Effects of oral and transdermal hormonal contraception on vascular risk markers: a randomized controlled trial
Department of Obstetrics and Gynecology
Administration, Cutaneous; Adolescent; Adult; Analysis of Variance; Antithrombins; Blood Coagulation; Blood Proteins; C-Reactive Protein; Contraceptives, Oral, Hormonal; Cross-Over Studies; Ethinyl Estradiol; Factor VIII; Female; Fibrinogen; Humans; Norgestrel; Oximes; Protein S; Risk Factors; Thrombosis; von Willebrand Factor
Obstetrics and Gynecology
OBJECTIVE: To compare the effects of oral and transdermal contraceptives containing similar hormone formulations on vascular risk markers.
METHODS: We conducted a randomized, investigator-blinded, crossover, clinical trial with 24 healthy women, aged 18-35 years, who received 2 months of transdermal or oral contraceptive, 2 months washout, then 2 months of the alternative medication. The transdermal contraceptive contained 0.75 mg ethinyl estradiol and 6 mg norelgestromin. The oral contraceptive contained 35 mcg ethinyl estradiol and 250 mcg norgestimate. Blood samples taken before and after each treatment were analyzed in batch for D-dimer, von Willebrand factor, factor VIII, total and free protein S, antithrombin, fibrinogen, C-reactive protein, and normalized activated protein C sensitivity ratio (nAPCsr) determined with two thrombin generation-based assays, the alpha2macroglobulin-thrombin end point method (alpha2M-IIa) and calibrated automated thrombinography. Repeated measures analysis of variance was used for analysis.
RESULTS: For both contraceptives (transdermal, oral) there were significant declines in free (19%, 11%) and total protein S (19%, 13%) and antithrombin (13%, 10%); increases in fibrinogen (8%, 10%), C-reactive protein (220%, 292%), nAPCsr alpha2M-IIa (81%, 61%), and nAPCsr calibrated automated thrombinography (102%, 68%), all P
CONCLUSION: Oral and transdermal contraception with similar hormones had similar adverse effects on vascular risk markers. This suggests that this transdermal contraceptive has at least a similar thrombosis risk as its oral counterpart.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00554632
LEVEL OF EVIDENCE: I.
DOI of Published Version
Obstet Gynecol. 2008 Feb;111(2 Pt 1):278-84. doi: 10.1097/AOG.0b013e3181626d1b. Link to article on publisher's site
Obstetrics and gynecology
Johnson, Julia V.; Lowell, Jane; Badger, Gary J.; Rosing, Jan; Tchaikovski, Svetlana; and Cushman, Mary, "Effects of oral and transdermal hormonal contraception on vascular risk markers: a randomized controlled trial" (2008). Obstetrics and Gynecology Publications and Presentations. 63.