Hormonale Kontrazeptiva der zweiten, dritten und vierten Generation : Risiko venöser und arterieller Thrombembolie (Arzneimitteltherapie)

Not only venous thromboembolic events but also the sum of all side effects are decisive for the prescription of oral contraceptives. Based on the data available today, the following conclusions may be drawn for the clinical management: 1. Venous thromboembolisms are among the undesirable, but rare side effects of hormonal contraceptives. The risk of thrombosis is highest in the first year of use, particularly during the first 3 months. 2. There is no evidence for a different risk of venous thromboembolism between older oral contraceptives and newer pills in comparably healthy populations. The crucial aspects determining risk are predisposition, age, personal risk factors, and heeding the classic contraindications. 3. Myocardial infarction and chronic venous insufficiency are so uncommon in young women that available studies do not permit definitive conclusions to be drawn. In nonsmokers the risk does not appear to be elevated. 4. In healthy young women without recognizable risk factors preference must be given to second-generation drugs over newer oral contraceptives for first-time prescriptions. 5. The risk of venous thromboembolism is not lower under non-oral combined hormonal contraceptives than under combined oral hormonal contraception. 6. In the presence of risk factors and when thrombophilia is suspected, progestin-only preparations, a progestin-releasing IUD, or a non-hormonal method should be employed.