Oral Contraceptive Question

[mike10980]

Sorry if this is the wrong place to post this, but I had a question that I couldn't find the answer for.

Why exactly do OCP's cause the patient to enter a hypercoagulable state? I know I am missing some connection here (probably related to increased formation of clotting factors or something).

Sorry if this is a dumb question, but I can't remember for the life of me why this happens.

THANKS in advance!!

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[kingkenny]

It inhibits Anti thrombin 3 and also increases the formation of Factor 5 and 8. For this second reason, it can be used in mild Hemophilia A.

Goljan text, the source.

Hope this helps.

 

[ArcGurren]

Estrogen also increases the production of liver proteins in general including a wide variety of clotting factors --> hence hypercoaguability.

 

[lilPhysician]

anyone else who's heard Goljan audio hear his voice in their head saying "Hy-per-co-ag-u-la-ble"? lol

But seriously, estrogen/ birth control has lts of effects and lots of potential questions. Another important thing it does is make you less likely to have osteoporosis. It inhibits IL-1 (aka Osteoclast activating factor) so osteoclasts are inhibited, less likely to have bone resorption, less likely to hae oteoporosis in young women...at least until menopause unless they are taking estrogen.

 

[mike10980]

Thank you so much guys! I knew the answer was on the tip of my tongue, and now referring back to Goljan, I am kicking myself for forgetting.

Once again, thanks a lot everyone.

 

[KSDeacon]

i've actually got a related question. why are estrogen containing contraceptive devices (combo pill, nuvaring) contraindicated in those women with chronic hypertension? does it directly worsen their blood pressure (if so, anyone know by what mechanism) or does it have anything to do with the damage that's already done to the vasculature by being a chronic hypertensive?

 

[ArcGurren]

i've actually got a related question. why are estrogen containing contraceptive devices (combo pill, nuvaring) contraindicated in those women with chronic hypertension? does it directly worsen their blood pressure (if so, anyone know by what mechanism) or does it have anything to do with the damage that's already done to the vasculature by being a chronic hypertensive?

OCPs also cause fluid retention, which almost certainly worsens chronic HTN

 

[IandIatrogenic]

I see the physiology behind use of OCPs since decreased Antithrombin III will result in increased activation of factor VIII by thrombin.

Yet it isn't mentioned on Uptodate or in Williams or Harrisons. Typically DDAVP is used to treat mild to moderate hemophilia A.