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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A summary of what is currently known about the negative side effects associated with oral contraceptive usage is presented, and recommendations for prescribing OCs (oral contraceptives) are made. According to the results of several investigations, 2-18% of all women who take OCs develop hypertension. For most of these women the effects are mild; however, for some the increase in blood pressure is marked and results in renal damage. Several studies demonstrate that the risk of peripheral venous thrombosis and pulmonary embolism is enhanced for women who use OCs compared to nonusers. The risk is somewhat reduced for those who take low estrogen OCs. Women aged 30-39, who take OCs, are 3 times more likely to suffer a myocardial infarction than those who do not use OCs. This risk is markedly increased among OC users who either smoke or suffer from hypertension, diabetes, or hypercholesterolemia. OC users have a 9.5 times greater risk of thrombolic stroke and a 2.0 times greater risk of hemorrhagic stroke than nonusers. For women over 27 years of age, OC usage is associated with the development of benign hepatic adenoma. This risk increases markedly with duration of pill use and is greater for women who take pills containing mestranol compared to those who take pills containing ethinyl estradiol. Occasionally cases of pulmonary hypertension, peripheral arterial occlusion, mesenteric vascular insufficiency, Budd-Chiari syndrome, and noninflammatory cholestatic liver injury are reported among OC users. Recommendations are: 1) women with thromboembolic disorders and women over 34 years old, who smoke or who are obese or hypertensive should be advised to consider other forms of contraception; 2) prescriptions should be written for a 6 month supply and renewed only after a follow-up visit; 3) women who experience elevated blood pressure readings should be advised to discontinue usage; 4) serum triglyceride and cholesterol should be checked every 6 months; and 5) consider the use of low dose heparin for OC users who are recovering from trauma or surgery or who are confined to bed for long periods of time.
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PMID:A review: adverse effects of oral contraceptives. 22 69

A perspective study by the Royal College of General Practitioners reported that the risk of developing deep venous thrombosis of the legs in women taking oral contraceptives was 5.66 times higher than women not on medication. Estrogen-progestogen compounds are highly potent hormones that produce alterations in metabolic and endocrine functions. Clinical examination of the leg is the most reliable method of determining the earliest indication of thrombophlebitis even with the latest diagnostic tools of venography. The key to diagnosis and treatment of pulmonary embolism, which often occurs with patients with thrombophlebitis, is a patient's complaint of leg pains. Those who have undergone surgery, especially abdominal and pelvic, are bedridden, and those who are taking oral contraceptives are at risk of thrombophlebitis. Deep thrombophlebitis of the leg is not recognized clinically in 50-80% of those with venographically documented thrombophlebitis because the signs and symptoms are so protean. Treatment with heparin and leg bandages is most common. Heparin is often followed with coumarin therapy. Some methods of diagnosis are calf tenderness, edema, skin temperature, Homan's Sign, Lowenberg's Sign, Pratt's Sign, cyanosis, systemic signs, and contrast venogram.
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PMID:A review of the birth control pill and its relationship to thrombophlebitis. 44 35

An IGG lambda was purified and its binding properties analyzed from the serum of a woman who had suffered a pulmonary embolism after taking an oral contraceptive (50 mcg ethinyl estradiol and 500 mcg norethisterone) for over 2 years. The purification steps were 1) precipitation with 25% ammonium sulfate; 2) gel filtration on DEAE Sepha dex A25-Sephadex G-25 at pH 10.5 with 6 M urea; 3) repeat gel filtration, but at pH 8.6 without urea; 4) chromatography on Sepharose 4B CNBr coupled with ethinyl estradiol. The activities of the fractions were analyzed by double diffusion immunoelectrophoresis. Scatchard plots by both dialysis and by ultracentrifugation generated an association constant of 2.7 X 10 7 M -1 for ethinyl estradiol, .4 X 10 7 M -1 for 17beta-estradiol, and a valence of 2. Normal human sera had such low affinities for ethinyl estradiol that the Ka could not be calculated. Immunoelectrophoresis showed only a single protein, of about 150,000 molecular weight in polyacrylamide gel. Equilibrium dialysis against other steroids demonstrated that the IgC was specific for ethinyl estradiol, but binding was inhibited to a lesser extent by the following, in order of potency: 17beta-estradiol, progesterone, estr adiol, testosterone, and estrone. The Ka was midway between that of albuinn and the highly specific steroid binding protein. The relationships between oral contraception, this apparent monoclonal gammapathy, and the pulmonary embolism are discussed.
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PMID:[Monoclonal human immunoglobulin (IgG lambda) with antiethinylestradiol activity, oral contraceptives, and arterial pulmonary thrombosis]. 80 20

