EFFECT OF A ‘PROGESTIN ONLY’ CONTRACEPTIVE ON PLATELET AGGREGATION IN A PAKISTANI SET OF POPULATION

Nasir Ali Afsar, Qamaruddin Barakzai, Salman Naseem Adil

Abstract


Background: Safe use of progestin-only hormonal preparations has remained quite controversial
though they are being employed in various disorders very commonly. These hormones result in a
number of adverse effects in the body, the most drastic being predisposition to higher risk of
thromboembolism with reports of involvement of platelets. Despite a large number of studies, no
definite inference had been derived regarding the effects of these agents on blood coagulation. It
has been reported that the response in various ethnic groups may vary. Therefore this study is
designed to observe the effects of progestin-only hormonal contraceptives regarding primary
hemostasis in our population. Methods: We carried out this study on 50 women divided into two
equal groups of 25 each, namely, a group of users of Progestin-only injectable hormonal
contraceptive Norethisterone oenanthate 200 mg used as a 2-monthly injection and a control group
and studied platelet aggregation against ADP, Collagen, Epinephrine and Ristocetin. Results:
There was no statistical difference regarding the platelet aggregation studies against ADP,
collagen, epinephrine and ristocetin between users and nonusers of progestin-only injectable
contraceptive. The menstrual irregularities were found to be more frequent in users of injectable
hormonal contraceptives than in non-users, especially amenorrhea and irregularities of menstrual
flow. In users of injectable hormonal contraceptives, hemoglobin and hematocrit were slightly
better maintained as compared to non-users. Conclusion: This suggests that Norethisterone
oenanthate at currently used doses does not increase the platelet aggregation against ADP,
collagen, epinephrine and ristocetin in our population.
Key Words: Progestin, Norethisterone, Contraceptive, Coagulation, Thrombosis, Thrombophilia,
Platelet Aggregation.

Full Text:

PDF

References


Lobo RA, Stanczyk FZ. New knowledge in the physiology of

hormonal contraceptives. Am J Obstet Gynecol 1994;170(5

Pt 2): 1499-1507.

Loose-Mitchell DS, Stancel GM. Estrogens And Progestins.

In: Hardman JG, Limbird LE, Gilman AG, editors.Goodman

& Gilman’s Pharmacological Basis Of Therapy. 10th ed; New

York:McGraw Hill Companies,Inc;2001.p.1628;

Herkert O, Kuhl H, Sandow J, Busse R, Schini-Kerth VB.

Sex steroids used in hormonal treatment increase vascular

procoagulant activity by inducing thrombin receptor (PAR-1)

expression: role of the glucocorticoid receptor. Circulation

;104(23): 2826-31.

Setiabudy RD, Affandi B, Witjaksono B, Wirawan R,

Hendratna M, Hidayat E. The effect of Norplant on some

hemostatic parameters in Indonesian women. Southeast

Asian J Trop Med Public Health. 1993; 24 Suppl 1:234-36.

Viegas OA, Singh K, Koh S, Singh P, Ratnam SS. The

effects of Norplant on clinical chemistry in Singaporean

acceptors after 1 year of use: I. Haemostatic changes.

Contraception1988;38(3):313-23.

Howie PW, Mallinson AC, Prentice CR, Horne CH, McNicol

GP. Effect of combined oestrogen-progestogen oral

contraceptives, oestrogen, and progestogen on antiplasmin

and antithrombin activity. Lancet 1970; 2:1329-32.

Leck I, Thomson JM, Bocaz JA, Barja P, Bonnar J, Daly L,

et al. A multicentre study of coagulation and haemostatic

variables during oral contraception: variations with

geographical location and ethnicity. Task Force on Oral

Contraceptives – WHO Special Programme of Research,

Development and Research Training in Human

Reproduction. Int J Epidemiol 1991;20(4):913-20.

Ferreira AC, Montes MB, Franceschini SA, Toloi MR.

Third-generation progestogen type influences hemostatic

changes caused by oral contraceptives in Brazilian women.

Contraception 2001;64(6):353-56.

Gader A, Bahakim H, Awadalla S, Malaika S. Ethnic

variations in the haemostatic system: comparison between

Arabs, Westerners (Europeans and Americans), Asians and

Africans. Blood Coagul Fibrinolysis 1995;6(6):537-42.

Bocaz JA, Barja P, Bonnar J, Daly L, Carrol A, Coutinho E,

et al. Differences in coagulation and hemostatic parameters

in normal women of childbearing age from different ethnic

groups and geographical locations. Task Force on Oral

Contraceptives – WHO Special Programme of research,

Development and Research Training in Human

Reproduction. Thromb Haemost 1986;55(3):390-95.

