Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The combined estrogen/progestogen oral contraceptive (OC) is the most common form of contraception that is used by sexually active women who are between the ages of 15-35 years. Serious side-effects are infrequent, and the failure rate is exceedingly low. The major side-effects of OC administration are seen in 4 distinct areas: subsequent fertility; the cardiovascular system; metabolic effects; and malignancy. Approximately 1% of women experience persistent amenorrhea after they cease to take OCs, but considerable doubt exists as to whether this is purely an effect of OC or is due to other factors such as weight change, excessive exercise, or psychological disturbances. The major cardiovascular problems are those of hormone-induced hypertension, deep vein thrombosis, coronary artery disease, and stroke. It is not possible to predict which patients will develop hypertension while taking OCs, and all patients should have their blood pressure checked within 6 months of starting OC use and then approximately once a year. There is little doubt that the increased risk of deep vein thrombosis that was observed in women using OCs in the 1960s was related to the high estrogen content of the early OCs. As the dose of estrogen has been reduced progressively, the incidence of deep vein thrombosis has decliined. It is now a rare occurrence in clinical practice. The association between coronary artery disease and cerebrovascular disease and OCs has been known for the last 5-6 years. It is evident that the risk is increased in women who smoke, especially when they are over age 35. The main predictor of the risk of coronary artery disease and stroke appears to be a reduction of high-density lipoprotein (HDL) cholesterol levels. In the combined OC preparations, the action of 1 steroid is variably balanced by the other, and the overall effect on HDL cholesterol levels is often minimal. The major metabolic side-effects concern the changes in gluclose tolerance and an apparently increased risk of gall bladder disease. Low-dose OCS have virtually no effect on glucose status and, providing that diabetic patients are supervised adequately and have no evidence of vascular disease, low-dose OC preparations can be used safely. The question of whether the steroidal components of OCs may have initiating or promoting effects in relation to the development of cancer continues to be debated. The major concern recently is in relation to breast and cervical malignancies.
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PMID:Beneficial and adverse side-effects of hormonal contraception. 394 15

4 kinds of progestin only oral contraceptives (OCs) and numerous combined OCs containing ethinyl estradiol (EE) or occasionally mestranol and either norgestrel or norethindrone are currently available in Australia. All progestins except norgestrel are effective in vivo after metabolism to norethindrone. Mestranol is effective in the human after demethylation to EE. The main side effects of OCs, including menstrual disturbances and changes in weight and mood, are primarily of nuisance value. Menstrual blood loss with OCs is almost invariably less than during spontaneous menses, but breakthrough bleeding and midcycle spotting may cause concern in patients. Amenorrhea and weight gain are rare with low dose pills. Approximately 6 in 1000 women remain anovulatory for 12 months or more after discontinuing OCs, but it is not yet know whether the amenorrhea is related to pill use and it is usually corrected by induction of ovulation. Cardiovascular side effects including venous thrombosis and pulmonary embolism are seen less frequently with new lower dose pills. The effects of OCs on the cardiovascular system are complex and depend on the interaction of estrogen and progestin. Amounts of estrogen and progestin should be the lowest possible to prevent ovulation, and routine monitoring should be provided for all women using pills. Older high dose formulations altered lipid metabolism in the direction of greater risk of coronary heart disease. Although research suggests the lowest dose triphasic pills have no significant effect, not enough large studies have been done with matched controls. Any effects on carbohydrate metabolism of the low dose pills are apparently minor and of little clinical significance. Insulin dependent diabetics with adequate supervision may safely use low dose pills. Combined OCs reduce the incidence of endometrial and ovarian malignancy. No relationship between OCs and the risk of breast cancer has been demonstrated except possibly in women under 35 when the cancer developed. The risk of intraepithelial neoplasia may be increased in women taking OCs for more than 8 years. Data on drug interactions are inconclusive, but women on rifampicin should use some other method. Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation. Progestin only OCs have a higher rate of failure and irregular bleeding than combined pills and their main use is for breastfeeding women and those with contraindications to estrogen. The pill of 1st choice should be a triphasic low-dose formulation.
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PMID:Oral contraceptives. 650 52

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

A 34-year-old woman with a long-term history of amenorrhoea, headache and visual disturbances was operated for a hypothalamic tumor which could be completely removed. Postoperatively the patient developed a transient SIADH-syndrome and deep vein thrombosis; otherwise the clinical course was uneventful. There has been no sign of tumor recurrence at a follow-up period of fifteen months. Histological examination of the tumor revealed an ectopic pituitary adenoma with production of ACTH and TSH shown by immunohistochemistry.
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PMID:ACTH and TSH producing ectopic suprasellar pituitary adenoma of the hypothalamic region: case report. 839 55

