The effects on hemostasis of oral contraceptives containing desogestrel

Abstract

Epidemiologic research has shown that current low-dose estrogen oral contraceptives are associated with a low risk of vascular events (e.g., myocardial infarction, stroke, and venous thrombosis or thromboembolism). Yet questions still persist about the effects of low-dose oral contraceptives on the cardiovascular system. Changes in the coagulation system have been linked primarily to the estrogen component; however, it has been proposed that the progestin may have an influence on the fibrinolytic system. Desogestrel, a new gonane progestin, has been commercially available in Europe since 1981. It has been widely shown to produce minimal changes of the coagulation and fibrinolytic systems, and it has not been associated with an increased risk of thromboembolic disorders.

PIP: Epidemiologic research has correlated current low-dose estrogen oral contraceptives with a low risk of myocardial infarction, stroke, and venous thrombosis or thromboembolism. Nevertheless, misgivings still linger about the effects of low-dose oral contraceptives on the cardiovascular system. Changes in the coagulation system have been linked primarily to the estrogen component; however, the progestin may have an influence on the fibrinolytic system. Oral contraceptives (OCs) containing desogestrel, a new progestin, became commercially available in Europe in 1981. Since that time, more than 30 million women have used the monophasic preparation containing 150 mcg of desogestrel and 30 mcg of ethinyl estradiol. During this widespread clinical use, desogestrel-containing OCs have not been associated with an increase in the risk of thromboembolic disorders. A total of 13 studies from different countries involving different ethnic groups were reviewed concerning the effects of OCs containing novel progestins on coagulation and fibrinolytic variables. The observed changes indicate that a new balance has occurred, increases in both procoagulation and profibrinolysis factors and their inhibitors. With the exception of two studies, all studies were comparative versus a variety of low-dose oral contraceptives. None of the studies observed a notable difference between the desogestrel OC and the comparison OC, and no incidental difference between OCs was confirmed in a subsequent study. This lack of a specific progestin effect confirms an earlier theory that any thrombogenic effect of oral contraceptives is caused by the estrogen component. Desogestrel differs from progestins currently in use in its lower relative androgenicity, which eliminates or reduces adverse effects on lipid and carbohydrate metabolism. The use of the desogestrel-containing OC is associated with minimal changes in the coagulation and fibrinolytic systems. A careful medical and family history rather than the selection of a particular OC combination is an effective means of preventing thromboembolic disorders.