Sexual activity is quite common among women aged 14 to 20 in developed countries, averaging perhaps 10% at age 15 to about 70% at 19. Thus, the need for contraception may begin quite early in life and will continue for as long as 30 years. One of the best candidates for long-term contraception for young sexually active females is the oral contraceptive (OC), which provides health benefits besides contraception. Long-term benefits include lowered rates of ovarian and endometrial cancer, as well as of benign breast disease and ovarian cysts. Another benefit is protection against upper-tract sequelae of sexually transmitted diseases. Short-term benefits are correction of menstrual irregularity, reduction in menstrual flow, and diminished premenstrual syndrome and dysmenorrhea. Recent OC formulations contain only one-third the estrogenic potency of older OCs and therefore are associated with dramatic decreases in what were always the major side effects of OCs: heart attack, stroke, and pulmonary embolism. Other side effects of OCs have been most closely associated with the progestogenic component, and are related to the androgenic effects of progestins, particularly some synthetic progestins. However, some new synthetic progestins have been found to have minimal androgen receptor activity in preclinical testing and to cause minimal or no androgen-related side effects in clinical trials. One of these new progestins having a favorable androgenic profile is norgestimate. Its efficacy and safety in combination with low doses of ethinyl estradiol have been documented in the European and the American literature.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The androgenicity of oral contraceptives: the young patient's concerns. 136 88

In 1983, a previously healthy 21-year old mother came to University Hospital in Dijon, France feeling weak and had a severe frontal headache with vomiting. Clinical and biochemical tests were normal. She smoked 20 cigarettes/day and used a high dosed combined oral contraceptive (OC) (ethinyl estradiol and cyproterone acetate). 15 days later, the headache returned and she could not understand spoken words and the bilateral section of the brain had slowed. Yet her mental status was normal as were cerebrospinal fluid and cerebral computerized tomography tests. The antiherpes virus drug, vidabarine, did not alleviate symptoms. At least 1 month later, a severe left pulmonary embolism caused acute right heart failure. She also had a prethrombotic left iliac vein, so physicians began heparin therapy, adding nifedipine and buflomedil to control the spasms in the right internal iliac artery and both external iliac arteries. Acute ischemia of the lower limbs eased within a week but sensory disorders remained for 2 months. Satisfactory collaterality transpired due to a blocked left external iliac artery and left iliac vein. The following signs and symptoms indicated her condition to be homocystinuria: blond hair with deep blue eyes, macrocytic anemia, factor VII deficit (51%), strong positive Brandt's reaction, cystine homocystine in the plasma, and presence of homocystine, cystathionine, and methionine in the urine. Physicians took her off the OC and discharged her on vitamin B6/day, folic acid/day, betaine citrate/day, and the anticoagulant Coumadin. A subsequent check of her 19-year old sister found she had it too. They assessed the patient's condition yearly. In 1988, her left leg developed edema and she limped when not using elastic stockings. Effects of iliac vein phlebitis were evident. She no longer suffered from headaches. Since plasma methionine was within the normal range and homocystine no longer was present in plasma and urine, the physicians halted the anticoagulant therapy. In conclusion, the OC precipitated this partial form of homocystinuria.
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PMID:Vascular manifestations in homocystinuria. 161 Jun 63

The pharmacology, clinical performance, and metabolic effects of the identical combined oral contraceptive Femodene (Schering) and Minulet (Wyeth), are compared with Microgynon 30, the most widely used pill in the United Kingdom. Femodene and Minulet both contain 30 mcg ethinyl estradiol and 75 mcg gestodene, while Microgynon contains 30 mcg ethinyl estradiol and 150 mcg levonorgestrel. Gestodene is active on its own, so it suppresses ovulation at a very low dose. It is a strong anti-estrogen, has low androgenic, and minimal anti-mineralocorticoid effects. Femodene/Minulet appears to cause less breakthrough bleeding, even in the 1st few cycles, than Microgynon. It raises triglycerides and phospholipids, but does not affect lipids or carbohydrates. Like many oral contraceptives, these formulations increase clotting Factor Vii, yet accelerate fibrinolysis. There have been extremely few reports of severe adverse effects: a 19-year old Femodene user died from pulmonary embolism. These formulations are 2-4 times as expensive as other popular combined oral contraceptives marketed in England.
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PMID:Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE. 177

