Effects on hemostatic variables of desogestrel- and gestodene-containing oral contraceptives in comparison with levonorgestrel-containing oral contraceptives: A review

• Published in: American journal of obstetrics and gynecology Vol. 179; no. 3; pp. s51 - s61
• Main Author: Winkler, Ulrich H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.1998
• Subjects: Activated protein C sensitivity ratio; Contraceptives, Oral, Hormonal - adverse effects; Contraceptives, Oral, Synthetic - adverse effects; Desogestrel - adverse effects; factor VII; Female; hemostasis; Hemostasis - drug effects; Humans; Norpregnenes - adverse effects; oral contraceptives; Progesterone Congeners - adverse effects; Protein C - drug effects; Risk; Thrombosis - chemically induced; venous thromboembolism; oral contraceptives; Activated protein C sensitivity ratio; hemostasis; factor VII; venous thromboembolism; Hemic System; Contraceptive Agents > pharmacodynamics; Contraceptive Agents, Female > pharmacodynamics; Oral Contraceptives > side effects; Risk Factors; Biology; Contraception; Contraceptive Methods > side effects; Family Planning; Oral Contraceptives, Combined > side effects; Desogestrel > pharmacodynamics; Embolism; Diseases; Contraceptive Agents, Progestin > pharmacodynamics; Gestodene > pharmacodynamics; Literature Review; Hematological Effects; Vascular Diseases; Blood Coagulation Effects; Physiology; Levonorgestrel > pharmacodynamics; Thromboembolism
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1053/ob.1998.v179.a92633

In some studies third-generation oral contraceptives have been reported to be associated with a higher risk of venous thromboembolism than are second-generation oral contraceptives, whereas recent, more refined studies have not confirmed this. The reasons for the alleged differences are under discussion, and differential effects on hemostasis have been proposed. Eighteen studies comparing second- and third-generation oral contraceptives with respect to their effects on hemostasis were analyzed. Significant changes from baseline were reported for many variables with both second- and third-generation oral contraceptives without significant between-group differences. Also, in a combined analysis of nonsignificant changes, no consistent pattern of change emerged for any marker, with the exception of higher factor VII levels associated with third-generation oral contraceptives. However, factor VII is not related to venous thromboembolism risk. In addition, 1 cross-sectional study with an unvalidated assay reported a higher ratio of activated protein C sensitivity with third-generation oral contraceptives. Only 2 components of the hemostatic system (factor VII and activated protein C sensitivity ratio) emerged as potentially differentially affected by second- and third-generation oral contraceptives; the association with venous thromboembolism risk is questionable in the former case and unknown in the latter. (Am J Obstet Gynecol 1998;179:S51-61.)