Archive for the ‘Special situations’ Category
Yasmin, Yaz and Other Drospirenone Contraceptives: Risk for VTE
It has long been known that estrogen-containing birth control preparations (pill, patch, ring) increase the risk for DVT and PE (venous thromboembolism = VTE). This risk is partially due to the estrogen. However, part of the risk is also due to the type of progestin in these preparations. Read the rest of this entry »
Pregnancy and Venous Thromboembolism: Prevention, Diagnosis, Treatment
A new guideline about the prevention, diagnosis, and treatment of DVT and PE associated with pregnancy was published today by ACOG (American College of Obstetricians and Gynecologists) in its respected series of Practice Bulletins. The bulletin includes detailed reference to thromboprophylaxis in pregnant women with thrombophilia. Read the rest of this entry »
Postpartum – Safe Contraceptive Methods
The CDC today published recommendations on use of contraceptive methods for non-breast feeding women in the post-partum period (full text is here). The key recommendations are as follows: Read the rest of this entry »
Pregnancy Loss and Thrombophilia
How common is pregnancy loss? What are the causes?
Pregnancy loss in the general population is common. Most losses occur in the first trimester. As many as 5 % of women have 2 or more early losses; 1-2 % have 3 or more early losses [ref 1]. Well established risk factors for pregnancy loss are: (a) advanced maternal age, (b) anatomic uterine abnormalities (fibroids, septum, etc), (c) chromosome abnormalities of fetus, mother or father, (d) comorbid diseases of the mother (endocrine, immunologic). The acquired antiphospholipid antibody syndrome is also a risk factor for pregnancy loss. The role of inherited thrombophilias contributing to pregnancy loss is less clear. Read the rest of this entry »
Incidentally Discovered DVT, PE or Other Clots
General comments
CT or MRI scans will occasionally detect an incidental iliofemoral DVT, PE or intra-abdominal thrombosis (IVC, portal, splenic, mesenteric or renal vein). This is particularly common in cancer patients undergoing staging CT scans. When such an incidental, asymptomatic venous thromboembolism (VTE) is discovered, the question arises whether the patient should be treated with anticoagulants or not. Read the rest of this entry »
Athletes and DVT + PE
Background
Many people think of DVT and PE as a problem occurring in elderly people, but not in young and apparently healthy individuals. While it is certainly true that they occur more commonly in the elderly and in non-athletic overweight individuals, they can, nevertheless, happen in young, normal weight, and athletic people. Read the rest of this entry »
Progestin-only Contraceptives and Thrombosis
Background
It is well known that combination contraceptives (containing estrogens AND progestins) increase the risk for venous thromboembolism (VTE). Relatively few data, however, have been published on progestin-only contraceptives, so that until recently it was not clear whether they increase the risk for venous thromboembolism (VTE) or not. Read the rest of this entry »
Heavy Menstrual Bleeds on Anticoagulants – Treatment Options
Evaluation
Anticoagulants often increase the amount of bleeding during menses and sometimes the number of days that a woman bleeds. However, this does not happen in every woman. In general, the more vaginal bleeding a woman has, the more cramping she experiences. Since warfarin may increase the vaginal bleeding Read the rest of this entry »