The significance of antibodies against ethinyl estradiol (anti-EE-Ab) and other risk factors was discussed for a series of 1318 cases of venous and arterial thrombosis in oral contraceptive users, in comparison to 61 non-users and 124 health current pill users. The cases included 264 deep vein thromboses, 159 pulmonary embolism, 37 coronary artery, 33 systemic artery, 763 cerebrovascular artery thromboses, and 10 hepatic vein thromboses collected from 88 French hospitals from 1976-1988. There were 98 cases with successive or multiple sites involved. The mean age of contraceptive users with thrombosis was 32.1, compared to 28.8 in healthy users. Duration of use was slightly longer in affected users than healthy users, but some cases were affected as early as their 1st cycle. 87.2% had no related history. The anti-EE-Ab were absent in never users, averaged 318 c./min in pill users with thrombosis, but 60 in healthy pill users. There was no correlation between anti-EE-Ab level and dose or duration of pill use. Similar anti-EE-Ab levels were found in those with venous or arterial thrombosis, but women with arterial thrombosis were older, had used pills longer, had fewer predisposing factors of surgery or labor and delivery, but more frequent incidence of hyperlipidemia, smoking, and hypertension. The most frequent associated factors with thrombosis were presence of anti-ee-Ab and smoking: 15.6% smoked, 31.1% had anti-EE-Ab, and 47.6% had both, but only 9.5% had neither factor. It is interesting that lowering the estrogen dose of oral contraceptives has decreased the frequency of venous thrombosis, but not that of arterial thrombosis or mortality, nor anti-EE-Ab levels. The vascular lesions in arterial thrombosis seen in pill users are thought to resemble those in many autoimmune diseases.
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PMID:Oral contraceptives, sex steroid-induced antibodies and vascular thrombosis: results from 1318 cases. 178 53

Between 1963-82, 286 deaths were diagnosed after autopsy as due to pulmonary embolism at the Medico-Legal Institute of Plzen, Czechoslovakia. In almost 95% of cases, there was a massive and acute embolism of the pulmonary artery. 155 women and 131 men were involved. The average age of victims was 70 years for women and 66 for men. A thrombosis of the deep veins of the legs was found in 95% of the men and women. Unilateral or bilateral varices or their trophic complications were observed in 30% of women and 27% of men. Almost all patients were affected by arteriosclerosis, with the most serious sclerosis occurring in 32% of the women and 27% of the men. 32% of the men and 53% of the women were obese. The pulmonary embolism coexisted with another serious illness or a trauma in over 90% of cases. The deaths of 12 men and 13 women under 50 years old were studied in greater detail. In this group the cause of death was massive embolism of the pulmonary artery accompanied by deep thrombosis of the legs. The greatest differences were found in the degree of sclerosis of the arteries. Trauma preceded death in 30% of these patients. 50% of the women and 30% of the men were obese. A 32-year-old obese, nonsmoking woman originally consulted for intolerable back pains. About 8 days later she was hospitalized and died. The autopsy revealed a massive and acute pulmonary embolism with vast hemorrhagic infarcts. Thrombosis of the veins was discovered to be the source of the embolism. Microscopic examination also disclosed a venous thrombosis in the ovaries. A proliferation of elastic tissue and a visible thickening of the intima were seen in the arteries, as well as a dilatation of the lymphatic vessels. There was no indication of thrombophlebitis in the leg veins. The medical history showed that the woman had been taking an oral contraceptive (OC) for the past 3 years and continued doing so until the day before her death. The woman's gynecologist stated that 4 months before her death a routine liver examination was slightly positive and the patient was advised to discontinue her combined OC (Non-Ovlon) for 3 months. The woman felt well and disregarded the advice. Non-Ovlon contains 1 mg of norethisterone acetate and .5 mg of ethinyl estradiol.
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PMID:[Sudden death in venous diseases]. 242 70

