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    Oral Communication

    Women’s Health

    Hemostatic Balance and Anticoagulants in Women’s Health

    OC 35.4 - Longitudinal profile of estrogen-related thrombotic biomarkers after cessation of combined hormonal contraceptives : the prospective PILL-OFF study

    Monday, June 26, 2023
    11:30 – 11:45 ET
    Room: 511
    Session Available As: On-Demand

      Presenting Author(s)

    • Justine Hugon-Rodin, MD PhD (she/her/hers)

      Gynecology department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris Division of Gynecology, University Hospitals of Geneve, Geneva, Switzerland
      Paris, Ile-de-France, France

      • Co-Author(s)

    • Pierre Fontana, MD PhD (he/him/his)

      Head of Geneva Platelet Group
      Division of Angiology and Haemostasis, University Hospitals of Geneva, Switzerland
      Geneva, Geneve, Switzerland

    • aP

      antoine Poncet

      Biostatistician
      Center for Clinical Research, Geneva University Hospitals
      Geneva, Geneve, Switzerland

    • IS

      Isabelle Streuli

      MD
      Division of Gynecology, Geneva University Hospitals
      Geneva, Geneve, Switzerland

    • Alessandro Casini, MD

      MD
      Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
      Geneva, Geneve, Switzerland

    • Marc Blondon, MD MS (he/him/his)

      MD
      Division of Angiology and Hemostasis, Geneva University Hospitals
      Geneva, Geneve, Switzerland

    Background: Combined hormonal contraceptives (CHC) cause venous thromboembolism (VTE). After CHC cessation, the precise delay until normalization of the thrombotic risk is unknown. This delay is critical to guide clinical decisions, such as the management of CHC after VTE or before a surgery.

    Aims: to define the time until normalization of the estrogen-related thrombotic biomarkers, within 3 months after CHC cessation.

    Methods: We enrolled women aged 18-50 years who had decided to stop their CHC, excluding those with a personal history of VTE, current anticoagulation, known thrombophilia, a recent medical event or pregnancy. The study started prior to cessation of contraceptive, with 6 visits after baseline (at 1-2-4-6-12 weeks post-cessation). Primary outcomes were sensitivity ratios to activated protein C (nAPCsr) / thrombomodulin (nTMsr), with sex hormone-binding globulin (SHBG) as a secondary endpoint. We also included a control group of women without CHC. Approval from the local ethics committee and individual informed consent were obtained.

    Results: From 7.2018 until 9.2020, 66 users of CHC were enrolled, with 2nd-generation (n=36), 3rd generation (n=20), last generation (n=10) CHC. On average, from baseline until 12w, nAPCsr, nTMsr and SHBG decreased from 4.11 (SD2.06), 2.53 (SD1.03) and 167 nmol/L (SD103) to 1.28 (SD0.82), 1.11 (0.58) and 55.4nmol/L (SD26.7), respectively. On a relative scale, 85.8%, 81.3% and 76.2% of the decrease from baseline until 12 weeks was achieved at 2 weeks, and 86.7%, 85.5% and 87.8% at 4 weeks after CHC cessation, respectively (Figure 1). Levels were not modified throughout the study period among control women (n=28).

    Conclusion(s): CHC cessation is followed by a rapid decrease in estrogen-related thrombotic biomarkers, with 80% of the decrease by 2 weeks. Two to four weeks of cessation prior to withdrawal of anticoagulants or planned major surgery is probably sufficient for the majority of women.

    Learning Objectives:

    • At the end of this session, participants will be able to identify venous thrombosi risks related to contraceptive use
    • At the end of this session, participants will be able to know which surrogate markers use in the field of hormones and venous thrombosis
    • At the end of this session, participants will be able to adapt their contraceptive prescription before a surgery and after a venous thrombosis