How would you approach anticoagulation for a newly recurrent VTE on progestin-only therapy?
Prior history of OCP-related PE treated with time-limited anticoagulation, and was switched to progesterone-only-based hormonal contraception. Would you consider this recurrence event hormonally induced and discontinue transdermal progestin, or would you consider this an unprovoked event? Would you consider continuing on progesterone-only hormonal contraception if maintaining on anticoagulation, and does prophylactic vs therapeutic dosing matter?
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Would you continue transdermal progestin for contraception in setting VTE without other clear risk factors?
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1 Answer
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Hematology · University of Rochester School of Medicine and Dentistry
Answered on · Updated on
Would you consider this recurrence event hormonally induced and discontinue transdermal progestin, or would you consider this an unprovoked event?
- I would likely consider this an unprovoked event, as the provoking factor of transdermal progesterone should be extremely weak, if at all.
Would you consider continuing on progesterone-only hormonal contraception if maintaining on anticoagulation, and does prophylactic vs therapeutic dosing matter?
- Yes, continuing progesterone-only hormonal contraception would be reasonable if anticoagulation is continued. I would treat for 3-6 months, depending on the size and location of the thrombus and resolution of symptoms. At that point, I would decrease to prophylactic dosing.
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