Vascular risk, mainly thromboembolitic risk, attributed to oral contraceptives (OCs) since 1962, has been primarily linked to ethinyl estradiol (EE). OCs which combine estrogen and have been associated with cerebral vascular accidents. A 1977 study showed a 40% increase of mortality due to cardiovascular complications in women taking OCs. There were of both an arterial and a venous character. The risk of myocardial infarction was 3 times more frequent among OC users. Deep venous thrombosis and pulmonary embolism were more numerous. Some other risk factors include smoking, hypertension, diabetes, and age 35. The risk of heart attack vanishes a few years after stopping OC use. The reduction of EE (and similarly progesterone) dosage from 100-50 mcg also lower the risk of hypertension, cerebral vascular accidents, and venous thrombosis. Prolonged use of OCs causes disorders of hemostasis affecting the walls of blood vessels, modifying the viscosity of blood flow (increase of hematocrits, reduction of venous tonus), modifying plasmatic coagulation (increase of platelets, increase of factors VII and X and plasma fibrinogen, and decrease of antithrombin III activity), and increased fibrinolysis. These anomalies are exclusively associated with high doses of estrogens. 5% of women using OCs develop moderate hypertension of 5-10 mm Hg of systolic pressure 5 years later, but after cessation it is reversed. OCs stimulate the renin-angiotensin-aldosterone system causing accelerated production of angiotensin II with the resultant forceful vasotension. 3 months after quitting OC use, high blood pressure returns to normal. EE can provoke diabetes; it increases very low density lipoprotein (VLDL) and high density lipoprotein (HDL) production, but total cholesterol is hardly affected. The androgenic property of progestogens reduces HDL. Combined OCs are contraindicated for women with hypertension, hyperlipidemia, diabetes, and a family history of vascular accidents.
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PMID:[Oral contraception and the vascular risk]. 251 20

Focus in this discussion of pulmonary embolism is on the following: risk factors (age, heredity and blood type, obesity, estrogen and oral contraceptive use/pregnancy, cardiovascular disease, cancer, and other risk factors); pathophysiology and presenting symptoms; laboratory procedures and findings (radiography, electrocardiography, lung scanning, and evaluation of lower extremity veins); treatment modalities (heparin therapy, thrombolysis, and surgery); and prevention. Pulmonary embolism may be the primary cause or a major contributory cause in as many as 200,000 deaths per year in the US. Most of these deaths occur in patients in whom the diagnosis is not suspected and, thus, not treated. The mortality rate for untreated pulmonary embolism is approximately 30%. 90% of patients survive the initial embolic event, but the correct diagnosis is made in no more than 2/3 of cases. Risk factors for the development of deep venous thrombosis are based upon the Virchow-Aschoff postulates, which include: trauma or disruption of the vein wall; stasis of blood flow in the veins; and increased coagulability of the blood. More than 85-90% of all pulmonary emboli originate from deep venous thromboses in the popliteal and femoral deep veins. Other important, although less frequent, sites of origin of venous thromboembolism include the pelvic veins, the renal and hepatic veins, the axillary veins in the upper extremities, and the right atrium. Accurate diagnosis and effective prevention and treatment depend on the clinician's awareness of risk factors for development of deep vein thrombosis. Estrogen may accelerate intimal proliferation in arteries and veins, and it may also increase permeability of venous vascular endothelium. The risk of thromboembolism increases as the dose of estrogen increases. Both pregnancy and oral contraceptive use significantly decrease venous tone and the velocity of blood flow in the calf of the leg. Appropriate treatment includes thrombolytic therapy for patients with massive pulmonary embolism, which results in hypotension or shock. Anticoagulant therapy with herapin followed by an oral anticoagulant is the primary treatment for most patients with submassive emboli in which there is less cardiovascular compromise. When thrombolytic therapy is used, it should always be followed by anticoagulant therapy. Prevention of primary or recurrent deep vein thrombosis is directed toward improving venous blood flow and reducing hypercoagulability.
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PMID:Pulmonary embolism: incidence, diagnosis, prevention, and treatment. 398 Feb 63


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