular system, thus they have been investigated in clinical studies. One of these utilized a patient register since 1977 involving 794 Danish women aged 15-44 who had a transitory ischemic attack or a cerebral insult during 1985-89. Out of these, 497 women had a certain diagnosis and were compared with 1370 age-matched controls without cerebral embolism taken from the register. The final sample consisted of 323 cases and 1198 controls. 36.3% of cases were taking oral contraceptives (OCs) at the time of the cerebrovascular event, while only 16% of controls were OC users. The relative risk (RR) of cerebrovascular disorder in OC users was 3.0 and in a subgroup 50 mcg of ethinyl estradiol (EE) yielded an RR of 2.9, 30-40 mcg of EE produced only an RR of 1.8, and pure gestagen preparations only an RR of 0.9. Smoking increased the risk of cerebral embolism in both groups by about 50%. The absolute risk from epidemiological data was very small: 0.3-4 cases a year among one million women using OCs. Estrogen seems to be responsible for the increased rate of cerebral embolism, since pure gestagen preparations do not influence the risk significantly. Estrogens can stimulate in a dose-dependent fashion the synthesis of hepatic coagulation factors such as Factor VII and X as well as the fibrinogens and lead to increased blood plasma levels of these proteins. Through this, hypercoagulability can develop, which favors the appearance of thromboembolism. It needs to be stressed, however, that the risk of thromboembolism in postmenopausal hormone substitution in contrast to oral contraception is not increased. The conclusion is that these risks, especially for smokers, should be clarified when prescribing an OC.
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