Thrombotic diathesis has been a well-known complication of oral contraceptive use for more than 50 years. This is true not only for venous thrombosis but also for an arterial one. The etiology is usually multifactorial and depends on several additional risk factors. We analyzed the prevalence of inherited and acquired thrombophilia in a cohort of 770 females who had a thrombotic event in association with oral contraceptive use (700 women with venous thromboembolism [VTE], 70 with stroke). Moreover, we tried to identify additional risk factors. Inherited thrombophilia was found in 44.5% with higher frequency in the cohort with VTE (42%) than in females with stroke (24%). The most frequent finding was factor V Leiden. Cigarette smoking was significantly more frequent in the group with stroke (50% vs 25%). The prevalence of cigarette smoking in the group with VTE did not exceed the frequency in general population. Women on oral contraceptive pills have higher risk of venous as well as arterial thrombosis. The risk of venous thrombosis is increased in females with inherited thrombophilia, whereas those with some additional acquired risk factors (especially smoking) may be predisposed to arterial thrombosis. However, the absolute risk of thrombosis in healthy women is low, far less than the risk of unintended pregnancy. Moreover, the risk may be reduced by keeping some rules before the prescription of the pills, healthy life style, and a proper choice of contraception.

2nd Department of Internal Medicine Charles University Medical Faculty in Pilsen Pilsen Czech Republic

4th Department of Internal Medicine and Hematology University Hospital and Medical Faculty in Hradec Kralove Hradec Kralove Czech Republic

Biomedical Centre Charles University Medical Faculty in Pilsen Pilsen Czech Republic

Department of Clinical Biochemistry University Hospital and Medical Faculty in Hradec Kralove Hradec Kralove Czech Republic

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Nordström M, Lindblad B, Bergqvist D, Kjellström T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med. 1992;232(2):155–160. PubMed

American College of Obstetricians and Gynecologists: ACOG Practice Bulletin No. 110: Noncontraceptive Uses of Hormonal Contraceptives. Obstet Gynecol. 2010;115(1):206–218. PubMed

Stegeman BH, De Bastos M, Rosendaal FR, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ. 2013;347:f5298. PubMed PMC

Rosendaal FR. Thrombosis in the young: epidemiology and risk factors. A focus on venous thrombosis. Tromb Haemost. 1997;78(1):1–3. PubMed

Kaunitz AM. Clinical practice. Hormonal contraception in women of older reproductive age. N Engl J Med. 2008;358(12):1262–1270. PubMed

Lidegaard Ø, Løkkegaard E, Jensen A, et al. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012;366(24):2257–2266. PubMed

Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007;6(2):162–170. PubMed

Martinelli I, Bucciarelli P, Passamonti SM, et al. Long-term evaluation of the risk of recurrence after cerebral sinus-venous thrombosis. Circulation. 2010;121(25):2740–2746. PubMed

Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 2012;43(12):3375–3377. PubMed

Martinelli I, Sacchi E, Landi G, et al. High risk of cerebral-vein thrombosis in carriers of a prothrombin-gene mutation and in users of oral contraceptives. N Engl J Med. 1998;338(25):1793–1797. PubMed

Arboix A, Massons J, García-Eroles L, Oliveres M. Stroke in young adults: incidence and clinical picture in 280 patients according to their aetiological subtype. Med Clin (Barc). 2016;146(5):207–211. PubMed

van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, et al. The venous thrombotic risk of oral contraceptives, effects of estrogen dose and progestogen type: results of MEGA case-control study. BMJ. 2009;339:b2921. PubMed PMC

Bloemenkamp KWM, Rosendaal FR, Helmerhorst FM, Vandenbroucke JP. Higher risk of venous thrombosis during early use of oral contraceptives in women with inherited clotting defects. Arch Intern Med. 2000;160(1):49–52. PubMed

Herings RMC, Urquhart J, Leufkens HGM. Venous thromboembolism among new users of different oral contraceptives. Lancet. 1999;354(9173):127–128. PubMed

Dulicek P, Maly J, Pecka M, et al. Venous thromboembolism in young female while on oral contraceptives: high frequency of inherited thrombophilia and analysis of thrombotic events in 400 Czech women. Clin Appl Thromb Hemost. 2009;15(5):567–573. PubMed

Peragallo Urrutia R, Coeytaux RR, McBroom AJ, et al. Risk of acute thromboembolic events with oral contraceptive use: a systematic review and meta-analysis. Obstet Gynecol. 2013;122(2 pt 1):380–389. PubMed

Saposnik G, Barinagarrementeria F, Brown RD, Jr, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158–1192. PubMed

Abdollahi M, Cushman M, Rosendaal FR. Obesity: risk factors and oral contraceptive use. Thromb Haemost. 2003;89(3):493–498. PubMed

Kemmeren JM, Algra A, Grobbee DE. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. BMJ. 2001;323(7305):131–134. PubMed PMC

Battaglioni T, Martinelli I. Hormone therapy and thromboembolic disease. Curr Opion Hematol. 2007;14(5):488–493. PubMed

Xu Z, Li Y, Tang S, Huang X, Chen T. Current use of oral contraceptives and the risk of first-ever ischemic stroke: a meta-analysis of observational studies. Thromb Res. 2015;136(1):52–60. PubMed

Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009;339:b2890. PubMed PMC

Lidegaard Ø, Nielsen LH, Skovlund CW, et al. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study 2001-9. BMJ. 2011;343:d6423. PubMed PMC

Lidegaard O, Kreiner S. Contraceptives and cerebral thrombosis: a five year national case-control study. Contraception. 2002;65(3):197–205. PubMed

Chakhtoura Z, Canonico M, Gompel A, et al. Progestogen-only contraceptives and the risk of stroke: a meta-analysis. Stroke. 2009;40(4):1059–1062. PubMed

Petiti DB. Hormonal contraceptives and arterial thrombosis—not risk free but safe enough. N Engl J Med. 2012;366(24):2316–2318. PubMed

Martinelli I, Battaglioli T, Burgo I, et al. Oral contraceptive use, thrombophilia and their interaction in young women with ischemic stroke. Haematologica. 2006;91(6):844–847. PubMed

Examination of in Factor V Leiden and Prothrombin II Thrombophilic Mutations in Czech Young Women Using ddPCR-Prevalence and Cost-Benefit Analysis