Spitzer WO, Lewis MA, Heineman LA, Thorogood M,

MacRae KD. Third generation oral contraceptives and risk of

venous thromboembolic disorders: an international casecontrol study. Transnational Research Group on Oral

Contraceptives and health of Young Women. BMJ 1996;

:83-88.

Grady D, Wenger, NK, Herrington D, Khan S, Furberg C,

Hunninghake D, et al. Postmenopausal hormone therapy

increases the risk for venous thromboembolism. The Heart

and Estrogen/progestin Replacement Study (HERS). Ann.

Intern Med 2000;132:689-96.

Daly E, Vessey MP, Hawkins MM, Carson JL, Gough P,

Marsh S. Risk of venous thromboembolism in users of

hormone replacement therapy. Lancet 1996;348:977-80.

Jick H, Jick SS, Gurewich V, Myers MW, Vasilakis C. Risk

of idiopathic cardiovascular death and non fatal venous

thromboembolism in women using oral contraceptives with

differing progestogen components. Lancet 1995;346:1589-

Jick, H, Derby LE, Myers MW, Vasilakis C, Newton KM.

Risk of hospital admission for idiopathic venous

thromboembolism among users of postmenopausal estrogens.

Lancet 1996;348: 981-83.

Wilson PWF, Garrison RJ, Castelli WP. Postmenopausal

estrogen use, cigarette smoking and cardiovascular morbidity

in women over 50: the Framingham Study. N Engl J Med

;313:1038-43.

Scholz D, Carmichael JM. Contraception. In: Herfindal ET,

Gourley DR, editors. Textbook Of Therapeutics, Drugs and

Disease Management, 7th edition Philadelphia:Lippincott

Williams & Wikins 2000. p.2024;.

WHO Collaborative Study of Cardiovascular Disease and

Steroid Hormone Contraception. Venous thromboembolic

disease and combined oral contraceptives: results of

international case-control study. Lancet 1995; 346:1575-82.

WHO Collaborative Study of Cardiovascular Disease and

Steroid Hormone Contraception. Effect of different

progestogens in low estrogen oral contraceptives on venous

thromboembolic disease. Lancet. 1995; 346:1582-88.

Paros NL. Side-Effects of Oral Contraceptives. Br Med J.

; 5383:630-5.

Loehry CA. Pulmonary emboli in young adults. Br Med J

; 5499:1327-8.

Inman WHW, Vessey MP. Investigation of deaths from

pulmonary, coronary, and cerebral thrombosis and embolism

in women of childbearing age. BMJ 1968; 2(599):193-9.

Budev MM, Thacker HL. Contraceptive Preparations and the

Risk of VTE. The Cleveland Clinic 2003. Available

from:http://www.clevelandclinicmeded.com/diseasemanage

ment/women/exogenous/exogenous.htm#top

Feng D, Lindpaintner K, Larson MG, Rao VS, O'Donnell CJ,

Lipinska I, et al. Increased platelet aggregability associated

with platelet GPIIIa PlA2 polymorphism: the Framingham

Offspring Study. Arterioscler Thromb Vasc Biol 1999;

(4):1142-47.

O'Donnell CJ, Larson MG, Feng D, Sutherland PA,

Lindpaintner K, Myers RH, et al. Genetic and environmental

contributions to platelet aggregation: the Framingham heart

study. Circulation 2001; 103(25):3051-56.

Michelson AD, Furman MI, Goldschmidt-Clermont P,

Mascelli MA, Hendrix C, Coleman L, et al. Platelet GP IIIa

J Ayub Med Coll Abbottabad 2005;17(3)

Pl(A) polymorphisms display different sensitivities to

agonists. Circulation 2000; 101(9):1013-8.

Fontana P, Dupont A, Gandrille S, Bachelot-Loza C, Reny

JL, Aiach M, et al. Adenosine diphosphate-induced platelet

aggregation is associated with P2Y12 gene sequence

variations in healthy subjects. Circulation 2003; 108(8):989-

Ciavatti M, Davenas E, Blache D, Monnier MA, Renaud S.

Biosynthesis of platelet lipids in relation to aggregation in

women using oral contraceptives. Contraception 1982;

(6):629-38.

Meng YX, Jiang HY, Chen AJ, Lu FY, Yang H, Zhang MY,

et al. Hemostatic changes in women using a monthly

injectable contraceptive for one year. Contraception 1990;

(4):455-66.

Task Force for Epidemiological Research on Reproductive

Health, UNDP/UNPF/WHO/WB Special Programme of

Research, Development and Research Training in Human

Reproduction, WHO. Effects of contraceptives on

hemoglobin and ferritin. Contraception 1998;58(5):262-73.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]