Pulmonary embolism and deep vein thrombosis related to oral contraceptive use

Kim, Ji Yeong; Kim, Yun Sook

doi:10.5468/ogs.2013.56.4.273

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…The link between OCCP containing estrogen and DVT is well established in the literature [ 13 ]. However, recent studies have illustrated that the addition of progestin contributes to an increased risk of DVT, but not if it was used alone, as it was shown by a systematic review [ 14 , 15 ]. One study shows that overall, OCCP increases the risk of thrombosis by 5-fold, and drospirenone, which is what our patient was using, specifically increases the risk by 6.3-fold [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement

et al. 2018

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Patient: Female, 42Final Diagnosis: Cauda Equina syndrome due to extensive DVTSymptoms: Back pain • incontinence • swelling legs • weakness of the lower limbsMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Rare diseaseBackground:Epidural venous plexus (EVP) engorgement occurs due to many conditions, so it can be easily misdiagnosed. This becomes problematic when the diagnosis requires prompt treatment for a good outcome, especially when it results in cauda equina syndrome (CES). We report a case of extensive iliocaval thrombosis leading to epidural venous plexus and ascending lumbar vein engorgement as an outcome of deep venous thrombosis (DVT) due to probable adverse effects of oral combined contraceptive pills (OCCP).Case Report:A 42-year-old woman presented to a rural medical facility with bilateral lower-limb swelling and skin darkening for 2 days. She was transferred to a tertiary medical facility where her condition deteriorated to severe CES. A lower-limbs ultrasonography confirmed the presence of extensive DVT extending to the lower segment of the inferior vena cava. Spine magnetic resonance imaging showed abnormal enhancement of the conus medullaris with thick enhanced cauda equina nerve roots, consistent with a possible case of Guillain-Barré syndrome. However, there was engorgement of the EVP extending to the ascending lumbar, azygos, and hemiazygos veins, which was misdiagnosed. The patient was managed immediately with low-molecular-weight heparin and steroids. She died 4 weeks after admission due to hospital-acquired pneumonia and acute respiratory distress syndrome, probably due to the high dose of steroids.Conclusions:Acute CES has a wide differential diagnosis. This report describes an unusual cause of CES and emphasizes the importance of early recognition to avoid misdiagnosis and management delay. Early identification of this clinical entity markedly decreases morbidity and mortality and thus improves the prognosis. Likewise, underlying causing factors such as venous congestion due to OCCP-related DVT should be considered in the diagnosis.

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Section: Discussionmentioning

confidence: 99%

An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement

et al. 2018

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“…[2][3][4][5] Pulmonary embolism often presents with chest discomfort, tightness, pain and difficulty in breathing. The clinical conditions frequently recorded in which pulmonary embolism occurs are deep vein thrombosis, following long journey in confined spaces such as aircrafts, post surgery, atrial fibrillation, congestive cardiac failure, sickle cell anemia 6 dehydration, during treatment with antipsychotics, 7 oral contraceptive usage, 8 and hypercoaguable states. In many instances it occurs without an underlying clinical condition and amongst these patients lupus anticoagulant and antiphospholipid antibodies are sometimes present.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism associated with the act of defecation. “The bed pan syndrome”

Daisley¹

2018

JLPRR

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Pulmonary embolism as the cause of death is frequent in a hospital setting. The authors report on seven cases of fatal pulmonary embolism that occurred during or after defecation, which they referred to as the Bed Pan Syndrome. A retrospective autopsy study for the three years 2015-2017 was done on all deaths reported as pulmonary embolism. During the period of study 1778 autopsies were performed and eighty one (81) deaths were recorded as pulmonary embolism, which represented 4.6% of the cause of death during the period of study. Seven cases or 8.6% of those dying from pulmonary embolism, died suddenly during the act of defecation. The mean age of patient in this study was 64.7 years. Diabetes Mellitus and Essential hypertension were cor-mobidities in 42.9% of cases. Pulmonary embolism associated with the act of defecation is seldom reported in the medical literature and the seven ( 7) such cases are the subject of discussion in this presentation.

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“…COC-associated VTE is a very rare condition in Korean women, which has caused it to be overlooked by numerous physicians and healthcare professionals. A few case reports have described COC-induced VTE or arterial thrombosis in Korean women [10][11][12][13][14]. However, these describe a single case across different hospitals (Table 1), not as a single or multicenter case series.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism associated with combined oral contraceptive use: a single-institution experience

2021

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Objective Combined oral contraceptives (COCs) are used for various reasons. However, venous thromboembolism (VTE), a significant side effect, can be fatal. This study reports the first case series in Korea involving patients with COC-associated VTE registered at a university hospital.Methods This study recruited 13 patients diagnosed with COC-associated VTE between June 2006 and May 2018. Risk factors, including age, body mass index, smoking habits, estrogen dosage, type of progestin, and duration of COC use, were evaluated.Results Among patients with VTE, 9 showed pulmonary embolism (PE) concomitant with deep vein thrombosis (DVT). However, the remaining patients showed DVT (1 patient), PE (1 patient), and cerebral venous thrombosis (2 patients). The median duration between the onset of symptoms and a hospital visit was 3 days, and it sometimes took as long as 32 days. Among the 10 patients with PE, 1 high-risk group and 2 intermediate-high risk groups were treated with tissue plasminogen activators before anticoagulants. There were no cases of recurrence among patients who continued to take anticoagulants for 3 months.Conclusion These findings emphasize that healthcare professionals who prescribe or dispense COCs to women must inform them of the risk of VTE, including the risk factors, differences in risk depending on the type of progestin present in the product, and pertinent signs and symptoms. Efforts should also be made to inform patients of VTE, even through information campaigns such as brochures. Most importantly, women should remain alert for signs and symptoms of VTE when using COCs.

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Pulmonary embolism and deep vein thrombosis related to oral contraceptive use

Cited by 6 publications

References 11 publications

An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement

An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement

Pulmonary embolism associated with the act of defecation. “The bed pan syndrome”

Venous thromboembolism associated with combined oral contraceptive use: a single-institution experience

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