A 27-year-old woman, after 31 weeks of amenorrhoea during her second pregnancy, developed a left external iliac and femoral deep vein thrombosis, confirmed by venous ultrasonography and magnetic resonance imaging. The infusion of tissue plasminogen activator (rt-PA: 1.2 mg/kg, i.e. 80 mg over 3 hours), on the 2nd day, allowed revascularization of the femoral junction, while the external iliac vein remained occluded. The patient did not develop pulmonary embolism or haemorrhage, particularly obstetric haemorrhage. The subsequent pregnancy was uneventful until delivery, six weeks later, of a normal child. Three years later, the patient has no sequelae of her deep vein thrombosis. When required by the patient's condition, it seems that rt-PA can be used to treat severe deep vein thrombosis during pregnancy, either isolated or complicated by pulmonary embolism. Very rigorous cardiological, obstetric and laboratory surveillance is essential. A sufficient dosage, identical to that used in clinical settings other than pregnancy and a brief treatment duration (2 to 3 hours) are probably more effective and more reliable than lower doses continued for several days. However, the risk of haemorrhage remains difficult to predict and its prognosis, especially foetal, is often very poor. A larger series of cases is therefore necessary before this drug can unreservedly recommended in pregnant women.
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PMID:[Ilio-femoral vein thrombosis treated with tissue plasminogen activator in a pregnant woman]. 903 5

Reports regarding the question of whether oral contraceptive (OC) use enhances the risk of cancer or one of several serious cardiovascular disorders, i.e., thromboembolic disease, stroke, and myocardial infarction are reviewed. In 1974 the Royal College of General Practitioners (RCGP) issued an interim report of a large prospective study involving 46,000 women. The study found a 5-fold increase in the risk of deep venous thrombosis among women taking OCs. Laboratory studies have tried to establish a direct causal relationship between OC use and altered hemostatis. In review of these studies, Bingel and Benoit reported an increased incidence of thromboembolism in OC users with blood group A. Other hemostatic alterations in OC users were also noted. Other investigators have examined the effect of OCs on antithrombin 3. In 1 study, the inhibitory activity of antithrombin 3 on factor X was significantly reduced among 57 women using the combined OCs, but there was no substantial difference in the quantity of antithrombin 3 in these women as compared with 48 women in the control group. In 1 retrospective case control study of 60 surgical patients with complications of pulmonary embolism or venous thrombosis, the risk of postoperative thromboembolism was 6.7 times greater in OC users than in 97 well matched surgical controls. The RCGP study showed that the risk of cerebrovascular disease in women using OCs was 4 times greater than in nonusers. This finding was substantiated by the Boston-based Collaborative Group for the Study of Stroke in Young Women, which observed a 2-fold increase in risk for all types of stroke among OC users. Several studies have demonstrated that serum lipids are higher in women who use OCs than in those who do not, with estrogen being implicated as the cause of the elevation. Other studies have attempted to link serum lipid elevations to myocardial infarction, but the association is unclear. Both epidemiological and laboratory studies have implicated OCs in the genesis of essential hypertension. Several studies have examined mortality trends associated with OC use. In 1 analysis of data from 21 countries, women between 15 and 44 years of age were found to have a 3-fold to 5-fold increase in cardiovascular mortality that was associated with OC use. The principle evidence that suggested a possible link between OCs and breast carcinoma derived from experiments in laboratory animals. There is no conclusive evidence that OCs cause breast cancer in humans. The association between OC use and endometrial cancer is also inconclusive at this time. A marked increase in the incidence of hepatic adenomas among OC users has also been noted recently. The following other effects associated with OC use are reviewed briefly: glucose tolerance tests; birth defects; gallbladder disease; postpill amenorrhea; laboratory tests; and drug activity. Absolute and relative contraindications for OC use are listed.
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PMID:Oral contraceptive risks: a realistic appraisal. 1227 76

(1) Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation. The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly. In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years. There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception. However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD. The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection. There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections. In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use. The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy. The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception.
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PMID:Intrauterine devices: an effective alternative to oral hormonal contraception. 1963 36

Current guidelines recommend that hormone therapy (HT) in postmenopausal women with a uterus include a progestin to protect against endometrial hyperplasia. However, many concerns relating to HT use appear to be related to the progestin component, including cardiovascular risk, breast stimulation, and irregular vaginal bleeding. Conjugated estrogens (CE) combined with the selective estrogen receptor modulator bazedoxifene (BZA) is a new progestin-free HT option for alleviating estrogen deficiency symptoms in postmenopausal women with a uterus for whom treatment with progestin-containing therapy is not appropriate. Five double-blind, randomized, placebo-controlled, phase 3 studies, known as the Selective estrogens, Menopause, And Response to Therapy (SMART) trials have investigated the efficacy of CE/BZA for relieving vasomotor symptoms (VMS), and effect on bone mass, as well as endometrial and breast safety in postmenopausal women. In a 12-week study, CE 0.45 mg/BZA 20 mg significantly reduced the number and severity of hot flushes compared with placebo at weeks 4 and 12. Unlike estrogen-progestin therapy (EPT), CE 0.45 mg/BZA 20 mg did not increase breast density compared with placebo. In clinical trials up to 2 years, CE/BZA had a favorable tolerability profile, demonstrated by amenorrhea rates similar to placebo. Vascular disorders including venous thromboembolic events (pulmonary embolism, retinal vein thrombosis, deep vein thrombosis, and thrombophlebitis) were rare events, occurring in less than 1 per 1000 patients. CE/BZA was associated with significantly higher incidences of amenorrhea and lower incidences of bleeding compared with CE/medroxyprogesterone acetate in 2 comparative trials. Therefore, CE 0.45 mg/BZA 20mg provides an effective, well-tolerated, progestin-free alternative to EPT for postmenopausal women with a uterus.
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PMID:Perspective on prescribing conjugated estrogens/bazedoxifene for estrogen-deficiency symptoms of menopause: a practical guide. 2568 82